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All Journal Jurnal Dunia Kesmas International Journal of Health and Pharmaceutical (IJHP)
Nurlestari, Astri
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Environmental Science Nursing Public Health

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Analysis of Managed Care In Primary Health Care Services In Indonesian Health Insurance Management Widyadhari, Elysia; Nurlestari, Astri; Dwi Muthashani, Femy; Puspitaloka Mahadewi, Erlina
International Journal of Health and Pharmaceutical (IJHP) Vol. 5 No. 3 (2025): August 2025 (Indonesia - Malaysia)
Publisher : CV. Inara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51601/ijhp.v5i3.378

Abstract

This study aims analyzes and to evaluate the implementation of the National Health Insurance Program (JKN) in Indonesia, through the perspective of the managed care model. Managed care itself is an approach that combines financing mechanisms and health services in a single integrated system, with a focus on cost efficiency and improving service quality, as implemented by BPJS Kesehatan in Indonesia. This study used a systematic literature review method of 30 scientific articles published between 2016 and 2025. The results of the study indicate that the capitation payment system and INA-CBGs play a role in increasing spending efficiency and expanding access to health services. However, several challenges remain, such as infrastructure gaps, unequal distribution of health workers, and barriers in the referral system. This study also discusses various managed care models such as EPO, IDS, HMO, PPO, and POS, and the relevance of their implementation in the Indonesian context. The findings of the proposed improvement strategies include the use of digital health service technology, strengthening community-based public education, revising more adaptive capitation rates, and improving the monitoring system for service quality and costs. These steps are necessary to support the sustainability and equity of health services throughout Indonesia going forward, along with concrete solutions.
Analisa Perilaku Produsen dan Konsumen pada Sektor Kesehatan di Indonesia Nurlestari, Astri; Arini, Kartika Destya; Hartono, Budi; Daud, Alfani Ghutsa
Jurnal Dunia Kesmas Vol 15, No 2 (2026): Volume 15 Nomor 2
Publisher : Persatuan Dosen Kesehatan Masyarakat

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Abstract

Analisa perilaku produsen dan konsumen dalam bidang kesehatan di Indonesia menunjukkanberbagai aspek penting. Produsen, seperti rumah sakit dan penyedia layanan kesehatan, cenderung fokus pada profitabilitas, kualitas pelayanan, dan kepuasan pasien untuk memastikan keberlangsungan bisnis mereka. Konsumen, sebagai pasien, memiliki perilaku yang dipengaruhi oleh citra rumah sakit, kualitas pelayanan, dan faktor lain seperti aksesibilitas, biaya, dan kepraktisan.Penelitian ini mengadopsi pendekatan Systematic Literature Review (SLR) dengan pendekatan deskriptif kualitatif untuk menganalisa perilaku produsen dan konsumen dalam bidang kesehatan di Indonesia . Hasil dari analisis ini diharapkan dapat meningkatkan efektivitas layanan kesehatan, memahami kebutuhan masyarakat, dan mengembangkan strategi pemasaran yang tepat. Dengan memahami bagaimana produsen (seperti rumah sakit, klinik, atau perusahaan farmasi)berperilaku dan bagaimana konsumen (pasien, keluarga, atau masyarakat umum) berinteraksi dengan layanan kesehatan, dapat dilakukan pemetaan kebutuhan, penyesuaian layanan, dan peningkatan kualitas secara keseluruhan
Co-Authors Arini, Kartika Destya Budi Hartono Daud, Alfani Ghutsa Dwi Muthashani, Femy Mahadewi, Erlina Puspitaloka Widyadhari, Elysia