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All Journal Jurnal Kesehatan Masyarakat Jurnal Jaminan Kesehatan Nasional Jurnal Manajemen Pelayanan Kesehatan (The Indonesian Journal of Health Service Management) Journal of Indonesian Health Policy and Administration
Yulita Hendrartini
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Decision Sciences, Operations Research & Management Dentistry Health Professions Medicine & Pharmacology Public Health

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DAMPAK KEBIJAKAN KEPESERTAAN MANDIRI JAMINAN KESEHATAN NASIONAL (JKN) DI YOGYAKARTA Endartiwi, Sri Sularsih; Trisnantoro, Laksono; Hendrartini, Yulita
Jurnal Kesehatan Masyarakat Vol 10, No 1 (2017): Jurnal Kesehatan Masyarakat Volume 10/ Nomor 01
Publisher : STIKES Wira Husada Yogyakarta

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ABSTRACT Background: The implementation of National Health Insurance (JKN) had been started since 1 January 2014. In the first semester, several problems are found in the admission department. First, it is found that there about 10% or 4,400 participants are they who are suffering for disease or have used the health insurance. Second, there are participants who are already undergoing treatment at the hospital and turning out a large cost then they are newly registered as JKN participants. Objective: To monitoring the implementation of independent participants policy of the National Health Insurance (JKN) in Yogyakarta. Methods: This research is a case study with qualitative and quantitative approaches. Research will be conducted in the BPJS Yogyakarta, Academic Hospital of the Gadjah Mada University, the Office of the Provincial Council Commission D Yogyakarta, Yogyakarta Provincial Health Office in April 2015. The study was conducted by in-depth interviews as well as filling the form of independent patient data. Results: The viewpoint of the national health insurance participant is positive. Independent participants consider it is important to enforce the national health insurance program. Participants also consider it is reasonable for them to pay the monthly dues. Their motivation to register as an independent participant is already going to take advantage of health services, a precaution and to protect themselves against the risk of illness. Compliance participants who pay dues are in arrears to pay dues by 27%. The impact of independent participants is people who are already sick or have health services and will utilize it for about 123% claims ratio. It is better for the hospital to do socialization, add more facilities and infrastructure, improve the hospital services, leadership and bureaucracy. Conclusion: Independent participants policy is to motivate people who are already sick to register as a participants and 27% of participants who had recovered in arrears to pay.The fundamental improvement in the independentparticipants policy is an improvement on Presidential Decree No. 12 of 2013, especially chapters 4 and 5, Presidential Decree No. 111 of 2013 chapter 16F, and The Health Minister regulations No. 71 of 2013 article 21 paragraph 1 and 22 paragraph 1 Keywords: impact, independent participant,National Health Insurance (JKN)
DISPUTE ANALYSIS OF CLAIMS FOR PATIENTS WITH COVID-19: A CASE STUDY AT HOSPITAL X CLASS B IN BANTUL REGENCY Putri, Beby Antika; Hafidz, Firdaus; Hendrartini, Yulita
Journal of Indonesian Health Policy and Administration Vol. 8, No. 1
Publisher : UI Scholars Hub

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The Indonesian Government established referral hospitals for COVID-19 as an effort in combating the pandemic. Referral hospitals for COVID-19 submit their services’ claims to the Ministry of Health. Hospital X in Bantul experienced challenges in submitting COVID-19 claims and underwent claim disputes which caused delays in payment process. This research aimed to explore the factors that led to the disputes over the COVID-19 claims. This descriptive research was conducted with a qualitative approach, using in-depth interviews and observations. The additional descriptive analysis used secondary data COVID-19 claim dispute file reports from 2020. The results showed that the highest criteria of disputed claims at Hospital X were the criteria for non- compliant guaranteed participants, incomplete claim files, non-compliant comorbid diagnoses, and identities that did not comply with the provisions. The causes of the disputes over claims for patients with COVID-19 included inaccurate history taking, differences in regulation perceptions between the provider and payer, PCR results were not provided, and doctors had a lack of understanding regarding the technical guidelines for COVID-19 claims. In addition, there were technical problems faced by the hospital during the process of submitting claims, including regulations were changed frequently, errors in applications, incomplete medical resumes, and unreadable doctors’ writings. Disputed claims did not affect the hospital cash flow, yet delayed the payment process to health workers, which might harm the quality of services.
KLAIM TIDAK LAYAK BAYAR PESERTA JAMINAN KESEHATAN NASIONAL DI LAYANAN RAWAT JALAN RUMAH SAKIT JIWA PROF. DR. SOEROJO, MAGELANG Vera Otifa; Andreasta Meliala; Yulita Hendrartini
Journal of Health Service Management Vol 19 No 4 (2016)
Publisher : Departemen of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta Jl. Farmako Sekip Utara Yogyakarta 55281 Telp 0274-547490

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (474.169 KB) | DOI: 10.22146/jmpk.v19i4.2033

