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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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Influencing Factors in Patient Referrals: A Doctor’s Perspective on Primary Health Care Facilities (FKTP) Ridwan, Ridwan; Ramadhan, Syahru
Jurnal Jaminan Kesehatan Nasional Vol. 5 No. 1 (2025): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v5i1.255

Abstract

An effective and efficient referral system is essential for ensuring patients receive the appropriate treatment for their medical conditions. Primary Health Care Facilities (FKTP) play a critical role in addressing the healthcare needs of patients at the first level. Despite receiving 100% Performance-Based Capitation (KBK), FKTPs exhibit a high referral rate, as indicated by referral rates, referral ratios, and Non-Specialist Referral (RNS) metrics. This quantitative study explores the factors influencing patient referrals in FKTPs, as perceived by doctors. A structured questionnaire was used to gather data from 69 doctors across 148 FKTPs in the BPJS Kesehatan Branch of Banda Aceh in July 2024. The survey addressed various aspects, including doctors' competence, patient behavior, FKTP capabilities, and referral mechanisms. The results revealed that the location of health facilities significantly impacts referral rates and healthcare costs, with facilities located closer to villages reducing the need for referrals and enhancing healthcare accessibility for remote populations. BPJS Kesehatan can improve collaboration with FKTPs by identifying strategic locations in rural areas and leveraging the Aplicares web to map and optimize health services. Furthermore, the government could enhance healthcare access by creating maps to develop public health centers in rural areas or collaborating with private and family doctors to expand services in underserved regions. This study provides valuable insights for policymakers, suggesting that improving FKTP accessibility and addressing resource limitations could significantly reduce unnecessary referrals, lower healthcare costs, and improve the efficiency of the healthcare system in rural areas.
Evaluation of Staged Payment Plan Program to Improve Collectability of Independent Participant Contributions Ningtiyas, Sri Ayu; Puspandari, Dyah Ayu
Jurnal Jaminan Kesehatan Nasional Vol. 5 No. 1 (2025): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v5i1.260

Abstract

The main problem causing high arrears among Independent Participant and Non-Employee participants is the lack of a strong mechanism to ensure continuous payment of contributions. This study aimed to explore the Staged Payment Plan Program (REHAB) as an effort to increase the collectability of contributions from independent participants at BPJS Kesehatan Yogyakarta Branch Office in 2023. This research uses with program evaluation method. there were 251,494 (11,65%) Independent Participant and Non-Employee participants, with 109,280 (62,33%) in arrears as of February 2023. However, only 6.53% of them registered for the REHAB program. The input component shows that many participants still do not know about this program. The REHAB process shows that digitalization in the implementation of the REHAB program has not been maximized; there is no data update and notification for the billing process to participants. Internal monitoring is carried out regularly however, there is no monitoring of participants. The results component shows that Independent Participants contributions is 80.89%, but this collectability includes all forms of revenues owned by BPJS Kesehatan. The conclusion is the REHAB program has not yet achieved its goal of helping independent participants pay off contribution arrears. Socialization carried out is still not optimal because it has not reached all levels of society. There has been no regular update of participant data or direct evaluation of participants. The implementation of the REHAB program has not been proven to contribute to collectability because there is no data on collectability achievements sourced from the REHAB program
Lifestyle Factors of Low Birth Weight: Evidence from the 2023 Indonesian Health Survey Marhadi, Nancy; Anisah, Zhafirah Yanzli; Saputro, Widiantoro
Jurnal Jaminan Kesehatan Nasional Vol. 5 No. 1 (2025): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v5i1.268

Abstract

The stagnant prevalence of low birth weight (LBW) in Indonesia creates challenges for the National Health Insurance (Jaminan Kesehatan Nasional/JKN), as it often needs more medical care with higher inpatient claim costs and affects the long-term growth and development of the country’s future generations. The objective of this study was to identify significant maternal lifestyle factors associated with LBW by analyzing the data from the Indonesian Health Survey (SKI) 2023. A total of 30,516 mothers who had given birth at least once during the five-year period preceding the SKI 2023 were included in the study. Bivariate and multivariable logistic regression analyses were used to identify key maternal factors associated with the outcome. Living in urban areas (AOR: 1.228; 95% CI: 1.038–1.453), exposure to second-hand smoke (AOR: 1.383; 95% CI: 1.149–1.664), infrequent consumption of energy drinks (AOR: 2.501; 95% CI: 1.015–6.161), and frequent vegetable consumption (AOR: 1.217; 95% CI: 1.030–1.437) were significant contributors. Additionally, the effect of low-frequency instant food consumption was more pronounced among mothers with only primary education (AOR: 4.740; 95% CI: 1.438–15.623). To lower LBW rates, healthcare providers should focus on educating expectant mothers about the risks of second-hand smoke and unbalanced nutrition through quality antenatal care.
Stakeholders’ Perceptions of Performance-Based Capitation Design Using Chronic Disease Indicators at Primary Health Care Facilities Sitorus, Susy Hartati Novintry
Jurnal Jaminan Kesehatan Nasional Vol. 5 No. 1 (2025): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v5i1.273

