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Jurnal JKN
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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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Implementasi Sistem Pencegahan Kecurangan Pelayanan Kesehatan Di Rumah Sakit Kota Prabumulih Pada Masa Pandemi Covid 19 Fadliana Fathinuddin; Arief Wisnu Wardhana; Cholidi Zainuddin
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.v3i1.124

Abstract

Fraud in financing of health insurance is alleged to have burdened the cost of health services. The government issued Permenkes 16 of 2019 concerning prevention and handling of fraud and administrative sanctions against fraud in the implementation of JKN in an effort to prevent fraud. However, there is still potential for fraud to increase with pandemic conditions. This research aims to determine the implementation of the JKN Claim and Covid-19 Claim fraud prevention system and forms of fraud at the Prabumulih City Hospital during the Covid. This research can be useful theoretically and practically both in the field of health law politics and used by the Government, BPJS Health and Hospitals in an effort to improve fraud prevention system. The research method is empirical research with primary data sources from interviews with Prabumulih City Health Office, Prabumulih City Health BPJS and 4 Hospitals in Prabumulih. Results of the study shown that implementation of the fraud prevention system for health services at Prabumulih City Hospital during  Covid at the Health Service and BPJS Health KC Prabumulih was quite good, but in Prabumulih City Hospital  needed to be improved. Forms of fraud that can occur during the Covid-19 Pandemic at the Prabumulih City Hospital are fee contributions to participants for the Covid-19 antigen screening examination, extending the length of treatment for Covid-19 claims, submitting repeated claims to both JKN and covid claims and use the identity of another participant by not using the finger print in the participant's eligibility check.
Analisis Kendala Pengadaan Obat Program Rujuk Balik (PRB) di Fasilitas Kesehatan Tingkat Pertama (Studi Kasus Pada Puskesmas BLUD di Kabupaten Indragiri Hilir) : Analisis Kendala Pengadaan Obat Program Rujuk Balik (PRB) di Fasilitas Kesehatan Tingkat Pertama (Studi Kasus Pada Puskesmas BLUD di Kabupaten Indragiri Hilir) elinda rahayu; Fitriyah Kusumawati
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.v3i1.126

Abstract

Program Rujuk Balik (PRB) is a health service program for Jaminan Kesehatan Nasional (JKN) participants with chronic illnesses in stable condition and still require long-term care. PRB has not run optimally; one of the reasons is related to drugs. The aim of the study was to examine the procurement of drugs for PRB patients at the  Public health center (Puskesmas). This research in Indragiri Hilir Regency, Riau Province, in 2022. Data collection was carried out by Focused Group Discussions (FGD) and in-depth interviews with the Leaders and Managers of the pharmacy department at 5 Puskesmas and the Pharmaceuticals and medical devices (Farmalkes) Sub-coordinator at the Public Health Office Indragiri Hilir. The results showed that Puskesmas did not procure PRB drugs because the drugs were provided by pharmacies in collaboration with BPJS Kesehatan, and they didn’t know how to procure drugs through e-purchasing. Constraints in procuring PRB drugs at the Puskesmas: a). The need for PRB drugs for each Puskesmas were different; b). Puskesmas do not yet have competent human resources; c). Not all Puskesmas have pharmacists; d). The budget plan for drug expenditure at the Puskesmas doesn’t match with payment period for PRB drug claims. Socialization and assistance of drug procurement by e-purchasing at the Puskesmas level, periodic evaluations, and increasing of the Health Service Office must be carried out. The drug procurement system needs to be simplified, and Puskesmas also requires adequate human resources in number and competence for the procurement.
The Pengaruh Google Sites “Ketoprak” terhadap Tingkat Pemahaman dan Capaian Kepatuhan Fasilitas Kesehatan Mitra BPJS Kesehatan KC Purwokerto: Pengaruh Googlesites “Ketoprak” sebagai Dashboard Performance Kepatuhan Terhadap Kontrak terhadap Pemahaman dan Capaian Kepatuhan Terhadap Kontrak Fasilitas Kesehatan Rujukan Tingkat Lanjutan (FKRTL) di Wilayah Kerja BPJS Kesehatan KC Purwokerto Mitsalina Maulida Hafizh; Unting Patri Wicaksono Pribadi
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.v3i1.132

