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All Journal ACADEMICS IN ACTION Journal of Community Empowerment FIRM: Journal of Management Studies RIO LAW JURNAL International Journal of Social Service and Research
Praja, Nucky Indra
Unknown Affiliation
Humanities Decision Sciences, Operations Research & Management Economics, Econometrics & Finance Education Engineering Environmental Science Languange, Linguistic, Communication & Media Law, Crime, Criminology & Criminal Justice Social Sciences

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Perbandingan Sistem BPJS dan Asuransi Kesehatan Negara Jerman dalam Percepatan Penanganan Cedera Patah Tulang pada Kasus Kecelakaan Praja, Nucky Indra; Hoesein, Zainal Arifin
RIO LAW JURNAL Vol 6, No 1 (2025): Rio Law Jurnal
Publisher : Universitas Muara Bungo

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36355/rlj.v6i1.1567

Abstract

Perbandingan sistem BPJS Kesehatan Indonesia dengan sistem asuransi kesehatan di Jerman dalam konteks percepatan penanganan medis pada cedera patah tulang akibat kecelakaan menunjukkan perbedaan signifikan dalam hal efisiensi, aksesibilitas, dan penggunaan teknologi. Tujuan penelitian ini adalah untuk menganalisis efektivitas sistem BPJS Kesehatan di Indonesia dalam percepatan penanganan operasi patah tulang akibat kecelakaan, dan menganalisis perbandingan sistem asuransi kesehatan di Jerman dengan BPJS Kesehatan di Indonesia dalam hal percepatan penanganan medis pada operasi patah tulang akibat kecelakaan. Metode yang digunakan adalah penelitian yuridis normatif dengan pendekatan perbandingan sistem kesehatan. Pembahasan mencakup analisis mengenai struktur sistem asuransi kesehatan di Indonesia dan Jerman, serta peran teknologi informasi dalam meningkatkan efisiensi layanan medis. Hasil analisis menunjukkan bahwa sistem asuransi kesehatan di Jerman memiliki keunggulan dalam hal akses data medis yang lebih cepat dan integrasi teknologi yang lebih baik, yang berpengaruh langsung pada percepatan penanganan medis. Penelitian ini menyimpulkan bahwa Indonesia dapat belajar dari sistem Jerman, khususnya dalam hal digitalisasi dan integrasi antar-fasilitas kesehatan. Saran yang diberikan adalah pengembangan sistem informasi medis yang lebih efisien dan pelatihan bagi tenaga medis untuk meningkatkan responsivitas dalam situasi darurat.
The Effectiveness of Health BPJS Claim Discrepancies Against Health Service Standards in Indonesia Praja, Nucky Indra; Ferianasari, Ineke Winda; Jaqualina, Cornelia
FIRM Journal of Management Studies Vol 9, No 1 (2024): FIRM JOURNAL OF MANAGEMENT STUDIES
Publisher : President University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33021/firm.v9i1.5804

Abstract

This study aims to evaluate the effectiveness of the Badan Penyelenggara Jaminan Sosial (BPJS) health system in addressing claim discrepancies in relation to health service standards in Indonesia. As a social security administration agency, BPJS Health faces various challenges concerning claim discrepancies, which can impact the quality of healthcare services provided to the community. Health insurance claims refer to submissions made by healthcare facilities to BPJS for reimbursement of healthcare service costs. These claims are submitted collectively on a monthly basis, accompanied by supporting documents. Upon submission, the claims undergo a verification process conducted by BPJS Health verifiers, whose role is to assess the accuracy and completeness of the administrative accountability for services provided to patients. Following claim verification, the insurer at the healthcare facility receives one of four claim status outcomes: eligible claim status, ineligible claim status (pending), post-claim verification status, or disputed claim status. This study employs a normative juridical research method, involving the collection and analysis of primary, secondary, and tertiary legal materials. The findings reveal several factors contributing to claim discrepancies, including hospitals’ and healthcare professionals’ limited understanding of claim procedures, as well as inefficiencies in BPJS Health’s monitoring and evaluation system. The study also highlights that claim discrepancies often have a negative impact on patient satisfaction and the overall quality of healthcare services. To enhance the effectiveness of the BPJS Health claims system, improvements are needed, including systematic reforms, increased dissemination of information, targeted training programs for healthcare workers, and the strengthening of monitoring and evaluation mechanisms. These measures will contribute to improving the efficiency and reliability of healthcare services in Indonesia.
Pelatihan Pertolongan Pertama pada Berbagai Jenis Cedera Alfaqih, Muhammad Subhan; Montolalu, Ivan Adrian; Anugrah, Andreas Surya; Praja, Nucky Indra; Faizi, Muhammad; Minawati, Minawati
ACADEMICS IN ACTION Journal of Community Empowerment Vol 5, No 2 (2023)
Publisher : President University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33021/aia.v5i2.5808