Abstract

Based on BPJS Kesehatan’s utilization review data (Social Security Administrative body for Health) until December 2023, only 32% of 273 primary healthcare facilities met the fourth level for the Controlled prolanis participant ratio (RPPT) indicator. This indicator reflects the percentage of Prolanis-registered patients diagnosed with Diabetes Mellitus (DM) or Hypertension (HT) who have achieved controlled fasting blood glucose (for DM) or controlled blood pressure (for HT), with a performance target of ≥ 5%. Meanwhile, 42% of facilities reached the Angka Kontak (AK/Contact Number) target, which measures the number of participants who contacted Primary Health Care Facilities (FKTP) compared to the total registered participants, multiplied by 1,000; the target is ≥ 150 per mille. However, 83% of facilities achieved the Non-Specialist Referral Ratio (RRNS) target, which compares the number of non-specialist case referrals to total referrals; the target is ≤ 2%. These findings highlight the need for stronger motivation mechanisms, such as financial incentives, to support FKTP in achieving better scores in the Performance-Based Capitation (KBK) model. This study explores stakeholder perceptions regarding an incentive-based KBK model using the RPPT indicator in FKTPs in Medan. Stakeholders shared several key perspectives: (1) RPPT targets should range between 5% and 10%, with incentives tied to rating levels; (2) intermediate outcome indicators should include HbA1c for DM and blood pressure for HT; (3) incentive payments should be allocated to FKTPs and managed to strengthen chronic disease services; and (4) these payments must be consistent and sustainable.
Analysis of Factors Affecting Referral Rates in Community Health Centers: A Scoping Review Juwita, Nanda Elok; Santoso, Dwi
Jurnal Jaminan Kesehatan Nasional Vol. 5 No. 1 (2025): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v5i1.300

Abstract

The implementation of the National Health Insurance (JKN) in Indonesia has gone well, with the strengthening of primary care functions. One health facility that provides primary health care services owned by the government is the Community Health Center (Puskesmas). The target referral rate for Puskesmas in 2024 is a challenge to control. The high number of referrals can increase hospital visits and costs. Special efforts are needed to achieve these targets. This study aims to determine the factors affecting referral rates in community health centers. The study used a scoping review method. The literature search was conducted in the 2021-2024 range using Researchgate, PubMed, Google Scholar, and other sources. The keywords used were Primary Care, Referral Rate, and Community Health Centers. Literature selection resulted in eight articles that met the criteria for analysis. Some factors found were facilities and infrastructure, human resources, disease complications, drug availability, patient perceptions, location of community health centers, Standard Operating Procedures (SOP) for referrals, and applicable regulations. Fulfillment of these factors is necessary to achieve referral rates.
Analysis of Factors Affecting Medical Cost and Insurance Reimbursement Gaps in Hypertension Heart Failure Patients Suri, Nurma; Kylalona, Gracylia
Jurnal Jaminan Kesehatan Nasional Vol. 5 No. 1 (2025): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v5i1.303

Abstract

Hypertension with congestive heart failure (CHF) results in high disease-related costs, placing a burden on patients, families, and healthcare facilities. Direct medical costs are known to be the highest proportion. This study aims to identify factors associated with direct medical costs in patients with hypertension and CHF and the difference in payment amounts compared to insurance reimbursements. This research uses a cross-sectional design at Hospital X in Lampung Province. The study population consists of patients diagnosed with hypertension and CHF within the period 2020-2022, with samples selected using total sampling. From 101 samples, the total direct medical cost for all cost components was IDR 908,700,216, with an average direct medical cost of IDR 8,997,032. The highest cost component was cardiac catheterization, with a total IDR of 473,081,000 and an average IDR of 36,390,846. The lowest cost component was additional medical expenses, with a total IDR 16,348,780 and an average IDR 166,824. Bivariate analysis showed a significant relationship between direct medical costs and length of hospital stay, insurance classes, and comorbid conditions. In addition, bivariate analysis showed a significant difference between direct medical costs and insurance reimbursement, with a positive discrepancy of IDR 4.437.619. This study concludes that length of stay, insurance classes, and comorbidities are significantly associated with direct medical costs. There is also a significant difference between direct medical costs and the amount of insurance reimbursement.
Enhancing The Quality and Cost Control Team's Role in Improving Primary Care Referrals in Bantaeng. Wahidah, Muhayyina; Yuliana Sari, Andi Rifika; Prasetiya, Ihwan; Firdaus, Firdaus; Ahmad, St. Musdalifah
Jurnal Jaminan Kesehatan Nasional Vol. 5 No. 1 (2025): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v5i1.306