Abstract

This study aims to determine the effect of the compliance performance dashboard through Google Sites which is easily accessed by Health Facilities on the level of understanding and achievement of by Health Facilities compliance with contracts. The method used a quasi-experimental using one research sample and the data analysis used qualitative methods. The results showed that there was an increasing on the understanding of representatives of Management and PIC by Health Facilities regarding Health Facility compliance with contracts and there was an increasing on the Health Facility compliance score with contracts from August 2022 to September 2022. The percentage increase in compliance scores can reach 20%. The results of this study can be used by internal team of BPJS Kesehatan in order to create an application for monitoring the achievement of Health Facility compliance with contracts and for increasing the level of stakeholder engagement
Deteksi Inefisiensi pada Klaim BPJS Kesehatan dengan menggunakan Machine Learning Hanif Noer Rofiq
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.v3i1.134

Abstract

Inefficiency in claims submitted by health facilities to BPJS Kesehatan is a problem that needs attention. With the growing number of claims, traditional method such as manual verification is unable to handle enormous amounts of data swiftly. Simultaneously, there is a demand to accelerate the settlement of claims with a limited number of verifiers. One way that can be adopted is to use Machine Learning to detect potential inefficient transactions rapidly. This study compares several Machine Learning algorithms: Random Forest, Gradient Boosting Classifier, Decision Tree, Support Vector Machine, Naive Bayes, CatBoost, and XGBoost. In addition, oversampling and under sampling methods are also used because the dataset is imbalanced. The best results were obtained using the Random Forest + Tomek Links model, which produced an F1 score of 19,53, with the five most influential variables: location of the health facility, participant's age, first-level health facilities diagnosis, participant's primary diagnosis, and health facility type.
A Pengaruh Keikutsertaan Program Pengelolaan Penyakit Kronis Terhadap Kendali Glukosa Darah Pasien Diabetes Melitus Tipe 2 Di Cabang Pematangsiantar : Pengaruh Keikutsertaan Program Pengelolaan Penyakit Kronis Terhadap Kendali Glukosa Darah Pasien Diabetes Melitus Tipe 2 Di Cabang Pematangsiantar Kiki Christmar Marbun; Firdauz Hafidz As Shidieq
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.v3i1.139

Abstract

DM Type 2 is a chronic disease and Indonesia is ranked 7th in the world. This situation causes health burden, both economically and disability. The Disease Management Program was developed to control patient health status and control costs. Prolanis is a form of disease management program organized by BPJS Kesehatan. The purpose of this study was to analize impact of  Type 2 DM Prolanis on controlling blood glucose levels in patients. This is a quantitative study with a crosssectional design by comparing Type 2 DM patients who participate in Type 2 DM Prolanis with those who do not take part in the program at 15 target FKTPs in  the region of  Pematangsiantar branch of BPJS Kesehatan. Using secondary data which was conducted retrospectively in 2021 involving 717 respondents.The majority of respondents were participants I Type 2 DM Prolanis (70,29%), aged 56 years and over,  female (57,34%), high school educated (39,47%), coming from the BP segment (retirement) (40o.44%). Have followed Type 2 DM Prolanis for more than 6 months (more than 85 % of respondents), and actively visited FKTPs for more than 3 times during the period of January to December 2021.
Efektivitas Implementasi Monitoring Intensif Pemanfaatan Antrean Online melalui Mobile JKN di Fasilitas Kesehatan Rujukan Tingkat Lanjutan (FKRTL) Champion Kantor Cabang Bulukumba Tahun 2022. Muhayyina Wahidah; Andi Rismaniswati Syaiful; Rini Oktaviani Najib; ihwan Prasetiya; Andi Syamsul Bakhri; Andi Rifka Yuliana Sari; Lily Alfy Sahraini; Muhammad Fiqri Adim; Muhammad Rezki; I Gede Bayu Edwin Jenuar
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.v3i1.140

