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All Journal Berita Kedokteran Masyarakat Jurnal Kesehatan Masyarakat
Septiani, Trisna
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Education Nursing Public Health

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Contracts between Referral Health Facilities and Social Health Insurance in Indonesia and England Puspandari, Diah Ayu; Rimawati, Rimawari; Aristianti, Vini; Fadlika, Findri; Septiani, Trisna; Ruby, Mahlil; Wibowo, Mulyo; Febriyanti, Maya; Siregar, Dedy Revelino; Baros, Wan Aisyiah; Manurung, Kathrina
Jurnal Kesehatan Masyarakat Vol. 20 No. 3 (2025)
Publisher : Universitas Negeri Semarang in collaboration with Ikatan Ahli Kesehatan Masyarakat Indonesia (IAKMI Tingkat Pusat) and Jejaring Nasional Pendidikan Kesehatan (JNPK)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15294/kemas.v20i3.21231

Abstract

Purchasers and providers are important in providing quality health services for participants. This is formally regulated through a contractual mechanism to achieve the potential benefits of strategic health purchasing (SHP) and ensure effectiveness, efficiency, and quality. The experience of contracting with providers differs in each country due to underlying determinants. This study aims to identify differences in contracts between referral health facilities and social health insurance in Indonesia and England. A normative legal research approach is used, utilizing secondary data sources such as literature, regulations, and contractual arrangements. Important clauses in the contract, such as rights and obligations, service tariff setting, agreement period, monitoring and evaluation, settlement of expired or disputed claims, mechanisms for providing information, and handling complaints, have been regulated in contracts in both Indonesia and England. Unlike the case in England, incentive payment policies have not been further regulated in Indonesia’s contracts. Additionally, notification and communication procedures for the parties involved have been integrated into the system in England. It is expected that learning from the NHS contracts will provide the potential for developing a more ideal contract implementation, effective monitoring and evaluation, and the delivery of optimal and high-quality health services.
JKN participation in accessing health services during the COVID-19 period in Sleman Regency (secondary data analysis of HDSS 2020) Septiani, Trisna; Hafidz, Firdaus
BKM Public Health and Community Medicine Vol 38 No 09 (2022)
Publisher : Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/bkm.v38i9.5612

Abstract

Purpose: Participation in JKN (Jaminan Kesehatan Nasional) is one of the factors that has a positive effect on healthcare utilization. The utilization of JKN has continued to increase, reaching 276.1 million visits in 2019. However, the COVID-19 pandemic has caused disruptions in the utilization of healthcare. Visits to health facilities are reported to have decreased, with 224.7 million visits in 2020. This research aims to describe utilization patterns based on the type of health facilities visited and determine the relationship between JKN participation and other factors on health service utilization during the COVID-19 pandemic. Methods: Descriptive analytical study with a cross-sectional design using secondary data from the Health and Demography Surveillance System (HDSS) 2020 cycle 6. The quantitative data analysis was conducted using univariate, bivariate, and multivariate analyses. Results: 69.77% of respondents used healthcare, while 30.23% did not. Other health facilities, particularly pharmacies, were the most commonly used choices by respondents to address their health problems. Not being sick enough to receive treatment (83.94%) and fear of contracting COVID-19 (11.92%) were the primary reasons respondents cited for not accessing healthcare. There was no significant correlation between the variables of JKN involvement, age, gender, education level, marital status, economic status, and residence location and the use of healthcare services (p > 0.05). The most critical variable was a history of NCD (p<0.05). Conclusion: The need factor, combined with the history of NCD, is the primary predictor of health service utilization among the people of Sleman Regency during the COVID-19 pandemic.
Co-Authors Baros, Wan Aisyiah Fadlika, Findri Febriyanti, Maya Firdaus Hafidz As Shidieq Manurung, Kathrina Rimawati, Rimawari Ruby, Mahlil Siregar, Dedy Revelino Vini Aristianti, Vini Wibowo, Mulyo