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All Journal Jurnal Untuk Masyarakat Sehat (JUKMAS) International Journal of Health and Pharmaceutical (IJHP)
Dickson, Dickson
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Health Professions Nursing Public Health

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Analysis of the Possibility of Fraud in the National Health Insurance Program in Indonesia Agustini, Purwanti; Veranica, Romauli; Dickson, Dickson; Puspitaloka Mahadewi, Erlina
International Journal of Health and Pharmaceutical (IJHP) Vol. 5 No. 1 (2025): February 2025 (Indonesia - Turkey - Malaysia - Australia - Iran)
Publisher : CV. Inara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51601/ijhp.v5i1.394

Abstract

The study focused on the purpose of finding out the effect and covering fraud in the National Health Insurance. Fraud is an act carried out intentionally to gain financial gain from the JKN program in the National Social Security System, through fraudulent acts that are not in accordance with the provisions of laws and regulations. Health fraud is a serious threat to the world, causing financial misuse of scarce resources and negative impacts on access to health, infrastructure, and social determinants of health. In Indonesia, cases of fraud continue to increase from year to year. The purpose of this study is to find out the latest studies related to the analysis of the opportunities for fraud in health insurance, and how the mechanism for effective prevention and mitigation efforts can be implemented in the implementation of the Health Insurance program in Indonesia. The method used in this journal uses qualitative descriptive through a literature study approach. Opportunities for fraud practices in JKN can be identity falsification, collusion to make false claims, unnecessary health care, excessive invoices, deviations or upcoding of diagnosis codes, document discrepancies, and duplicate claims. The reasons for fraud that usually occur are known as the fraud triangle, namely motivation, opportunity, and rationalization. Result of this study suggested systematic prevention efforts are needed together by health service providers, BPJS, and the Government by implementing the principles of a fraud prevention system, and the formation of a fraud prevention team that is adjusted to the needs for scale of the organization and national, in the future to reduce the negative impacts that occur.
Evaluasi Keberhasilan Program Terapi Pencegahan Tuberkulosis di Puskesmas Wilayah Jakarta Barat Tahun 2024 Dickson, Dickson; Suratmi, Tri; Samingan, Samingan
Jurnal Untuk Masyarakat Sehat (JUKMAS) Vol 9, No 2 (2025): Jurnal Untuk Masyarakat Sehat (JUKMAS)
Publisher : LPPM Universitas Respati Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52643/jukmas.v9i2.6926

Abstract

Tuberculosis (TBC) remains a global health challenge, including in Indonesia. Tuberculosis Preventive Therapy (TPT) is a key strategy to prevent Latent TB Infection (LTBI) from progressing to active TB. However, the 2024 TPT program achievement in West Jakarta was only 17% against a 68% target. This study aimed to evaluate the program's success at Public health centers (PHC) using a qualitative evaluative and phenomenological approach and the Context, Input, Process, Product (CIPP) model. Subjects included health office staff (1 person), PHC officers (16 people), and health cadres (8 people). Data were collected through in-depth interviews, document studies, observation, and Focus Group Discussions (FGD), and analyzed using content analysis with triangulation for validation. The results indicate that while the program follows Ministry of Health Regulation No. 67 of 2016, its implementation faces significant challenges. Limited availability of the 3HP drug regimen and low preference for the lengthy 6H regimen were major constraints. Healthcare workers faced high workloads, while community cadres had limited capacity for public education. Additional barriers included limited counseling time, negative public perceptions of TPT, and less effective cross-sectoral coordination. The overall achievement was only 17%, with large inter-area disparities (e.g., Palmerah at 67% vs. Grogol Petamburan at 12%). Low adherence to the 6H regimen further impacted outcomes. In conclusion, the success of the TPT program in West Jakarta is hindered by limited 3HP drug availability, low public understanding, and insufficient cross-sector coordination.
Co-Authors Agustini, Purwanti Puspitaloka Mahadewi, Erlina Rita Wahidi , Kemala Samingan Samingan sandra dewi suratmi, tri Veranica, Romauli