Abstract

This study aims to assess the effectiveness of the implementation of intensive monitoring of the achievements of online queuing system utilization through Mobile JKN for FKRTL Champion in 2022. The method used is descriptive quantitative by comparing data on online queue utilization, quality rate (QR), and the average total service time for outpatient visits through Mobile JKN before and after the implementation of monitoring and piloting of 3 (three) FKRTL Champions in Bulukumba District, Bantaeng Regency, and Jeneponto Regency in 2022 which were chosen to represent each type and class of FKRTL. The results of the study found that the implementation of intensive monitoring and the piloting of 3 FKRTL Champions which had been carried out since December 2022 had effectively increased the achievement of using online queues through Mobile JKN compared to other collaborative FKRTLs. Apart from that, intensive monitoring and the piloting of FKRTL Champion can also increase the Quality Rate with an average achievement above 80%, and the use of online queues through Mobile JKN effectively shows the efficiency of the average service time at FKRTL outpatient services at FKRTL Champion
Adult Cancer Patients’ Quality of Life After Outpatient Chemotherapy with JKN Coverage Nancy Nancy; Tutik Maysaroh; Hubertus Genias Unggulian
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.v3i1.144

Abstract

Adult cancer patients who received chemotherapy with JKN coverage were enrolled on this observational cross-sectional study to evaluate their quality of life (QOL) and to identify the associated variables that affected QOL. Eligible patients who received outpatient chemotherapy at Keluarga Sehat Hospital were asked to complete an EORTC QLQ-C30 questionnaire, as well as a socio-demographic inquiry. We collected answers from 53 patients and converted them into EORTC dimensions and symptoms. One-way analysis of variance was used in addition to descriptive statistics and independent t-tests. The QOL average score was 78.93 ± 20.89, with a 95% CI (73.31-84.55). The highest performance was on the cognitive scale (94.03 ± 16.85), while the poorest was on the role scale (73.27 ± 27.91). Pain (95% CI [24.05, 36.95]) and fatigue (95% CI [23.14, 35.98]) were the most troubling symptoms reported. The marital status (p < 0.05) and cancer treatment history (p < 0.01) were factors affecting our population’s QOL. Through the understanding of the relationship between QOL and socio-demographic and medical variables, oncologists, chemotherapy providers, and health insurers can improve the quality of life of vulnerable populations.
Supply Infrastructure Financing & Kualitas Mutu Layanan dalam Meningkatkan Kepuasan Peserta JKN Zirma Julianda; Ecep Mochammad Holiqurrahman
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.v3i1.146

Abstract

BPJS Kesehatan as the National Health Insurance Institutions needs to understand participant satisfaction to this is important to build public trust in the implementation of the National Health Insurance. Participant satisfaction is an indicator of the quality of health services that is measured and compared between expected services and services perceived. The quality of service depends on the ability of the service provider to consistently meet the expectations of participants. Participants' demands for service quality are not only related to physical healing of illnesses but also regarding customer satisfaction with attitudes, knowledge, skills of officers providing services, communication, availability of information, adequate facilities and physical environment. Health Facilities strive to continue developing infrastructure, working capital, complete facilities and infrastructure, as well as expanding service points in order to increase Health Facilities commitment in maintaining the quality of service to JKN-KIS participants. Based on the 2021 Participant Satisfaction Survey,satisfaction indicators of participants through Health Services include facilities and infrastructure, waiting room and chairs, completeness of medical devices and sophisticated equipment, Health Facilities accessible. This is the basis for BPJS Kesehatan to collaborate with Partner Banks to provide Supply Infrastructure Financing (SIF) to Health Facilities (partner) that require business development funds. The purpose of this research is to evaluate that health services in health facilities are related to the satisfaction of JKN participants. the results of the literacy review of previous researchers and the evaluation of the SIF realization, the authors conclude that JKN participant satisfaction is influenced by health facility services.
Gambaran Tingkat Kepuasan Rawat Inap Peserta JKN Terhadap Kualitas Pelayanan di RSU Islam Harapan Anda Agung Laksana Hendra Pamungkas Hendra Pamungkas; Silvia Silvia; asni afifah; Trifany Arlita
Jurnal Jaminan Kesehatan Nasional Vol. 3 No. 2 (2023): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v3i2.99

