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All Journal Jurnal Keperawatan Prosiding University Research Colloquium Jurnal Ilmiah Kesehatan Keperawatan
Cahyu Septiwi
Universitas Muhammadiyah Gombong
Humanities Computer Science & IT Environmental Science Health Professions Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Nursing Public Health

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Digitalization of National Health Insurance (JKN) claims and hospital operational efficiency in BPJS Kesehatan partner hospitals: A Systematic Literature Review with Conditional Meta-Analysis Shafitri Nire pangestika; Ernawati Ernawati; Rita Rahmawati; Lazuardi Fatahilah Hamdi; Cahyu Septiwi
Jurnal Keperawatan Vol. 17 No. 2 (2026): May
Publisher : University of Muhammadiyah Malang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22219/jk.v17i2.45167

Abstract

Introduction: Digitalization of National Health Insurance (JKN) claims is a major administrative health reform in Indonesia; since JKN's 2014 launch, transaction volumes have exceeded 1.37 million claims per day, straining conventional paper-based systems. No prior review has systematically synthesized digitalization's cumulative impact on operational efficiency in BPJS Kesehatan partner hospitals.Objectives: This study aimed to synthesize evidence on the relationship between JKN claim digitalization and hospital operational efficiency, and to estimate the pooled effect on claim cycle time where study homogeneity permits.Methods: A Systematic Literature Review using the PRISMA 2020 protocol searched five databases—PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, and Garuda—for publications from January 2014 to December 2024. Quality was assessed using STROBE, CASP, MMAT, and AMSTAR 2, and a conditional random-effects meta-analysis targeted claim cycle time, the outcome with adequate homogeneity across studies.Results: From 438 records, 25 articles met the inclusion criteria, reporting six efficiency dimensions: claim cycle time, first-pass rejection rate, cash flow/days in accounts receivable, staff utilization, ICD coding accuracy, and administrative cost per claim. Meta-analysis of 11 homogeneous studies showed a pooled mean reduction in claim cycle time of 19.6 days (95% CI: 14.2–25.1) post-implementation, with high heterogeneity (I² = 78.4%).Conclusions: The integrated TAM-UTAUT-RBV framework explains this evidence: systems combining automated bridging with real-time validation outperform partial digitalization, with human resource competency and IT infrastructure as key contextual factors. Findings carry implications for future research and for BPJS Kesehatan, the Ministry of Health, and hospitals in prioritizing capacity-adjusted digitalization strategies.
Co-Authors Anton Wiyahya Dadi Santoso Endah Setianingsih Ernawati Ernawati Fajar Agung Nugroho Holin Sulistyorini Lazuardi Fatahilah Hamdi Linda Ernati Lulu Permata Sari Luthfiana Dewi Maudy Rismawati Al Maisy Pangestika, Shafitri Nire Radita Isti Muharomah Rita Rahmawati Rizki Tri Mulyawati Robertus Eka Wardoyo