Abstract

This study evaluates how well the Quality and Cost Control Team (TKMKB) can improve referral quality by reviewing and medically auditing Non-Specialist Referral Rasio (RRNS) indicators with the First Level Health Facility (FKTP). The quantitative descriptive approach compares RRNS data with Time, Age, Complication, and Comorbidity (TACC). It evaluates the appropriateness of TACC criterion selections before and after implementing the medical audit and RRNS indicator review with TACC at FKTP in Bantaeng Regency. The FKTPs that were sampled were those that met RRNS indicators at Ulugalung Health Center, Kota Health Center, and Pabentengang Health Center in Bantaeng Regency, had KBK compensation, and achieved 100% KBK for six consecutive months. The study results show that non-specialist referrals (RNS) with TACC were lower than those with RRNS TACC before the review and medical audit intervention. In Bantaeng District, 92.05% of referrals were Specialist Referrals, while 7.95% were Non-Specialist Referrals (0.92% RNS without TACC and 7.03% RNS with TACC). Additionally, following the TKMKB intervention, TACC criteria for Time were also reduced, suggesting an increase in the quality of referrals, particularly in selecting TACC criteria at FKTP in compliance with current norms and guidelines. Thus, the Branch Quality and Cost Control Team's contribution to enhancing referral quality via the medical audit and assessment of RRNS indicators with TACC at FKTP is deemed successful.
Effectiveness of BPJS Kesehatan Service Quality Transformation Implementation Prasetyo, Rizky Fajar; Nurcahyo, Chandra; Wibhawa, Harie; Kumalasari, Anggraeny; Gadistina, Welly; Nugraha, Mohammad Satria; Arma, Sylvia; Gani, Muhammad Yusuf Syahputra
Jurnal Jaminan Kesehatan Nasional Vol. 5 No. 1 (2025): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v5i1.309

Abstract

BPJS Kesehatan has implemented Service Quality Transformation to enhance service accessibility, speed, and equity for National Health Insurance (JKN) participants. This transformation represents a collaborative effort between BPJS Kesehatan and the broader JKN ecosystem, including the Ministry of Health, Health Professional Associations, and Central and Regional Governments, primarily focusing on JKN participant satisfaction. This research aimed to evaluate the effectiveness level of service quality transformation implementation conducted by BPJS Kesehatan. The study employed quantitative methodology. The research used a population of 10.198 BPJS Kesehatan employees, 244 billion JKN participants, and 7.562 stakeholders (Central and Regional Governments, Professional Associations, and Healthcare Facilities). The analysis of service quality transformation implementation effectiveness encompassed two principal indicators: process indicators and impact/outcome indicators. Survey results indicated that the Service Quality Transformation Process Index achieved 87.40%, while the Service Quality Transformation Impact Index on customer perception reached 90.88%. Additionally, the impact of transformation implementation (TML) on Service Performance was measured at 1.94. This research generated recommendations for continuous improvement in service quality implementation, emphasizing the necessity for ongoing training and enhanced collaboration with stakeholders. These findings are expected to contribute significantly to developing health service policies and practices in Indonesia.
Employee Engagement, Satisfaction, and Commitment among BPJS Kesehatan Employees in 2024: A Quantitative Study Prasetyo, Rizky Fajar; Wibhawa, Harie; Nurcahyo, Chandra; Kumalasari, Anggraeny; Gadistina, Welly; Syahputra Gani, Muhammad Yusuf; Arma, Sylvia; Nugraha, Mohammad Satria; Ramadhan, Aditya; Shaqylla, Sitti
Jurnal Jaminan Kesehatan Nasional Vol. 5 No. 1 (2025): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v5i1.314

Abstract

This study analyzes employee engagement, satisfaction, and commitment among BPJS Kesehatan employees through an employee opinion survey in 2024. The survey conducted at BPJS Kesehatan showed positive results in several aspects but also identified areas that require attention. The Employee Engagement Index (EEI) reached 86.88%, indicating a high level of engagement, particularly among managerial positions. The Employee Satisfaction Index (ESI) also reached 87.77%, reflecting a very positive work environment for most employees. However, the survey found that 28.8% of employees experienced dissatisfaction, with excessive workload, policy changes, and organizational structural adjustments as the primary causes. Meanwhile, the Employee Commitment Index (ECI) reached 90.88%, showing strong commitment to the organization. This study emphasizes the importance of addressing employee welfare and recognition issues to significantly improve job satisfaction, especially in entry-level and mid-level positions. The survey reflects positive sentiment among BPJS Kesehatan employees regarding engagement, satisfaction, and commitment. However, it also highlights critical areas that need improvement to address dissatisfaction and enhance job readiness. By focusing on these areas, BPJS Kesehatan is expected to improve the overall work experience and productivity and create a more supportive work environment for all employees.

Page 8 of 8 | Total Record : 79

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