Jurnal Jaminan Kesehatan Nasional (JJKN) 2022-12-05T14:06:38+00:00 Windharlan Siallagan Open Journal Systems <p style="text-align: justify;">Jurnal Jaminan Kesehatan Nasional (JJKN) (ISSN <a href="" target="_blank" rel="noopener">2798-7183</a> and E-ISSN <a href="" target="_blank" rel="noopener">2798-6705</a>) published by Social Health Insurance Administration Body (BPJS Kesehatan Republik Indonesia) since July 2021.</p> <p style="text-align: justify;">This journal is a forum to accommodate the ideas and thoughts of Duta BPJS Kesehatan, as well as the other parties who have high concern and awareness to develop the sustainability of the Social Health Insurance Program through scientific research and development.</p> Analisa Kondisi Sumber Daya Manusia Lintas Generasi pada Era Revolusi Industri 4.0 di Indonesia: Tinjauan Literatur 2022-10-13T23:24:27+00:00 Nopi Hidayat Musa Hubeis Anggraini Sukmawati Eriyatno Bintang Akbar MB <p>Changes in digitalization and automation show that a country has entered the Industrial Revolution Era 4.0. In its history, the Industrial Revolution has always brought many transformations, including a shift in the function of Human Resources (HR) to machines. Basically the main goal of HR management is to ensure that the organization has the appropriate HR knowledge and skills in the present and future, including changing jobs with the necessary competencies in the right positions. This study helps provide an understanding of cross-generational HR management in the Industrial Revolution 4.0 Era. Talent Management is the key to the challenges in the Industrial Revolution Era 4.0. This study uses literature studies obtained from reference reading sources related to the similarity of human resource conditions in Western countries and Indonesia across generations. It was found that there were similarities in the occurrence of historical phenomena in American, European countries including Indonesia that affected the Baby Boomers Generation, X and Y. The similarity of ways of working, mindset and values in each generation are the advantages of Talent Management in preparing the right competencies in facing the Industrial Revolution Era 4.0.</p> 2022-12-05T00:00:00+00:00 Copyright (c) 2022 Nopi Hidayat, Musa Hubeis, Anggraini Sukmawati, Eriyatno, Bintang Akbar MB Efektivitas Peran dan Fungsi Tim Kendali Mutu Kendali Biaya (TKMKB) Provinsi dalam Memberikan Rekomendasi Penyelesaian Klaim Dispute di Provinsi Sulawesi Selatan Tahun 2021 2022-09-27T22:40:29+00:00 Muhayyina Wahidah Irawan Yusuf <p>This study aims to assess the effectiveness of the role and function of the South Sulawesi Province Quality and Cost Control Team in providing recommendations for the settlement of disputed claims. The method used is descriptive quantitative by comparing the claim dispute data in the Month of Loading from January to December 2021 in South Sulawesi Province. The data sources used are from the Monthly Routine Reports of Claims for Branch Office disputes as well as data on increasing claim maturity. The results of the study found that there was a decrease in dispute claim cases after the Quality and Cost Control Team Meeting in 6 Branch Offices and an increase in the quality of the maturity of advanced outpatient and advanced hospitalization claims, so that the role and function of Quality and Cost Control Team in providing recommendations for dispute resolution claims to Social Security Agency of Health and hospital was considered effective.</p> 2022-12-05T00:00:00+00:00 Copyright (c) 2022 Muhayyina Wahidah, Irawan Yusuf Kesiapan Rumah Sakit dalam Implementasi Sistem Pembayaran Global Budget di Kabupaten Purworejo 2022-10-15T02:46:19+00:00 Dina Anjayani Andreasta Meliala Yulita Hendrartini <p>In 2018, BPJS Kesehatan initiated a pilot project to integrate the INA CBGs and Global Budget mixed-method hospital payment system (global budget). Purworejo Regency is one of the areas designated as a pilot for the Global Budget payment system's deployment. The outcomes of the Hospital performance indicators in the first-semester review were less than ideal. Consequently, it is required to study the Hospital's readiness to implement the Global budget Payment System. This study set out to determine how prepared the hospitals in Purworejo Regency were to implement the Global Budget payment scheme. A descriptive design and a qualitative methodology were used in the research. The management of four hospitals in Purworejo Regency is the topic of the study. Observations and interviews were used to explore hospitals’ readiness