Abstract

Cedera merupakan salah satu penyebab mortalitas dan morbiditas utama di seluruh dunia, terutama pada kelompok usia produktif. Kasus cedera dapat terjadi di berbagai tempat termasuk di lingkungan kampus. Penanganan awal yang tepat pada cedera penting dilakukan agar tidak memperparah cedera. Kegiatan Pengabdian kepada Masyarakat (PKM) ini bertujuan untuk meningkatkan pemahaman dan keterampilan pertolongan pertama pada cedera di kalangan petugas garda terdepan di Universitas Presiden. Program ini melibatkan security, petugas kebersihan, dan petugas asrama, dengan pelatihan pertolongan pertama dengan metode pemberian materi, simulasi, serta evaluasi melalui pretest dan posttest. Terdapat peningkatan nilai posttest dibandingkan nilai pretest yang mengindikasikan adanya peningkatan pemahaman peserta setelah dilakukan pelatihan ini. Peserta juga memberikan umpan balik positif terkait manfaat pelatihan. Kegiatan ini diharapkan dapat berkontribusi dalam penanganan cedera dan pencegahan risiko lebih lanjut, serta direkomendasikan untuk dilakukan secara berkala dan diperluas ke kalangan masyarakat yang lebih luas.
The Legal Certainty and BPJS Health Policy Reformulation in the Medical Treatment of Victims of Violence and Traffic Accidents Praja, Nucky Indra; Amelia, Tina
International Journal of Social Service and Research Vol. 5 No. 6 (2025): International Journal of Social Service and Research
Publisher : Ridwan Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.46799/ijssr.v5i6.1251

Abstract

It has been observed that BPJS Kesehatan does not generally provide coverage for traffic accidents that are already covered by Jasa Raharja. However, it has also been observed that the insurance claim process for victims of violence and accidents can be both slow and burdensome for the victims' families, especially in cases where immediate medical treatment is required. This has given rise to a need for a streamlined legal framework that expedites claims processing and medical services for victims, ensuring that they can receive treatment promptly and effectively. This research aims to examine legal certainty in the insurance claim process through BPJS Kesehatan and Jasa Raharja for victims of violence and traffic accidents who require medical treatment, and to examine BPJS policy reformulation to improve accessibility and accelerate medical services for victims of violence and traffic accidents. The research method employed is a normative research method through a legislative approach and an analytical approach. The results obtained indicate that legal certainty in insurance claims for victims of violence and traffic accidents through BPJS Kesehatan and Jasa Raharja is based on regulations that guarantee fair access to health services. In addition, a structured mechanism has been established to allow victims to obtain initial compensation and further treatment without encountering excessive administrative obstacles. The ideal reformulation of BPJS Kesehatan policy should centre on the implementation of a one-stop service system that integrates BPJS Kesehatan, PT Jasa Raharja, Hospital, and Police Department
Co-Authors Alfaqih, Muhammad Subhan Amelia, Tina Anugrah, Andreas Surya Ferianasari, Ineke Winda Jaqualina, Cornelia Minawati Minawati, Minawati Montolalu, Ivan Adrian Muhammad Faizi, Muhammad Zainal Arifin Hoesein