Abstract

Pemerintah terus berbenah dalam memberikan layanan kesehatan pada masyarakat, melalui pelayanan kelas rawat inap standar dimana sebelumnya pasien rawat inap terbagi atas kelas 1, 2 dan 3 dengan fasilitas yang berbeda-beda. Dengan adanya kelas rawat inap standar ini seluruh pasien dapat menikmati fasilitas yang sama dan tentunya demi meningkatkan mutu pelayanan rumah sakit dan keselamatan pasien. Oleh karena itu rumah sakit dituntut untuk Penelitian ini merupakan penelitian survei deskriptif melalui pendekatan kuantitatif, dilakukan pada bulan Mei-Juni 2022 dengan jumlah 100 responden. Tingkat kepuasan pasien berdasarkan dimensi tangible (fasilitas IGD dan ruang rawat inap lengkap dan nyaman) sangat puas dengan total skor 52 dari 346. Dimensi reliability (akses rumah sakit mudah) puas dengan total skor 50 dari 331. Dimensi responsiveness (dokter menjelaskan tentang penyakit pasien) puas dengan total skor 47 dari 317. Dimensi assurance (kesopanan dalam bersikap dan berperilaku petugas terhadap pasien dan keluarga) sangat puas dengan total skor 52 dari 346. Dimensi empathy (dokter menanyakan keluhan pasien) puas dengan total skor 44 dari 318. Peserta JKN yang dirawat dikamar standar KRIS secara umum memiliki tingkat kepuasan pada 42,9% untuk sangat puas, 42,5% puas, kurang puas sebesar 13,8% dan 0,8% untuk tidak puas.
Estimasi Biaya Pelayanan Kesehatan sebagai Upaya Pencegahan Defisit Dana Jaminan Sosial untuk Penyakit Gagal Ginjal Mutiara Nurtandhee
Jurnal Jaminan Kesehatan Nasional Vol. 3 No. 2 (2023): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v3i2.104

Abstract

Not all medical expenses were paid promptly in 2018, which resulted in a deficit for BPJS Kesehatan. If DJS cannot meet the costs of health services, it will have an impact on other people who need care. Kidney failure is one of the catastrophic diseases with the highest costs, costing up to 6.5 trillion rupiah in 2021, an increase of 190% compared to 2020. This is also due to the increase in the number of sufferers, followed by an increase in cases of kidney failure. Some of the procedures include CAPD, hemodialysis, and organ transplantation, which can cost up to hundreds of millions of rupiah per patient. This research aims to forecast the prevalence rate of kidney failure in Indonesia for 2023–2025 using the Exponential Smoothing method and the literature study method. The results showed that people aged >45 years were more likely to get kidney failure. Compared to women, the prevalence for men is higher, which serves as a warning to the community to maintain a healthy lifestyle. Following the hypothesis, the total cost of kidney failure will increase with the increase in hemodialysis patients and cases. The total cost of treatment is expected to be between 7 and 10 trillion rupiah in 2023-2025. It is known that the cost containment scheme has succeeded in overcoming the problem of cost control in several countries. The United States uses cost sharing as a cost control scheme for the treatment of ESRD (End-Stage Kidney Disease). Therefore, Indonesia can also implement a cost-sharing scheme that is based on the forecasting results of kidney failure costs. This scheme is appropriate to overcome the problem of controlling insurance costs.

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