Julita Hendrartini
Bagian Ilmu Kedokteran Gigi Pencegahan dan Ilmu Kesehatan Gigi Masyarakat, Fakultas Kedokteran Gigi, Universitas Gadjah Mada, Yogyakarta, Indonesia

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Potret Masyarakat Sektor Informal di Indonesia: Mengenal Determinan Probabilitas Keikutsertaan Jaminan Kesehatan sebagai Upaya Perluasan Kepesertaan pada Skema Non PBI Mandiri Intiasari, Arih Diyaning; Trisnantoro, Laksono; Hendrartini, Julita
Jurnal Kebijakan Kesehatan Indonesia Vol 4, No 4 (2015)
Publisher : Center for Health Policy and Management

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jkki.v4i4.36122

Abstract

Latar Belakang: Perluasan kepesertaan jaminan kesehatan pada masyarakat sektor informal masih merupakan permasa- lahan nyata di berbagai negara. Karakteristik spesifik yang dimiliki oleh masyarakat sektor informal mempunyai potensi negatif dan positif yang harus bisa dikenali oleh pembuat kebijakan dalam rangka memberikan rekomendasi kebijakan yang paling tepat. Penelitian ini bertujuan untuk menganalisis hubungan karakteristik masyarakat sektor informal terhadap kepemilikan jaminan kesehatan. Hasil penelitian ini diharapkan dapat memberikan kontribusi dalam upaya perluasan cakupan kepesertaan Non PBI Mandiri dimasa yang akan datang. Metode Penelitian : Penelitian ini merupakan studi observasio- nal analitik dengan rancangan Cross sectional dengan pende- katan data kuantitatif yang digunakan berhasil mendapatkan sebanyak 349.491 responden masyarakat sektor informal di Indonesia. Untuk memberikan gambaran karakteristik masyara- kat sektor informal dalam kepemilikan Jaminan kesehatan digu- nakan analisis data univariat dan bivariat. Hasil : Berdasarkan hasil analisis diketahui bahwa faktor yang berhubungan dengan kepemilikian asuransi sukarela adalah umur (p<0,001), pendidikan (p<0,001), pekerjaan (p<0,001), status perkawinan (p=0,002), status dalam keluarga (p=0,035), tempat tinggal (p<0,001), status ekonomi (p<0,001), status tempat tinggal (p<0,001), kepemilikan obat tradisional (p<0,001) dan kepemilikan riwayat penyakit kronis (p<0,013). Sebanyak 95,4% responden tidak memiliki akses terhadap pelayanan kesehatan Kesimpulan: Upaya perluasan cakupan kepesertaan Non PBI mandiri tidak hanya membutuhkan promosi kesehatan yang baik, akan tetapi juga harus diimbangi dengan kebijakan peme- rataan akses dan peningkatan kuantitas serta kualitas pelayan- an kesehatan. Upaya untuk mengkaji potensi pembiayaan kesehatan, utamanya melalui identifikasi revenue collection dan metode pengumpulan premi yang tepat bagi masyarakat sektor informal harus terus dilakukan.Background: The effort of extending of health insurance enrollment to the informal sector has risen to become an agenda in Man countries. The informal sector has a specific characteristic with positive and negative potential that should be recognized by all of the decision-makers in order to make appropriate policy. This research aims to analyze the informal sector characteris- tic regarding health insurance enrollment. The Renault may contribute to extending universal coverage in the enrollment of Non-PBI (voluntary scheme) on JKN in the coming years. Method: This study was observational analytic with a cross-sectional design. A quantitative approach was used to analyze 349.492 respondents from informal sector community in Indonesia. Univariate and bivariate data analysis was used to give information about the correlation between informal sector charac- teristic and health insurance enrollment. Result: Data analysis showed the variables correlate into health insurance enrollment are : Age (p<0,001), Education (p<0,001), jobs(p<0,001), marital status (p=0,002), role on family (p=0,035), place of resident (p<0,001), economic status (p<0,001), home status (p<0,001), traditional medication stock (p<0,001) and history of chronic illness (p<0,013). Many re- spondents ( 95,4% ) have no access to health care provider Conclusion: Effort on extending of non PBI (voluntary scheme) enrollment not only need a good health promotion but also balancing with policies in order to ensure many factors such as equity on health care access and increasing the quantity and quality of health care. There must be a policy analysis to explore health financing potential on informal sector communi- ty, especially to identify the appropriate and adequate me- thods on revenue collection and premium collection.
STRATEGI SWITCHING PREMI DALAM PENGUMPULAN DANA MASYARAKAT SEKTOR INFORMAL SEBAGAI UPAYA PENCEGAHAN KETERLAMBATAN PEMBAYARAN PREMI JAMINAN KESEHATAN NASIONAL Intiasari, Arih Diyaning; Trisnantoro, Laksono; Hendrartini, Julita
Kesmas Indonesia: Jurnal Ilmiah Kesehatan Masyarakat Vol 9 No 1 (2017): Jurnal Kesmas Indonesia
Publisher : Jurusan Kesehatan Masyarakat dan Fakultas Ilmu-Ilmu Kesehatan Universitas Jenderal Soedirman

