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All Journal International Journal of Health and Pharmaceutical (IJHP)
Veranica, Romauli
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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.
The Correlation Between Physical Activity And Quality of Life Among The Elderly In North Jakarta Veranica, Romauli; Budi, Tri; Suratmi, Tri
International Journal of Health and Pharmaceutical (IJHP) Vol. 5 No. 4 (2025): November 2025
Publisher : CV. Inara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51601/ijhp.v5i4.446

Abstract

Indonesia has experienced a significant increase in its elderly population. According to Statistics Indonesia (BPS) in 2024, the number of older adults reached approximately 29 million, representing 12% of the total population. In Koja District, North Jakarta, based on the 2024 Koja Health Center Profile, the elderly population is recorded at 28,020 individuals. This demographic shift poses major challenges in maintaining and improving the quality of life of older adults, which can be promoted through active ageing strategies.This study aimed to analyze the correlation between physical activity and quality of life among the elderly. The research employed a descriptive-analytic design with a quantitative cross-sectional approach. The study population consisted of older adults living in the Koja Health Center working area, with respondents selected using random sampling. A total of 120 participants were included, determined by Slovin’s formula. Data collection utilized the WHOQOL-BREF questionnaire to assess quality of life and a modified PASE instrument to measure physical activity.Data analysis was conducted using univariate, bivariate (chi-square test), and multivariate (logistic regression) methods. The findings showed that most elderly participants engaged in moderate levels of physical activity, and their quality of life was categorized as fair to good. A statistically significant correlation was found between physical activity and quality of life (p < 0.05), with moderate physical activity showing the highest odds ratio (OR = 3.600). Moreover, independence level and family support were also significantly associated with quality of life.These findings confirm the essential role of physical activity in supporting elderly well-being. Strengthening community-based interventions, such as the Prolanis program and elderly health posts (posyandu lansia), is recommended to sustain elderly participation in physical activity and improve their overall quality of life.
Co-Authors Agustini, Purwanti Budi, Tri Dickson, Dickson Puspitaloka Mahadewi, Erlina suratmi, tri