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All Journal Hearty : Jurnal Kesehatan Masyarakat Jurnal Kesehatan Tambusai
Wulandari, Reny Yulita
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Dentistry Health Professions Medicine & Pharmacology Nursing Public Health Other

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A DAMPAK ASURANSI KESEHATAN TERHADAP AKSES PELAYANAN KESEHATAN IBU : TINJAUAN LITERATUR DI KONTEKS GLOBAL DAN INDONESIA Wulandari, Reny Yulita; Rachmawan, Ade; Alridjal, Rifqi; Abdelrazig, Omnia Amir Osman
Jurnal Kesehatan Tambusai Vol. 6 No. 3 (2025): SEPTEMBER 2025
Publisher : Universitas Pahlawan Tuanku Tambusai

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/jkt.v6i3.48470

Abstract

Akses terhadap pelayanan kesehatan ibu yang aman, berkualitas, dan terjangkau masih menjadi tantangan utama di banyak negara berpendapatan rendah dan menengah, termasuk Indonesia. Salah satu strategi yang digunakan untuk mengatasi hambatan tersebut adalah penerapan asuransi kesehatan, baik dalam bentuk skema nasional maupun berbasis sosial. Studi ini merupakan tinjauan pustaka sistematis yang bertujuan untuk menganalisis dampak asuransi kesehatan terhadap pemanfaatan layanan kesehatan ibu, dengan mengkaji sembilan artikel ilmiah dari konteks global dan nasional. Hasil tinjauan menunjukkan bahwa asuransi kesehatan secara umum meningkatkan angka kunjungan antenatal care (ANC) dan persalinan di fasilitas kesehatan, serta memberikan perlindungan finansial bagi kelompok rentan. Namun, manfaat tersebut belum dirasakan secara merata, mengingat masih adanya hambatan geografis, sosial, dan budaya yang membatasi akses layanan, khususnya bagi ibu di daerah terpencil. Selain itu, persepsi terhadap mutu layanan terbukti menjadi faktor penentu dalam keputusan ibu untuk mengakses layanan, yang dalam beberapa kasus bahkan lebih dominan dibandingkan kepemilikan asuransi. Oleh karena itu, keberhasilan program asuransi kesehatan sangat bergantung pada peningkatan mutu layanan, pemerataan sumber daya kesehatan, serta penguatan literasi masyarakat. Kajian ini merekomendasikan pendekatan kebijakan yang lebih holistik dan responsif untuk memastikan manfaat asuransi dapat berkontribusi signifikan dalam menurunkan angka kematian ibu dan meningkatkan keadilan dalam pelayanan kesehatan.
DELAYS IN HEALTH INSURANCE CLAIMS AT A THIRD-PARTY ADMINISTRATOR (TPA) PT. XYZ IN 2024 Wulandari, Reny Yulita; Purnamawati, Dewi
HEARTY Vol 13 No 4 (2025): AGUSTUS
Publisher : Fakultas Ilmu Kesehatan, Universitas Ibn Khaldun, Bogor

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32832/hearty.v13i4.20409

Abstract

Third-Party Administrators (TPA) play a crucial role in managing health insurance claims. However, delays in claim processing remain a major issue that negatively affects customer satisfaction. This study aims to describe the occurrence of delayed health insurance claims at one TPA in Indonesia in 2024. A descriptive quantitative approach was used, analyzing 442,279 secondary claim records to determine the frequency, type, and underlying causes of delayed claims. The findings revealed that 34% of all claims were classified as pending. Most pending claims involved outpatient and cashless services. The leading cause of the delay was incomplete documentation (55%), followed by invoice revisions and further claim investigations. These delays were largely attributed to unresolved administrative issues. Improving claim service quality in TPA requires the implementation of digital processing systems, enhanced staff competencies, and real-time document monitoring mechanisms.
PATIENT SATISFICATION AS CONSUMERS: A LITERATURE REVIEW ON THE DETERMINANTS OF HEALTH SERVICE QUALITY IN THE JKN ERA Wulandari, Reny Yulita; Rachmawan, Ade; Hartono, Budi; Daud, Alfani Ghutsa
HEARTY Vol 14 No 1 (2026): FEBARURI
Publisher : Fakultas Ilmu Kesehatan, Universitas Ibn Khaldun, Bogor

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32832/hearty.v14i1.20871

Abstract

Patient satisfaction is a key indicator in assessing the quality of healthcare services, particularly within the National Health Insurance (JKN) system, which aims to provide equitable access to healthcare for all Indonesian citizens. In the context of patients as consumers, understanding the determinants of satisfaction is crucial for improving service quality and maintaining public trust. This study is a literature review that aims to identify and analyze the factors influencing patient satisfaction based on findings from eleven relevant scientific articles. The method used is a literature review with a descriptive-qualitative approach. The review shows that service quality dimensions such as responsiveness, assurance, and empathy consistently have a significant influence on patient satisfaction. Additionally, factors such as perceived service equality between BPJS and non-BPJS patients, institutional image, and prior service experiences also affect satisfaction levels. These findings indicate that patient satisfaction is not only determined by technical aspects of service but also by relational aspects and perceptions of fairness. Therefore, improving service quality oriented towards patients' needs and expectations is essential to support the successful implementation of JKN sustainably.
Co-Authors Abdelrazig, Omnia Amir Osman Alridjal, Rifqi Budi Hartono Daud, Alfani Ghutsa Dewi Purnamawati Rachmawan, Ade