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INDONESIA
Jurnal Jaminan Kesehatan Nasional
Published by Badan Penyelenggara Jaminan Sosial Kesehatan
ISSN : 27987183     EISSN : 27986705     DOI : 10.53756
Core Subject : Health, Science,
Decision Sciences, Operations Research & Management Dentistry Health Professions Medicine & Pharmacology Public Health
Jurnal Jaminan Kesehatan Nasional merupakan salah satu bentuk upaya pengembangan dan menjadi rujukan ilmiah bagi para akademisi dan praktisi terkait Jaminan Kesehatan Nasional. Jurnal ini memuat artikel-artikel terkait bidang Jaminan Kesehatan Nasional melalui berbagai pendekatan ilmiah yang berfokus pada pembahasan mengenai Risk Pooling, Strategic Purchasing, Revenue Collection yang dapat menjadi pengayaan ilmu di bidang Jaminan Sosial Kesehatan. Selain itu, jurnal ini juga memuat berbagai aspek lainnya yang relevan, yakni Stakeholder Engagement dan Institutional Capability terkait penyelenggaraan Jaminan Kesehatan Nasional
Arjuna Subject : Umum - Umum
Articles 79 Documents
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Evaluasi Pasca Program Pembelajaran Khusus Kepala Kabupaten di Kedeputian Wilayah Papua & Papua Barat Tahun 2021 dengan Model Kirkpatrick Level 3 Win Dharlan Siallagan; Nurullah Hasibuan; Firman Adrian; Chandra Nurcahyo
Jurnal Jaminan Kesehatan Nasional Vol. 2 No. 2 (2022): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v2i2.75

Abstract

One way to create competent and professional human resources is through training designed according to the organization's needs and carried out comprehensively and continuously. BPJS Kesehatan, through Corporate University, plays a role in developing employees according to organizational needs in the form of a Learning Program. Corporate University evaluates all learning programs. This study aims to analyze the results of the evaluation after the Special Learning Program for District Heads in the Ministry of Papua and West Papua Regions in 2021 to provide an overview of the extent of the implementation of the learning program results, changes in participant behavior in the workplace, and provide proposed actions that need to be taken to improve the learning program in the future. This research uses descriptive methods with quantitative and qualitative approaches. Based on the results of the evaluation, it is known that the Competency Score for each competency is still below the target value of 5 on a scale of 6, namely the Building Trust competency with a score of 4.97; impact & influence competency with a score of 4.93 and Strive for Excellence competency with a score of 4.79. The results of the evaluation found that there were 13 behavioral indicators (68.4%) that had scores below the target value. The implementation of the results of the learning program still needs to have a significant influence on increasing the competence of participants. The learning program still has not changed participants’ behavior by the behavioral indicators of each competency that is the target of the learning program. The availability of facilities and infrastructure in the work environment still needs to be improved. Other factors that need attention are knowledge and skills, superior support, and self-motivation. The knowledge and skills that need to be improved are Communication Skills, Negotiation Skills, and regulations related to Local Government. External factors affecting performance are geography and security, family support, and cooperation with external parties.
A Efektivitas Peran dan Fungsi Tim Kendali Mutu Kendali Biaya (TKMKB) Provinsi Sulawesi Selatan Dalam Memberikan Rekomendasi Penyelesaian Dispute Klaim Tahun 2021: Efektivitas Peran dan Fungsi TKMKB Dalam Memberikan Rekomendasi Penyelesaian Dispute Klaom FKRTL Muhayyina Wahidah; Irawan Yusuf
Jurnal Jaminan Kesehatan Nasional Vol. 2 No. 2 (2022): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v2i2.78

Abstract

This study aims to assess the effectiveness of the role and function of the South Sulawesi Province Quality and Cost Control Team in providing recommendations for the settlement of disputed claims. The method used is descriptive quantitative by comparing the claim dispute data in the Month of Loading from January to December 2021 in South Sulawesi Province. The data sources used are from the Monthly Routine Reports of Claims for Branch Office disputes as well as data on increasing claim maturity. The results of the study found that there was a decrease in dispute claim cases after the Quality and Cost Control Team Meeting in 6 Branch Offices and an increase in the quality of the maturity of advanced outpatient and advanced hospitalization claims, so that the role and function of Quality and Cost Control Team in providing recommendations for dispute resolution claims to Social Security Agency of Health and hospital was considered effective.
Kesiapan Rumah Sakit Dalam Implementasi Sistem Pembayaran Global Budget Di Kabupaten Purworejo Dina Anjayani; Andreasta Meliala; Yulita Hendrartini
Jurnal Jaminan Kesehatan Nasional Vol. 2 No. 2 (2022): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v2i2.89

