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All Journal Jurnal Aisyah : Jurnal Ilmu Kesehatan Journal of Scientific Insights
Evriany, Nurul
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Education Engineering Health Professions Medicine & Pharmacology Nursing Public Health Social Sciences Veterinary Other

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Constraint Analysis National Health Insurance Evriany, Nurul; Favian, Rhesa Milzam; Rochmah, Thinni Nurul; Ernawaty, Ernawaty
Jurnal Aisyah : Jurnal Ilmu Kesehatan Vol 8, No 3: September 2023
Publisher : Universitas Aisyah Pringsewu

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30604/jika.v8i3.2348

Abstract

Introduction: The government ratifies and establishes the Healthcare and Social Security Agency that manages health insurance for all people in Indonesia. However, this agency, through the National Health Insurance program, can still not pay all claims submitted by hospitals. Several claims were rejected because the claimant did not meet the requirements for the benefits covered. This research analyzes national health insurance claims' constraints to reduce unworthy claims at Undata Hospital, Central Sulawesi Province. Method: This research is a Constraint Analysis with an analytical observational method and a cross-sectional approach where the researcher wants to identify constraints in each BPJS claim flow process, which consists of verification, data coding process, and file entry process at the National Health Insurance Unit of Undata Hospital, Central Sulawesi Province. This research was conducted from November 2020 to September 2021. There were 17 subjects in this study. Sampling using a purposive sampling technique. Results: The cause of the constraint in the BPJS Health verification claim process at Undata Hospital is that the health service verification process was not carried out before being it to Agency. The cause of the constraint in coding BPJS Health claim files at Undata Hospital is that, based on knowledge constraints, it is known that there is no training for coders regarding the coding process. Conclusion: Implementing the BPJS Health claim procedure at Undata Regional Hospital, Central Sulawesi Province, still needs improvement because the existing SOP still lacks a detailed explanation of the stages of the existing claim procedure.Keywords: Constraints, Health Guarantee, Claims
Implementation of Medical Device Logistics Management: A Qualitative Study Sari, Nur Mila; Windy, Widy Try; Evriany, Nurul; Toii, Indra Eka Wardana
Journal of Scientific Insights Vol. 3 No. 3 (2026): Available online
Publisher : Science Tech Group

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69930/jsi.v3i1.727

Abstract

The total expenditure on medical devices in 2016 was IDR 16.9 trillion from the total health budget in Indonesia. The main problems were the accessibility and quality of medical devices. Good logistics management of medical devices at the Public Health Center (PHC) will affect the quality and financing of health services. This research to find out logistics management of medical devices in Palu City Health Office. The method used Qualitative with case studies. In January-March 2017 in Palu City Health Office. The primary data was obtained through observation, in-depth interviews, and document review. The finding in this research are Palu City Health Office conducted bottom-up planning. However, the allocated budget was limited. Sources of funds were taken from the state budget (APBN) and local government budget (APBD). There was an involvement of official institutions and partners in the procurement of devices. The method of procurement was a tender and direct appointment that referred to e-catalog. But, the items would be available after a long wait. Misunderstanding of information occurred when distributing medical devices in the PHC. There was no special warehouse that was suitable for storing medical devices. The control process in the form of recording and reporting was experiencing errors. Logistics management of health device has not been carried out effectively and efficiently. Thus, it’s necessary to improve optimal coordination and commitment in logistics management of medical devices. This study aligns with SDG 3 (Good Health and Well-being), particularly Target 3.8 on universal health coverage and Target 3.b on access to quality health technologies. Findings also connect to SDG 9 (resilient health infrastructure) and SDG 12 (efficient resource use). Although data were collected in 2017, the structural challenges identified remain pertinent to ongoing health system strengthening in Indonesia and comparable settings.
Co-Authors Ernawaty Ernawaty Favian, Rhesa Milzam Nur Mila Sari Thinni Nurul Rochmah Toii, Indra Eka Wardana Windy, Widy Try