Yulita Hendrartini
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DAMPAK KEBIJAKAN KEPESERTAAN MANDIRI JAMINAN KESEHATAN NASIONAL (JKN) DI YOGYAKARTA Endartiwi, Sri Sularsih; Trisnantoro, Laksono; Hendrartini, Yulita
Jurnal Kesehatan Masyarakat Vol 10, No 1 (2017): Jurnal Kesehatan Masyarakat Volume 10/ Nomor 01
Publisher : STIKES Wira Husada Yogyakarta

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Abstract

ABSTRACT Background: The implementation of National Health Insurance (JKN) had been started since 1 January 2014. In the first semester, several problems are found in the admission department. First, it is found that there about 10% or 4,400 participants are they who are suffering for disease or have used the health insurance. Second, there are participants who are already undergoing treatment at the hospital and turning out a large cost then they are newly registered as JKN participants. Objective: To monitoring the implementation of independent participants policy of the National Health Insurance (JKN) in Yogyakarta. Methods: This research is a case study with qualitative and quantitative approaches. Research will be conducted in the BPJS Yogyakarta, Academic Hospital of the Gadjah Mada University, the Office of the Provincial Council Commission D Yogyakarta, Yogyakarta Provincial Health Office in April 2015. The study was conducted by in-depth interviews as well as filling the form of independent patient data. Results: The viewpoint of the national health insurance participant is positive. Independent participants consider it is important to enforce the national health insurance program. Participants also consider it is reasonable for them to pay the monthly dues. Their motivation to register as an independent participant is already going to take advantage of health services, a precaution and to protect themselves against the risk of illness. Compliance participants who pay dues are in arrears to pay dues by 27%. The impact of independent participants is people who are already sick or have health services and will utilize it for about 123% claims ratio. It is better for the hospital to do socialization, add more facilities and infrastructure, improve the hospital services, leadership and bureaucracy. Conclusion: Independent participants policy is to motivate people who are already sick to register as a participants and 27% of participants who had recovered in arrears to pay.The fundamental improvement in the independentparticipants policy is an improvement on Presidential Decree No. 12 of 2013, especially chapters 4 and 5, Presidential Decree No. 111 of 2013 chapter 16F, and The Health Minister regulations No. 71 of 2013 article 21 paragraph 1 and 22 paragraph 1 Keywords: impact, independent participant,National Health Insurance (JKN)
DISPUTE ANALYSIS OF CLAIMS FOR PATIENTS WITH COVID-19: A CASE STUDY AT HOSPITAL X CLASS B IN BANTUL REGENCY Beby Antika Putri; Firdaus Hafidz; Yulita Hendrartini
Journal of Indonesian Health Policy and Administration Vol 8, No 1 (2023)
Publisher : Faculty of Public Health Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.7454/ihpa.v8i1.6271

Abstract

The Indonesian Government established referral hospitals for COVID-19 as an effort in combating the pandemic. Referral hospitals for COVID-19 submit their services’ claims to the Ministry of Health. Hospital X in Bantul experienced challenges in submitting COVID-19 claims and underwent claim disputes which caused delays in payment process. This research aimed to explore the factors that led to the disputes over the COVID-19 claims. This descriptive research was conducted with a qualitative approach, using in-depth interviews and observations. The additional descriptive analysis used secondary data COVID-19 claim dispute file reports from 2020. The results showed that the highest criteria of disputed claims at Hospital X were the criteria for non-compliant guaranteed participants, incomplete claim files, non-compliant comorbid diagnoses, and identities that did not comply with the provisions. The causes of the disputes over claims for patients with COVID-19 included inaccurate history taking, differences in regulation perceptions between the provider and payer, PCR results were not provided, and doctors had a lack of understanding regarding the technical guidelines for COVID-19 claims. In addition, there were technical problems faced by the hospital during the process of submitting claims, including regulations were changed frequently, errors in applications, incomplete medical resumes, and unreadable doctors’ writings. Disputed claims did not affect the hospital cash flow, yet delayed the payment process to health workers, which might harm the quality of services.