Abstract

In 2018, BPJS Kesehatan initiated a pilot project to integrate the INA CBGs and Global Budget mixed-method hospital payment system (global budget). Purworejo Regency is one of the areas designated as a pilot for the Global Budget payment system's deployment. The outcomes of the Hospital performance indicators in the first-semester review were less than ideal. Consequently, it is required to study the Hospital's readiness to implement the Global budget Payment System. This study set out to determine how prepared the hospitals in Purworejo Regency were to implement the Global Budget payment scheme. A descriptive design and a qualitative methodology were used in the research. The management of four hospitals in Purworejo Regency is the topic of the study.  Observations and interviews were used to explore hospitals’ readiness to implement the Global Budget payment system in terms of health facilities’ perception, Quality Control and Cost Control strategies, Global Budget calculations, and patient satisfaction through the results of the Walk Through Audit.  Through the four key variables mentioned above, the scoring technique is used to evaluate the readiness of hospitals to implement the Global Budget payment system.  The modified CCCEAR (California Community Clinic EHR Evaluation and Readiness) tool is used for the readiness assessment, which has three readiness levels: 1) not ready (score 0-33), 2) moderately ready (34-66), and 3) ready (67-100).  Result:  According to a qualitative examination of data from observations and interviews, the hospital scored 26 from assessor II and 24 from assessor I, positioning it in the second range. This demonstrates that the hospital is not ready and has not considered developing a more comprehensive and in-depth plan for implementing the Global Budget payment system, nor how to create capacity to enable successful adoption and implementation.  Conclusion: The hospital is not yet at its highest level of readiness to adopt the Global Budget payment system in Purworejo Regency, according to the scoring findings on four variables of hospital readiness.
Sebuah Penelitian Urgensi Pelaksanaan Skrining Riwayat Kesehatan Peserta JKN-KIS dengan Pendekatan Stakeholder Engagement: Urgensi Skrining Riwayat Kesehatan Peserta JKN-KIS dan Kerangka Kerja Ray dan Miller sebagai metode Stakeholder Engagement Nanda Elok Juwita; Dwi Santoso
Jurnal Jaminan Kesehatan Nasional Vol. 2 No. 2 (2022): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v2i2.103

Abstract

Implementing health history screening is one of the main concerns at Badan Penyelenggara Jaminan Sosial Kesehatan Republik Indonesia (BPJS Kesehatan RI). Its implementation can be optimal if there is a good stakeholder engagement process. The purpose of this study is to analyze the urgency of health history screening. After that, the researcher uses Ray and Miller’s Framework from other studies and then compares the suitability of using the framework in the stakeholder engagement process that has been carried out in achieving health history screening at Kantor Cabang Singkawang (KC Singkawang). The method used in this study is a literature review combined with a comparison of the situation in the field. The use of references from various kinds of foreign and domestic research. Regarding the results, various data related to the five urgencies were found which ca,n be a strong reason that health history screening is mandatory for all Jaminan Kesehatan Nasional-Kartu Indonesia Sehat (JKN-KIS’s) participants and the Ray and Miller’s Framework is very suitable if applied further in the stakeholder engagement process at KC Singkawang. It is hoped that further research will be able to conduct quantitative research on the effect of  Ray and Miller’s Framework in implementing stakeholder engagement to achieve comprehensive health history screening
Universal Health Coverage: Internalisasi Norma di Indonesia Cipto Rizqi Agung Saputro; Fenny Fathiyah
Jurnal Jaminan Kesehatan Nasional Vol. 2 No. 2 (2022): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v2i2.108

Abstract

Access to health care is part of human rights. As an effort to realize this right, the United Nations (UN) and World Health Organization (WHO) initiated a program that is Universal Health Coverage (UHC). UHC, as a program that seeks to be implemented, cannot be separated from the values and benefits it stands for. This research aims to see the extent to which the internalization of UHC norms is implemented in Indonesia and the actors involved. This research uses a descriptive method with a qualitative approach. To achieve the research objectives, this study uses the concept of norm diffusion proposed by Finnemore & Sikkink and the concept of norm localization by Amitav Acharya. Through this research, it was found that UHC is a new norm in the international world that is trying to spread throughout the world. It was also found that the Government of Indonesia has internalized the norm and has entered the third phase, which is the final phase in the norm internalization process with the appointed designated local service, namely BPJS of health.
INISIATIF Culture Health Index: Mengukur Tingkat Kesehatan Budaya Organisasi BPJS Kesehatan Syarifuddin Syarifuddin; Afrizayanti; andi afdal
Jurnal Jaminan Kesehatan Nasional Vol. 2 No. 2 (2022): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v2i2.109