to implement the Global Budget payment system in terms of health facilities’ perception, Quality Control and Cost Control strategies, Global Budget calculations, and patient satisfaction through the results of the Walk Through Audit. Through the four key variables mentioned above, the scoring technique is used to evaluate the readiness of hospitals to implement the Global Budget payment system. The modified CCCEAR (California Community Clinic EHR Evaluation and Readiness) tool is used for the readiness assessment, which has three readiness levels: 1) not ready (score 0-33), 2) moderately ready (34-66), and 3) ready (67-100). Result: According to a qualitative examination of data from observations and interviews, the hospital scored 26 from assessor II and 24 from assessor I, positioning it in the second range. This demonstrates that the hospital is not ready and has not considered developing a more comprehensive and in-depth plan for implementing the Global Budget payment system, nor how to create capacity to enable successful adoption and implementation. Conclusion: The hospital is not yet at its highest level of readiness to adopt the Global Budget payment system in Purworejo Regency, according to the scoring findings on four variables of hospital readiness.</p> 2022-12-05T00:00:00+00:00 Copyright (c) 2022 Dina Anjayani, Andreasta Meliala, Yulita Hendrartini Urgensi Pelaksanaan Skrining Riwayat Kesehatan Peserta JKN-KIS dengan Pendekatan Stakeholder Engagement 2022-11-06T01:57:47+00:00 Nanda Elok Juwita Dwi Santoso <p>Implementing health history screening is one of the main concerns at Badan Penyelenggara Jaminan Sosial Kesehatan Republik Indonesia (BPJS Kesehatan RI). Its implementation can be optimal if there is a good stakeholder engagement process. The purpose of this study is to analyze the urgency of health history screening. After that, the researcher uses Ray and Miller’s Framework from other studies and then compares the suitability of using the framework in the stakeholder engagement process that has been carried out in achieving health history screening at Kantor Cabang Singkawang (KC Singkawang). The method used in this study is a literature review combined with a comparison of the situation in the field. The use of references from various kinds of foreign and domestic research. Regarding the results, various data related to the five urgencies were found which ca,n be a strong reason that health history screening is mandatory for all Jaminan Kesehatan Nasional-Kartu Indonesia Sehat (JKN-KIS’s) participants and the Ray and Miller’s Framework is very suitable if applied further in the stakeholder engagement process at KC Singkawang. It is hoped that further research will be able to conduct quantitative research on the effect of Ray and Miller’s Framework in implementing stakeholder engagement to achieve comprehensive health history screening</p> 2022-12-05T00:00:00+00:00 Copyright (c) 2022 Nanda Elok Juwita, Dwi Santoso INISIATIF Culture Health Index: Mengukur Tingkat Kesehatan Budaya Organisasi BPJS Kesehatan 2022-11-01T02:23:58+00:00 Syarifuddin Syarifuddin Afrizayanti andi afdal <p><strong>Background:</strong> Organizational culture is one of the key HR management elements in BPJS Kesehatan. Optimal management of organizational culture is expected to be able to make a significant contribution to achieving organizational targets, starting from careful planning, effective and efficient program execution, and measuring the effectiveness of cultural programs as an objective evaluation mechanism. To improve the management of organizational culture that is more optimal in the future, an objective evaluation is very important to do. <strong>Purpose:</strong> This study aims to obtain an overview of the level of organizational culture health index in BPJS Kesehatan. <strong>Methods:</strong> This study uses a descriptive quantitative approach. Data collection was carried out by filling out the Organization Culture Health Index (OCHI) survey by all BPJS Kesehatan employees as respondents (the participation rate in filling out the survey was 96.79% of the population) and focus group discussions (FGD) to obtain the required qualitative information. <strong>Results and Discussion:</strong> Based on the measurement results, the level of organizational culture health in BPJS Kesehatan is generally in the "Healthy Enough" category with a total index value of 72.6%. The implementation index of the 4 main values ​​is as follows: excellent service (71.3%), integrity (69.0%), innovative (67.6%), and collaboration (63.7%) and has been integrated into 5 awareness areas organization, namely: sustainability, relationship, growth, common goals, and meaning purpose area. The level of positive energy felt by employees at work is in the "High" category with an index value of 95.2%. This is because organizational culture as one of the important elements of HR management, has succeeded in forming a fun and meaningful work atmosphere to create positive energy felt by employees. <strong>Conclusions and Recommendations:</strong> BPJS Kesehatan is considered quite successful in internalizing organizational culture. INISIATIF as the main value system can be understood and become a shared belief for employees. However, in the context of optimizing the management of organizational culture, BPJS Kesehatan is expected to be able to enrich the latest literature reviews, perform benchmarking, especially to other organizations that have succeeded in forming a healthy organizational culture, and make various breakthroughs and innovations in managing<em> organizational </em>culture. Thus, it is hoped that the organizational culture at BPJS Kesehatan can reach the "Healthy" category and be able to form an organizational image that is recognized by all parties involved in the JKN ecosystem</p> 2022-12-05T00:00:00+00:00 Copyright (c) 2022 Syarifuddin Syarifuddin, Afrizayanti, andi afdal Evaluasi Pasca Program Pembelajaran Khusus Kepala Kabupaten di Kedeputian Wilayah Papua & Papua Barat Tahun 2021 dengan Model Kirkpatrick Level 3 2022-10-17T03:22:40+00:00 Win Dharlan Siallagan Nurullah Hasibuan Firman Adrian Chandra Nurcahyo <p>One way to create competent and professional human resources is through training designed according to the organization's needs and carried out comprehensively and continuously. BPJS Kesehatan, through Corporate University, plays a role in developing employees according to organizational needs in the form of a Learning Program. Corporate University evaluates all learning programs. This study aims to analyze the results of the evaluation after the Special Learning Program for District Heads in the Ministry of Papua and West Papua Regions in 2021 to provide an overview of the extent of the implementation of the learning program results, changes in participant behavior in the workplace, and provide proposed actions that need to be taken to improve the learning program in the future. This research uses descriptive methods with quantitative and qualitative approaches. Based on the results of the evaluation, it is known that the Competency Score for each competency is still below the target value of 5 on a scale of 6, namely the Building Trust competency with a score of 4.97; impact &amp; influence competency with a score of 4.93 and Strive for Excellence competency with a score of 4.79. The results of the evaluation found that there were 13 behavioral indicators (68.4%) that had scores below the target value. The implementation of the results of the learning program still needs to have a significant influence on increasing the competence of participants. The learning program still has not changed participants’ behavior by the behavioral indicators of each competency that is the target of the learning program. The availability of facilities and infrastructure in the work environment still needs to be improved. Other factors that need attention are knowledge and skills, superior support, and self-motivation. The knowledge and skills that need to be improved are Communication Skills, Negotiation Skills, and regulations related to Local Government. External factors affecting performance are geography and security, family support, and cooperation with external parties.</p> 2022-12-05T00:00:00+00:00 Copyright (c) 2022 Win Dharlan Siallagan, Nurullah Hasibuan, Firman Adrian, Chandra Nurcahyo Universal Health Coverage: Internalisasi Norma di Indonesia 2022-10-31T19:35:40+00:00 Cipto Rizqi Agung Saputro Fenny Fathiyah <p>Access to health care is part of human rights. As an effort to realize this right, the United Nations (UN) and World Health Organization (WHO) initiated a program that is Universal Health Coverage (UHC). UHC, as a program that seeks to be implemented, cannot be separated from the values and benefits it stands for. This research aims to see the extent to which the internalization of UHC norms is implemented in Indonesia and the actors involved. This research uses a descriptive method with a qualitative approach. To achieve the research objectives, this study uses the concept of norm diffusion proposed by Finnemore &amp; Sikkink and the concept of norm localization by Amitav Acharya. Through this research, it was found that UHC is a new norm in the international world that is trying to spread throughout the world. It was also found that the Government of Indonesia has internalized the norm and has entered the third phase, which is the final phase in the norm internalization process with the appointed designated local service, namely BPJS of health.