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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 94 Documents
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The Analysis of Factors Influencing Organizational Culture Success at Social Security Administrative Body for Health Prasetyo, Rizky Fajar; Siswandi, Siswandi; Gadistina, Welly; wibhawa, harie; Kumalasari, Anggraeny; Syahputra Gani, Muhammad Yusuf; Nugraha, M. Satria; Arma, Sylvia; Ramadhan, Aditya
Jurnal Jaminan Kesehatan Nasional Vol. 5 No. 2 (2025): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v5i2.342

Abstract

Organizational culture serves as the foundation for institutional behavior and performance. Employees’ perceptions of cultural success play a critical role in ensuring the effective implementation of core values. This study aims to analyze the factors associated with perceptions of organizational culture success at BPJS Kesehatan, using the INITIATIVE framework (Integrity, Collaboration, Excellent Service, and Innovation). A quantitative approach with a descriptive-analytical survey design was employed. Data was collected from 236 respondents using validated questionnaires and analyzed through Pearson correlation and multiple linear regression. The findings indicate that leadership role modeling, contextual value internalization, and system consistency are significantly associated with perceptions of cultural success. Other variables, such as change agents, communication, and structural support, show a positive but statistically insignificant association. These results provide practical recommendations to strengthen leadership, internalize values, and align systems to sustain an effective organizational culture in public service institutions
Sentiment Analysis of National Health Insurance Participants’ Reviews on Google Reviews Bau, Ariasto; Kapitan, Gregorius D.
Jurnal Jaminan Kesehatan Nasional Vol. 5 No. 2 (2025): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v5i2.344

Abstract

Public service institutions face constant expectations to provide excellent service to participants and minimize complaints. With advances in technology, participants can now provide direct feedback on public services via online platforms, such as Google Reviews. This study aims to analyze participants’ sentiment toward the services of the BPJS Kesehatan Kupang Branch using a quantitative approach. The data collection process employed Python web scraping to retrieve 530 reviews through March 2025. The collected text underwent comprehensive preprocessing, including cleaning, tokenization, stopword removal, and stemming, to ensure data . We assigned sentiment labels based on star ratings: 4- and 5-star reviews were classified as positive, 1- and 2-star reviews as negative, and 3-star reviews were excluded as neutral. A final dataset of 529 reviews was then processed using the Naïve Bayes classifier. The results show that the Naïve Bayes algorithm successfully classified sentiments with an accuracy rate of 98.11%. Additionally, the analysis revealed that positive sentiment accounted for 98.3%, driven by keywords related to service speed and staff friendliness. These findings indicate that sentiment analysis of online reviews is an effective and objective tool for evaluating participants’ perceptions of public service quality.
Technology Acceptance Model Toward Pandawa Service at the Social Security Administrative Body for Health Depok Yoam, Crefinda Hanna Ananda; Pujiyanto; Atik Nurwahyuni; Damaryanti, Laksmi
Jurnal Jaminan Kesehatan Nasional Vol. 5 No. 2 (2025): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v5i2.367

Abstract

Digital transformation has become a prominent topic in the era of globalization. Despite the growing digital transformation trend, many health service users in Indonesia still prefer face-to-face interactions, indicating a gap in digital literacy and service adoption. In response to this issue, the Social Security Administrative Body for Health launched a digital administrative service called Pandawa (Administrative Service via WhatsApp). This study aims to explore the perceptions of National Health Insurance participants who visited Social Security Administrative Body for Health Depok in 2025, focusing on the perceived ease of use and usefulness of the Pandawa service. The research employs a quantitative approach using the Technology Acceptance Model (TAM) through a cross-sectional study design. The secondary data used in this study consists of participant visits to the agency in 2024. Primary data will also be needed through distributed questionnaires. The sample consists of 109 National Health Insurance participants who are users of the Pandawa service and visited the agency during the study, conducted in February 2025. The analysis techniques of the research used the Chi-Square Test and the Binary Logistic Regression Test. The multivariate analysis shows that age, education, perceived ease of use, perceived usefulness, and attitude are significantly related to the intention to use the Pandawa service, with attitude being the dominant factor. Meanwhile, sex does not show a significant relationship to the intention to use the Pandawa service. Overall, user acceptance of the Pandawa service is relatively good, although further improvements in service quality are necessary to optimize its implementation.
Utilization of Preventive Care Visits in Primary Healthcare: Evidence from Indonesia’s National Health Insurance Hasibuan, Syarif Rahman
Jurnal Jaminan Kesehatan Nasional Vol. 5 No. 2 (2025): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v5i2.374