Abstract

Background: Organizational culture is one of the key HR management elements in BPJS Kesehatan. Optimal management of organizational culture is expected to be able to make a significant contribution to achieving organizational targets, starting from careful planning, effective and efficient program execution, and measuring the effectiveness of cultural programs as an objective evaluation mechanism. To improve the management of organizational culture that is more optimal in the future, an objective evaluation is very important to do. Purpose: This study aims to obtain an overview of the level of organizational culture health index in BPJS Kesehatan. Methods: This study uses a descriptive quantitative approach. Data collection was carried out by filling out the Organization Culture Health Index (OCHI) survey by all BPJS Kesehatan employees as respondents (the participation rate in filling out the survey was 96.79% of the population) and focus group discussions (FGD) to obtain the required qualitative information. Results and Discussion: Based on the measurement results, the level of organizational culture health in BPJS Kesehatan is generally in the "Healthy Enough" category with a total index value of 72.6%. The implementation index of the 4 main values ​​is as follows: excellent service (71.3%), integrity (69.0%), innovative (67.6%), and collaboration (63.7%) and has been integrated into 5 awareness areas organization, namely: sustainability, relationship, growth, common goals, and meaning purpose area. The level of positive energy felt by employees at work is in the "High" category with an index value of 95.2%. This is because organizational culture as one of the important elements of HR management, has succeeded in forming a fun and meaningful work atmosphere to create positive energy felt by employees. Conclusions and Recommendations: BPJS Kesehatan is considered quite successful in internalizing organizational culture. INISIATIF as the main value system can be understood and become a shared belief for employees. However, in the context of optimizing the management of organizational culture, BPJS Kesehatan is expected to be able to enrich the latest literature reviews, perform benchmarking, especially to other organizations that have succeeded in forming a healthy organizational culture, and make various breakthroughs and innovations in managing organizational culture. Thus, it is hoped that the organizational culture at BPJS Kesehatan can reach the "Healthy" category and be able to form an organizational image that is recognized by all parties involved in the JKN ecosystem
KEBIJAKAN ALIH MANFAAT COVID-19 DALAM MANFAAT JAMINAN KESEHATAN NASIONAL Gilbert Renardi Kusila; Endang Suparniati; Tonang Dwi Ardyanto; Donald Pardede; Firdaus Hafidz; Wan Aisyiah Baros; Dedy Revelino; Erzan Dhanalvin; Benyamin Saut; Citra Jaya; Ayunda Oktavia
Jurnal Jaminan Kesehatan Nasional Vol. 2 No. 2 (2022): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v2i2.111

Abstract

Since the COVID-19 pandemic occurred at the end of January 2020, the health social security administering body (BPJS Kesehatan) as the payer has an important part in handling COVID-19, namely by carrying out the process of verifying claims for COVID-19 cases while the financing is carried out by Ministry of Health. However, COVID-19 benefits may be transferred to the National Health Insurance benefits during the endemic period. Therefore, this study aims to evaluate services and obtain policy recommendations for the transfer of COVID-19 benefits. Qualitative research through focus group discussions was conducted in September 2021 with policymakers, clinicians, COVID-19 survivors, and BPJS Kesehatan. The results of the qualitative study show that there are still many obstacles in the service process. Therefore, it is necessary to regulate the provisions of service regulations. As for the claim process, health facilities find it difficult to change the dynamic regulations during the pandemic. BPJS Kesehatan requires policy certainty to determine the end of the pandemic period. If the COVID-19 benefits are transferred to JKN after the pandemic, the source of financing may not only be done through the conversion of contributions but there is also an option for assistance funds from the government. In terms of tariffs, it is necessary to calculate costs according to the agreed benefit package through INA-CBG. Gradual and thorough preparations are needed for the implementation of the transfer of COVID-19 benefits in the benefits of JKN.
Determinan Rujukan Non Spesialistik Dengan Kriteria TACC di FKTP Kabupaten Batang Hari Tahun 2022 Bathari Yanthi; Julita Hendratini; Dwi Handono Sulistyo
Jurnal Jaminan Kesehatan Nasional Vol. 3 No. 1 (2023): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v3i1.63

