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All Journal Narra J Berita Kedokteran Masyarakat Jurnal Kesehatan Masyarakat
Ruby, Mahlil
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Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Nursing Public Health

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Implementation of Aceh Health Insurance (Jaminan Kesehatan Aceh) 2013–2021: Has health equity been achieved for all Acehnese after armed conflict? Yani, Muhammad; Ruby, Mahlil; Puspandari, Diah A.; Munawar, Munawar; Fachrurrozi, Kamal; Candra, Aditya; Ilzana, Teuku M.; Khaled, Teuku M.; Rahmi, Cut R.
Narra J Vol. 3 No. 1 (2023): April 2023
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v3i1.160

Abstract

Aceh Health Insurance (Jaminan Kesehatan Aceh—JKA) has been implemented since 2010 to increase the health equity by covering the health expenses and guaranteeing that all Acehnese are covered regardless of their economic, educational, and social statuses. However, since its implementation, there has been no study on its impact on health quality, particularly regarding the utilization of the main referral hospital (Dr Zainoel Abidin Hospital located in Banda Aceh) and the effects of the geographic accessibility and the number of specialist doctors in each regency/city on hospital utilization. This retrospective study assessed the equity factors during the Aceh Health Insurance implementation and during its integration to National Health Insurance (Jaminan Kesehatan Nasional—JKN) from 2013 to 2021 using data of travel time (time spent for travelling from the origin regency/city of referred patients to the main referral center) and healthcare resources (number of specialist doctors). The data were analyzed using Student’s t-tests, Kolmogorov-Smirnov or Mann-Whitney U test when appropriate. Williamson Index was calculated to determine the disparities of health equity between regencies. Our data indicated the noticeably increase of health facilities utilization since the implantation of Aceh Health Insurance. However, there was no equity in the use of main referral facility by the residents in Aceh - was dominated by residents who lived closer and from more populated regencies/cities. In conclusion, there are accessibility and financial hardship barriers in accessing the health care facilities during the implementation of Aceh Health Insurance that need to be addressed by the government to achieve the health equity for all Acehnese.
Contracts between Referral Health Facilities and Social Health Insurance in Indonesia and England Puspandari, Diah Ayu; Rimawati, Rimawari; Aristianti, Vini; Fadlika, Findri; Septiani, Trisna; Ruby, Mahlil; Wibowo, Mulyo; Febriyanti, Maya; Siregar, Dedy Revelino; Baros, Wan Aisyiah; Manurung, Kathrina
Jurnal Kesehatan Masyarakat Vol. 20 No. 3 (2025)
Publisher : Universitas Negeri Semarang in collaboration with Ikatan Ahli Kesehatan Masyarakat Indonesia (IAKMI Tingkat Pusat) and Jejaring Nasional Pendidikan Kesehatan (JNPK)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15294/kemas.v20i3.21231

Abstract

Purchasers and providers are important in providing quality health services for participants. This is formally regulated through a contractual mechanism to achieve the potential benefits of strategic health purchasing (SHP) and ensure effectiveness, efficiency, and quality. The experience of contracting with providers differs in each country due to underlying determinants. This study aims to identify differences in contracts between referral health facilities and social health insurance in Indonesia and England. A normative legal research approach is used, utilizing secondary data sources such as literature, regulations, and contractual arrangements. Important clauses in the contract, such as rights and obligations, service tariff setting, agreement period, monitoring and evaluation, settlement of expired or disputed claims, mechanisms for providing information, and handling complaints, have been regulated in contracts in both Indonesia and England. Unlike the case in England, incentive payment policies have not been further regulated in Indonesia’s contracts. Additionally, notification and communication procedures for the parties involved have been integrated into the system in England. It is expected that learning from the NHS contracts will provide the potential for developing a more ideal contract implementation, effective monitoring and evaluation, and the delivery of optimal and high-quality health services.
Estimated cost of diabetic wound care in primary healthcare facilities using the time-driven activity-based costing method Budiarto, Arif; Oktafitria, Rita; Hafidz, Firdaus; Aristianti, Vini; Ekawati, Fitriana Murriya; Siregar, Dedy Revalino; Ilyasa; Budiman, Arif; Hendrawan, Donni; Ruby, Mahlil
BKM Public Health and Community Medicine Vol 41 No 11 (2025)
Publisher : Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/bkm.v41i11.23797

Abstract

Purpose: This study aimed to estimate the unit cost of diabetic wound care services in primary healthcare facilities (FKTPs) using the Time-Driven Activity-Based Costing (TDABC) method and to quantify the potential cost savings from reallocating cases from secondary (FKRTL) to primary care facilities. Methods: A micro-costing analysis was conducted across 40 FKTPs in Indonesia using a standardized five-step TDABC framework, covering personnel, facility, medical supplies, and overhead costs. Descriptive and nonparametric statistical methods, including the trimmed mean, geometric mean, and interquartile range, were applied to derive cost estimates, and simulations with 15% and 35% case shifting from FKRTL to FKTP were performed. Non-parametric methods (Kruskal–Wallis and Mann–Whitney U) were applied because the cost data were not normally distributed. Results: The estimated unit cost per diabetic wound-care visit ranged from IDR 67,121 (best-case scenario) to IDR 77,189 (realistic scenario). Cost-shifting simulations projected potential savings of up to IDR 28.15 billion in the 35% scenario. Conclusion: Strengthening diabetic wound-care services at the primary care level may enhance system-wide efficiency and reduce avoidable expenditures within the National Health Insurance (JKN) scheme, supporting the adoption of more cost-effective service delivery models in Indonesia.
Co-Authors Aditya Candra, Aditya Arif Budiarto Arif Budiman Baros, Wan Aisyiah Fadlika, Findri Febriyanti, Maya Firdaus Hafidz As Shidieq Fitriana Murriya Ekawati Hendrawan, Donni Ilyasa Ilzana, Teuku M. Kamal Fachrurrozi Khaled, Teuku M. Manurung, Kathrina Muhammad Yani, Muhammad Munawar Munawar Oktafitria, Rita Puspandari, Diah A. Rahmi, Cut R. Rimawati, Rimawari Septiani, Trisna Siregar, Dedy Revalino Siregar, Dedy Revelino Vini Aristianti, Vini Wibowo, Mulyo