Abstract

Visiting primary health care providers for preventive care services is vital for early disease detection and overall population health improvement. In Indonesia, various barriers such as financial, systemic, and social, contribute to the underutilization of preventive health visits. This analytic cross-sectional study analyzed secondary data from a 1% representative sample of Indonesia’s National Health Insurance (JKN) participants in 2023, including 608,572 individuals who had accessed at least one healthy visit at a primary care facility between 2017 and 2023. Descriptive statistics and a Generalized Linear Model assessed associations between healthy visit utilization and sex, generation, residence, and JKN membership segment. Utilization was higher among participants living in urban areas, government-subsidized members, non-workers, and older generations (particularly Baby Boomers), whereas the lowest rates were observed among informal workers, post-millennials, males, and participants residing in rural regencies. All associations were statistically significant (p < 0.01). These findings highlight significant disparities in healthy visit utilization across demographic and insurance groups in Indonesia’s National Health Insurance program. Targeted interventions to increase preventive care uptake among underrepresented populations are critical to achieving equitable health outcomes.
Hospitalization Costs and Duration for Preterm and Low Birth Weight Infants under National Health Insurance Kurniawan, Farhan; Yulianty Permanasari, Vetty; Nadjib, Mardiati; Chandra Nugraha, Erfan
Jurnal Jaminan Kesehatan Nasional Vol. 5 No. 2 (2025): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v5i2.377

Abstract

Preterm birth and low birth weight are major contributors to neonatal morbidity, mortality, and healthcare costs in Indonesia. This study investigates how maternal risk factors and hospital characteristics jointly influence length of stay and inpatient costs for preterm and low birth weight infants covered by the national health insurance program (JKN) in 2022–2023. Using a retrospective cohort of administrative claims data and multilevel generalized linear models, we find that younger maternal age, neonatal complications, and concurrent diagnoses of prematurity and low birth weight significantly increase both length of stay and costs. Infants from non-government-subsidized members group (PBI – Penerima Bantuan Iuran) and those admitted to referral or public hospitals experience longer stays, while regional tariff differences and hospital ownership shape cost variations. By linking maternal risk, facility capacity, and financial burden under Indonesia’s case-based payment system (INA-CBGs – Indonesia Case-Based Groups), this study highlights pathways to improve neonatal care efficiency. Strengthening antenatal services and referral systems may help reduce avoidable admissions and optimize resource use.
Length of Stay Among Schizophrenia Patients in Referral Health Facilities 2023: Kaplan-Meier and Cox Analysis Saefurrohim, Muhamad Zakki; Putri Rahayu , Eka; Ariyanti, Rea; Putri Rahayu , Agustin; Pratomo , Hadi
Jurnal Jaminan Kesehatan Nasional Vol. 5 No. 2 (2025): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v5i2.379