Abstract

Background: The hospital payment mechanism in National Health Insurance era used INA-CBG's package tarif. The service payment which had given by hospital was paid by Indonesian National Health Insurance Agency with claiming mechanism. There were several factors and causes that affected unfeasible payment claim which could harm the hospital. Objective: Identify the factors that caused the unfeasible payment claim, identify the cause of the unfeasible payment claim, describe the attitude of doctors, the attitude of the leader ship of the hospital, the attitude of the administration RSJS, attitude BPJS Health Magelang and describe RSJS leadership communication to the cause of the unfeasible payment claim in the outpatient service RSJS. Method: This research was an exploratory case study research with single holistic case study design. Analysis unit in this research was outpatient services in Prof. dr. Soerojo Magelang Mental Health Hospital. Research informants were specialized doctor and general practitioner RSJS, Prof. dr. Soerojo Magelang Mental Health Hospital's leaders, Prof. dr. Soerojo Magelang Mental Health Hospital's administrators, and Indonesian National Health Insurance Agency branch in Magelang City. The informant selection used purposive sampling. Data collection used in-depth interview and document observation. Result: The cause of unfeasible payment claim consisted of medical services cause and administrative cause. The cause of medical services most that one episode of outpatient, one episode of inpatient and diagnosis is not emergency. The data difffference between BPJS Kesehatan and medical record, non-emergency diagnosis that considered as emergency diagnosis, one episode of outpatient/inpatient considered as two episodes of outpatient/inpatient. The communication RSJS leaders about unfeasible payment claim is not optimal, the attitude doctor's with less information, the rules have not been clearly linked specifificity RSJS in healthcare delivery, indifffference claim services were they have rendered to the participant JKN, understanding verififier BPJS about medically less in determining the unfeasible payment claim into inconsistencies, too tight in the verifification process and the workload verififier BPJS in RSJS large enough can increase in unfeasible payment claim .The attitude of the leadership of RSJS own conduct follow-up but followup information was not communicated to the doctor RSJS, the attitude of the administration RSJS who respond positively to minimize the unfeasible payment claim. Conclusion: The leaders' communication, doctor's attitude, Indonesian National Health Insurance Agency's attitude and the unpresented operational standard, and procedure in determining steps of unfeasible payment claim were factors that could enhance the incidence of unfeasible payment claim.
Kesiapan Penerapan Pelayanan Kelas Standar Rawat Inap dan Persepsi Pemangku Kepentingan Kurniawati, Golda; Jaya, Citra; Andikashwari, Sekarnira; Hendrartini, Yulita; Dwi Ardyanto, Tonang; Iskandar, Kasir; Muttaqien, Muttaqien; Hidayat, Syamsu; Tsalatshita, Risky; Bismantara, Haryo
Jurnal Jaminan Kesehatan Nasional Vol. 1 No. 1 (2021): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (236.833 KB) | DOI: 10.53756/jjkn.v1i1.15

Abstract

Salah satu amanah dari Undang-Undang No. 40 Tahun 2004 tentang Sistem Jaminan Sosial Nasional (SJSN) adalah adanya pelayanan medis dan non-medis yang sama, tidak ada perbedaan, dalam rangka mencapai keadilan sosial. Dalam Program Jaminan Kesehatan Nasional (JKN), keadilan ini diterjemahkan sebagai pelayanan kelas standar rawat inap untuk menggantikan tingkatan fasilitas akomodasi rawat inap yang saat ini berlaku. Memasuki tahun keempat implementasi Program JKN, amanah ini masih belum dapat terwujud. Untuk itu, studi ini berupaya menganalisis kemungkinan penerapan kelas standar rawat inap, termasuk menghitung ketersediaan tempat tidur di Indonesia untuk mendukung penerapan tersebut. Studi ini menggunakan mixed method di mana studi kuantitatif dilakukan melalui metode survei terhadap 520 responden peserta JKN yang pernah mendapatkan pelayanan rawat inap di rumah sakit. Studi kualitatif dilakukan melalui wawancara dan diskusi terarah pada pembuat kebijakan Program JKN. Hasil studi menunjukkan bahwa seluruh responden studi dari peserta maupun pembuat kebijakan mendukung penerapan kelas standar rawat inap dengan preferensi yang beragam. Meskipun demikian, disepakati bahwa diperlukan waktu setidaknya 5 tahun untuk memastikan penerapan kelas standar rawat inap dapat dilaksanakan dengan baik. Rumah sakit khususnya membutuhkan waktu untuk mempersiapkan sarana dan prasarana agar sesuai dengan ketentuan kelas standar rawat inap. Studi ini merekomendasikan kepada seluruh pemangku kepentingan untuk mendukung kebijakan kelas standar rawat inap. Tenggat waktu penerapan kelas standar rawat inap pada dokumen Peta Jalan Jaminan Kesehatan perlu direvisi, dilengkapi dengan beberapa regulasi tambahan dan sosialisasi yang intensif.
Co-Authors Andikashwari, Sekarnira Andreasta Meliala Beby Antika Putri Bismantara, Haryo Citra Jaya Firdaus Hafidz As Shidieq Hapsari, Wulandari Indri Hidayat, Syamsu Iskandar, Kasir Kurniawati, Golda Laksono Trisnantoro Muttaqien Muttaqien, Muttaqien Putri, Beby Antika Sri Sularsih Endartiwi, Sri Sularsih Tonang Dwi Ardyanto Tsalatshita, Risky Vera Otifa