</p> 2022-12-05T00:00:00+00:00 Copyright (c) 2022 Cipto Rizqi Agung Saputro, Fenny Fathiyah Kebijakan Alih Manfaat Covid-19 Dalam Manfaat Jaminan Kesehatan Nasional 2022-11-17T01:29:30+00:00 Gilbert Renardi Kusila Endang Suparniati Tonang Dwi Ardyanto Donald Pardede Firdaus Hafidz Wan Aisyiah Baros Dedy Revelino Erzan Dhanalvin Benyamin Saut Citra Jaya Ayunda Oktavia <p>Since the COVID-19 pandemic occurred at the end of January 2020, the health social security administering body (BPJS Kesehatan) as the payer has an important part in handling COVID-19, namely by carrying out the process of verifying claims for COVID-19 cases while the financing is carried out by Ministry of Health. However, COVID-19 benefits may be transferred to the National Health Insurance benefits during the endemic period. Therefore, this study aims to evaluate services and obtain policy recommendations for the transfer of COVID-19 benefits. Qualitative research through focus group discussions was conducted in September 2021 with policymakers, clinicians, COVID-19 survivors, and BPJS Kesehatan. The results of the qualitative study show that there are still many obstacles in the service process. Therefore, it is necessary to regulate the provisions of service regulations. As for the claim process, health facilities find it difficult to change the dynamic regulations during the pandemic. BPJS Kesehatan requires policy certainty to determine the end of the pandemic period. If the COVID-19 benefits are transferred to JKN after the pandemic, the source of financing may not only be done through the conversion of contributions but there is also an option for assistance funds from the government. In terms of tariffs, it is necessary to calculate costs according to the agreed benefit package through INA-CBG. Gradual and thorough preparations are needed for the implementation of the transfer of COVID-19 benefits in the benefits of JKN.</p> 2022-12-05T00:00:00+00:00 Copyright (c) 2022 Gilbert Renardi Kusila, Endang Suparniati, Tonang Dwi Ardyanto, Donald Pardede, Firdaus Hafidz, Wan Aisyiah Baros, Dedy Revelino, Erzan Dhanalvin, Benyamin Saut, Citra Jaya, Ayunda Oktavia Faktor Yang Mempengaruhi Rawat Inap Berulang Pasien JKN di FKRTL Kantor Cabang Semarang Tahun 2021 2022-11-03T07:35:31+00:00 Anisa Hidayah Diah Ayu Puspandari Yulita Hendrartini <p>Repeated hospitalization is one of the performance indicators of global budget payments. Unplanned repeated hospitalization is a preventable event and its interval is influenced by several factors including the patients, the patients’ clinical condition, and the policy. This research is aimed at analyzing the effect of disease severity, Length of Stay (LOS), and patient discharge status on the repeated hospitalization interval among JKN patients at hospitals BPJS Kesehatan Semarang Branch Office in 2021. This study contributes to the claim management literature by focusing on repeated hospitalization as an evaluation tool to improve the quality of inpatient care. This research was a quantitative study with a cross-sectional design involving hospitalized patients returning for hospitalization within 30 days. Patients who were discharged being referred to other health facilities and those with transplantation, delivery, physiotherapy, and chronic diseases were excluded. Univariate and bivariate analyzes were then performed using the STATA software. The majority of repeated hospitalized patients were aged 12-25 years (69.47%), women (53.88%), and found in type C hospitals (32.85%). There was an association between disease severity and LOS with the repeated hospitalization interval. Increasing severity of illness was found to show a higher risk of repeated hospitalization &lt; 12 days (OR=1.23). Patients with LOS ≥ 4 days increased the risk of repeated hospitalization &lt; 12 days (OR = 1.33). There was no association between discharge status with repeated hospitalization. Conclusion: There is a significant association between disease severity and LOS with repeated hospitalization interval.</p> 2022-12-05T00:00:00+00:00 Copyright (c) 2022 Anisa Hidayah, Diah Ayu Puspandari, Yulita Hendrartini