Abstract

Schizophrenia contributes significantly to global disease burden, with hospitalization management being crucial for treatment outcomes. This study aimed to determine factors influencing length of stay and recovery outcomes among schizophrenia patients in Indonesian referral health facilities. Secondary data analysis was conducted using BPJS Kesehatan sample data from 2023. Of 54,820 mental health records, 2,562 schizophrenia patients treated at referral facilities were analyzed. Cox proportional hazards regression was used to identify factors associated with discharge status, while Kaplan-Meier analysis examined length of stay distribution. Mean length of stay was 19.9 days. Significant factors associated with better recovery outcomes included: treatment at general hospitals (HR=2.31, p<0.001), public hospitals (HR=0.57, p<0.001), undifferentiated (HR=1.45, p<0.001) and catatonic schizophrenia subtypes (HR=1.70, p=0.029), single medical procedure (HR=0.73, p<0.001), and local treatment facilities (HR=1.42, p=0.028). Healthcare service factors and clinical characteristics significantly outweigh demographic factors in determining recovery outcomes. These findings emphasize the importance of healthcare service quality and accessibility in schizophrenia treatment, supporting integrated care models and universal healthcare access policies.
Determinants of National Health Insurance Coverage for Family Planning Services Among Women in Indonesia Nurmayunita, Heny; Asri, Yuni; Zakaria, Amin; Muhtar , Muhammad Solihuddin
Jurnal Jaminan Kesehatan Nasional Vol. 5 No. 2 (2025): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v5i2.381

Abstract

Access to family planning services remains unequal in Indonesia despite the establishment of the National Health Insurance (NHI) program (Jaminan Kesehatan Nasional, JKN) to promote universal coverage. Disparities persist, particularly in contraceptive services, among women of reproductive age. This study examined the determinants of NHI coverage for contraceptive methods among Indonesian women of reproductive age. A cross-sectional analysis was conducted using data from 6,256 married or partnered women aged 15–49 years from the 2017 Indonesia Demographic and Health Survey (IDHS). Survey-weighted descriptive, bivariate, and multivariable logistic regression analyses were performed using Stata to identify the factors associated with NHI-covered contraceptive use. The results showed that Women with insurance schemes specifically covering family planning were significantly more likely to report contraceptive coverage through NHI (AOR: 47.5; 95% CI: 37.2–60.7). Secondary education (AOR: 2.08; 95% CI: 1.01–4.07) was positively associated with coverage, while rural residence (AOR: 0.71; 95% CI: 0.56–0.91), middle wealth status (AOR: 0.64; 95% CI: 0.46–0.88), and current employment (AOR: 0.79; 95% CI: 0.65–0.97) were negatively associated. These findings highlight persistent socioeconomic and geographic inequities in access to insured family planning services. Addressing these disparities requires targeted policy efforts, including automatic enrollment strategies for women in the informal sector, mobile registration units in rural areas, and public education campaigns to improve insurance literacy. Strengthening equitable access to family planning under the national insurance scheme is essential to achieving Indonesia’s reproductive health and universal coverage goals.
Factors Causing Fraud in Hospitals Under National Health Insurance and Prevention Strategies: A Scoping Review Noor Rachni, Silmi; Permanasari, Vetty Yulianty
Jurnal Jaminan Kesehatan Nasional Vol. 5 No. 2 (2025): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v5i2.386

Abstract

Fraud in the implementation of the National Health Insurance program poses a significant challenge to hospital governance in Indonesia, resulting in financial losses and eroding public trust in healthcare services. We conducted a scoping review to identify the root causes of fraud and summarize prevention strategies applied in hospitals participating in the scheme. The review analyzed literature published between 2022 and 2024, selected through database searches and manual screening, with a focus on fraud-related issues and prevention efforts within healthcare facilities. Findings reveal that multiple factors, including discrepancies between case-based payment tariffs and the actual cost of services, weak internal control systems, limited understanding among staff regarding the accountability of public funds, inadequate reporting mechanisms, and poor organizational ethics, drive fraud. Identified prevention strategies include the establishment of anti-fraud teams, implementation of internal audits, utilization of hospital information systems, staff training initiatives, and intersectoral collaboration. In conclusion, fraud prevention in national health insurance requires a comprehensive approach encompassing institutional policies, human resource capacity building, and the reinforcement of transparent and accountable governance across hospital management systems.
Managing Potential Fraud in Palembang Hospitals’ Health Insurance Implementation: A Qualitative Study in Indonesia Emilya, Melda; Misnaniarti, Misnaniarti; Syakurah, Rizma Adlia; Pratomo, Hadi
Jurnal Jaminan Kesehatan Nasional Vol. 5 No. 2 (2025): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v5i2.387