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (368.816 KB)

Abstract

The increase in the budget deficit BPJS in the first 3 years of implementation JKN require special attention. One of the problems in the implementation of JKN is high late payment of premiums by the participants of the Non PBI Mandiri. The purpose of this study was to determine the participants' perceptions of Non PBI Mandiri to the recommendations transition strategy JKN premium payer. This study is a policy with qualitative descriptive approach. The study design used policy aims to draw up a recommendation is the Case Study on the phenomenon of late payment of premiums. Depth interviews with 11 informants participants Independent Non PBI done with purposive sampling quota system. The result showed that the presence of positive consequences as the public response to the concept of a transitional strategy premium payer. Participants claimed to be greatly assisted if the program was held because it can ease the burden of their medical expenses when his advanced age and does not have income again, providing peace in the certainty of change of insurer premiums in non-productive age. Conclusion of the study were breakthrough made in a transitional strategy premium payer has received positive responses from the public policy goals.
SYSTEM FOR DETECTION OF NATIONAL HEALTHCARE INSURANCE FRAUD BASED ON COMPUTER APPLICATION Santoso, Budi; Hendrartini, Julita; Djoko Rianto, Bambang Udji; Trisnantoro, Laksono
Public Health of Indonesia Vol. 4 No. 2 (2018): April - June
Publisher : YCAB Publisher & IAKMI SULTRA

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (254.441 KB) | DOI: 10.36685/phi.v4i2.199

Abstract

Background: The national healthcare insurance (JKN) has been in deficit since 2014-2016; one of the causes is fraud inpatient hospital service. Objective: This study aimed to analyze the validity, reliability and effectiveness of detection system of national healthcare insurance fraud based on computer application in hospital.Methods: Cross-sectional method was used. Fraud data were collected at one episode in the inpatient JKN participant service.Results: Validity was assessed by Fischer exact test. The interpretation was done by hospital internal verification officer and BPJS Kesehatan verification officer. There were only 2 out of 1.106 services claims were different, resulted in p-value < 0.01. Reliability was assessed using Human Organization Technology Benefit questionnaire filled by admission administrator officer, BPJS Kesehatan officer and hospital internal verification officer; and then analyzed using Stata® software resulting in Cronbach's alpha value of > 0.8. Effectiveness was assessed by reducing potential fraud, conducted by RSUP dr. Soeradji Tirtonegoro from May until July 2017, which on May 2018 there were 8 findings, June 1 finding, and on July 2018 had no finding.Conclusion: System for detection of national healthcare insurance fraud based on computer application is valid, reliable and effective to be implemented in inpatient service in hospital.