Abstract

The capacity of primary healthcare as gatekeepers to handle 144 comprehensive and independent primary diagnoses is a form of strengthening primary healthcare facilities for the implementation of both quality and cost control. Non-specialist Referral diagnoses with TACC (Time, Age, Comorbidity, Complication) included in the 4A competency level for primary doctors allows the doctors to refer patients to Advanced Referral Health Facilities. This study aimed to identify the determinants that affect Non-Specialistist Referral with TACC in FKTP Batang Hari Regency. This research was a cross-sectional mixed-method study with a sequential explanatory design using primary doctors as the total sampling and heads of FKTP and National Health Insurance patients as sample representatives. The quantitative method using Chi-square analysis was used to determine the effect of each independent variable on the dependent variable. Qualitative analysis was carried out by quantitative data triangulation. The results of the statistical test show that there was a significant association between the availability of medical devices and drugs wNon-Specialististtist Referral with TACC (medical devices p=0.017, drugs p=0.002), while doctors’ knowledge, doctors’ competence, FKTP location, and type did not show a significant association. In-depth interviews revealed that patients’ request was one of the reasons for doctors’ referral. There is a significant association between the availability of medical devices and drugs with NonSpecialistst Referral with TACC supported by patients’ request for referral.
Gambaran Hasil Pemeriksaan Tekanan Darah antara Peserta Prolanis yang Memperoleh dengan Tidak Memperoleh Pelayanan Kontak Tidak Lansung ICHWAN HANDOYO
Jurnal Jaminan Kesehatan Nasional Vol. 3 No. 1 (2023): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v3i1.76

Abstract

The prevalence of chronic diseases constantly increases in Indonesia. Chronic diseases greatly affect the quality of human resources and have an impact on increasing healthcare costs. BPJS Kesehatan has constructed a healthcare system for Jaminan Kesehatan Nasional (JKN) members with a chronic disease, known as the Chronic Disease Management Program abbreviated as PROLANIS. Besides that, BPJS Kesehatan has developed indirect contact healthcare so that PROLANIS participants’ health status can be monitored to avoid complications while still complying with recommendations for physical distancing during the Covid-19 pandemic. Through this research, the writer aimed to describe quantitatively the frequency of PROLANIS Participants' checking their health at primary health care and the blood pressure test based on the frequency of indirect contact healthcare. The research is a descriptive study on secondary data of PROLANIS Participants’ health examination results from January 2021 to June 2022 by the primary health care in the BPJS Kesehatan Madiun branch working area. The results showed that the proportion of PROLANIS participants who regularly visited the primary health care for check-ups was greater in those who received indirect contact healthcare (29,35%) than those who did not (17,0 %).  The percentage of PROLANIS participants receiving indirect contact healthcare with controlled blood pressure was 12,73%. While those who did not receive indirect contact healthcare with controlled blood pressure were 14,30%.
Perspektif Masyarakat Pengguna BPJS Kesehatan mengenai Kebijakan Kelas Rawat Inap Standar (KRIS) Pramana Pramana; Chairunnisa Widya Priastuty
Jurnal Jaminan Kesehatan Nasional Vol. 3 No. 1 (2023): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v3i1.98

Abstract

The Republic of Indonesia's Government established BPJS Kesehatan as a public legal organization to organize the national health insurance program. The shift in the clustering policy of inpatient classes to Standard Inpatient Classes (KRIS) is one important adjustment implemented by the Government of Indonesia as part of a series of changes and improvements in regulations of the National Health Insurance (JKN). This change in KRIS raises the question of whether the existence of KRIS is adequate to meet the demands of the community after being acclimated to class-based inpatient facilities. To collect relevant information from the general public, this study uses a qualitative approach using a case study methodology. This study takes place in Klaten Regency and Yogyakarta Special Region Province based on a number of factors and considerations. Purposive sampling approach and in-depth interviews were used in this study to acquire data from four informants who represented various preset criteria. This study concluded that the acceptance of the community of active users of BPJS Kesehatan from each class at the research site related to the KRIS policy plan was relatively high. Furthermore, the study indicated that a thorough campaign is required as part of efforts to adopt KRIS based on the characteristics of the community and taking geographical and demographic variances into account

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