Abstract

Fraud poses a major threat to the integrity of Indonesia’s National Health Insurance–Healthy Indonesia Card (JKN-KIS) program, affecting health financing, hospital quality, and institutional reputation. Despite continuous efforts to combat fraud, allegations persist, particularly in hospitals in Palembang. This study aimed to identify potential fraud in hospitals in Palembang and analyze management countermeasures. Using a descriptive qualitative design with a phenomenological approach, the study was conducted from March to July 2022 and involved three hospitals in Palembang, the City Health Office, and the local branch of the Social Security Administrative Body for Health (BPJS Kesehatan). Data were collected through in-depth interviews with 16 informants representing hospitals, BPJS Kesehatan, and anti-fraud teams, supported by observations and document reviews. Thematic analysis revealed several fraud risks, including diagnosis manipulation, unnecessary treatment, and overcharging. Weak internal and external monitoring mechanisms fostered opportunities for fraud, often driven by financial pressure, revenue targets, and personal motives, and influenced by tenure and position within the organization. Fraud countermeasures remain suboptimal, although BPJS Kesehatan’s management shows potential that requires further improvement. Applying the Hexagon Vousina theory, this study emphasizes the need for a more comprehensive and integrated approach to fraud risk management. Strengthening oversight, professional ethics, inter-agency coordination, and policy enforcement is crucial to maintain the sustainability and effectiveness of the JKN-KIS program.
A Qualitative Study of Referral Back Programme Implementation in Palembang Health Centres for Chronic Disease hasyim, hamzah; Amayu, Rizka; Syakurah, Rizma Adlia; Misnaniarti, Misnaniarti; Windusari, Yuanita; Novrikasari, Novrikasari
Jurnal Jaminan Kesehatan Nasional Vol. 5 No. 2 (2025): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v5i2.388

Abstract

Despite the strategic intent of Indonesia’s National Health Insurance (NHI) to strengthen chronic disease management through the Referral Back Programme (PRB), its implementation at primary health centres (Puskesmas) continues to face operational and systemic barriers. This study aimed to analyse the implementation of the PRB for chronic non-communicable diseases in Palembang City. The research team employed a qualitative case study approach to explore key challenges in programme execution. The research team collected data from six purposively selected Puskesmas between July and September 2022, using in-depth interviews, focus group discussions, observations, and document reviews. They selected twenty-one informants—including BPJS Kesehatan officials, physicians, programme coordinators, and patients—using maximum-variation sampling to ensure diverse stakeholder representation. The team conducted a thematic analysis, identifying three key themes. First, organisational capacity constraints, such as staff shortages, dual workloads, inadequate training, and limited funding. Second, there are infrastructural and systemic barriers, including the lack of dedicated service corners, underdeveloped digital systems, medicine stockouts, and restricted distribution of referral tools. Third, communication and coordination gaps exist, including weak inter-agency reporting, inadequate feedback mechanisms, and limited outreach to JKN participants. These themes align with the input–process–output framework: input barriers reflected fragmented resources; process barriers involved absent guidelines and reactive supervision; output challenges included low patient adherence and insufficient reporting. These interlinked factors undermine the gatekeeping function of Puskesmas and disrupt the continuity of care for chronic conditions. Strengthening institutional capacity, aligning resources, and integrating digital infrastructure are crucial for enhancing the effectiveness and sustainability of the PRB, thereby supporting Indonesia's progress toward universal health coverage.

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