Jurnal Jaminan Kesehatan Nasional

Implementation of the National Health Insurance Programme in Achieving Universal Health Coverage in Indonesia

Muhammad Youri Alkayyis — 2024-12-30

Many countries have agreed to and enforced the implementation of Universal Health Coverage (UHC), yet achieving it is only occasionally seen in certain countries. The National Health Insurance (JKN) Programme is an Indonesian government initiative aimed at providing health protection to all residents of Indonesia through the JKN Programme. The oversight of the Programme and its pivotal role in Indonesia's pursuit of Universal Health Coverage (UHC) is managed by the Social Health Insurance Administration Body (BPJS Kesehatan). The objective of the JKN Programme is to furnish the populace with healthcare services and monetary safety. In Indonesia, the JKN Programme represents a concrete endeavour towards realising universal health coverage through the facilitation of health accessibility, financial safeguards, and the enhancement of healthcare service quality for all individuals. Based on this paper's foundation, this study aims to assess how the JKN Programme in Indonesia has been utilised to achieve UHC and identify the factors contributing to its success through a Systematic Literature Review (SLR). The methodology utilised in this research is the literature review approach. This investigation analysed research results linked to the subject matter being studied. Recent journals published between 2019 and 2023 were identified as the data sources for the literature review.

Beyond Immediate Needs: An Analysis of Social Insurance and Its Behavioral Economic Impact in Indonesia

Ucca Bhanuwati Astutiningtyas Palupi — 2024-12-30

Despite the relatively high GDP growth of around 5.3 in 2022, Indonesia still faces high inequality (Gini index 37.9), which challenges social-economic-security instruments. In January 2023, the government spent around IDR 5.3 trillion to protect public health, a 12% increase compared to last year (2022), making Badan Penyelenggara Jaminan Sosial Kesehatan shortened by BPJS Kesehatan as a medic-aid social insurance manager need to keep evolving to suffice the need. In this research, we investigate the potential impact of social insurance in Indonesia to determine the possible direction of the relationship between the adequacy of social-economic-security instruments and spending. The study utilises a vector error correction model (VECM) test as a tool to analyse quarter data from several online source datasets, including household consumption expenditures, gross national income, and capital stock from bps.go.id, social insurance participations from djsn.go.id, inflation and national savings proxy by broad money M2 from bi.go.id in the form of quarterly data, starts from 2016 Q1 until 2023 Q3. The regression result shows no immediate and significant relationship between social insurance and consumption. However, the analysis reveals that social insurance might contribute to economic resilience, potentially leading to higher productive spending and a potential behavioural transformation towards risk.

Evaluating Primary Care Providers' Compliance with Special Capitation in Indonesia's National Health Insurance

Rahma Anindita — 2024-12-30

To increase the effectiveness of the special capitation payment scheme implemented by the primary care providers (PCPs), to expand health service coverage and to provide additional incentives for the health workforce in remote areas, a commitment agreement with the primary care provider has been established. However, the PCP's achievement after implementing the commitment agreement was unclear. Hence, this study aims to analyse the commitment and achievements of the PCP in the special capitation payment scheme in 2021 and 2022. About 178 PCPs in 2021 and 191 PCPs in 2022 across Indonesia were included in this descriptive analysis using the quantitative method. The results reflected that special capitation payments accompanied by commitment agreements might influence increasing the capacity, access, and quality of health services. There was a 58% increase in the number of PCPs that achieved all PCP commitment indicators for capitation recipients in 2022 compared to 2021. The highest commitment indicator attained by PCP recipients of special capitation is the sending of health personnel. The quantity of capitation rates received, the simplicity of using capitation funds, the accessibility of physicians and other health professionals, and the assessment of service commitment accomplishments, which will affect payment, all influence the achievement of commitment indicators.

The Creation of Health Content on Social Media to Attract Public Interest in Health Literacy

Mohammad Ali — 2024-12-30

This research aims to analyse health content creation on social media to attract public interest in health literacy. Because social media is considered a medium of entertainment, health education is a medical approach. The method used in this research is qualitative, and data collection is a review of journals, books, and other relevant sources for this research. The data analysis is done by reviewing each data source and analysing the correlation with the research. The results showed that creating health content on social media is an effort to attract public interest in health literacy because social media is a medium of entertainment in interacting and sharing information. People are interested in getting information from social media due to the creation of exciting content such as YouTube, x / Twitter, TikTok, Instagram, and other media. The efforts to create health content on social media are because social media has good effectiveness and can be used as a medium for promotion and health education. In addition, communication is part of the success of health policy. It is appropriate for every individual to pay attention to health factors as primary needs in their lives.

Marketing Mix Strategy of Mabarrot AlMustasyfa Clinics in the Era of National Health Insurance

Ucy Nur Hamida Al Abrori — 2024-12-30

The National Health Insurance (JKN) has significantly changed the health service, especially in private clinics. Private clinics are offered the opportunity to participate in implementing the JKN to deliver quality care within a cost-control mechanism of capitation payment. Mabarrot AlMustasyfa Clinic is one of the private clinics in the Gresik regency that has contracted with BPJS to serve JKN participants since April 2024. The clinic accepts the capitation payment system, providing unique challenges to increase the satisfaction of the JKN members. In the capitation payment the clinic will receive a higher monthly capitation payment each month if there are new members enrolled in the clinic. However, the clinic faces financial risks if increasing demands and the clinic budget and revenue are constant. To ensure that the operational clinic is financially healthy, the management must have a marketing strategy to attract new members to enrol in the clinic. This study explains the marketing strategy using a marketing mix which consists of 7 P: products, prices, promotions, locations, people, processes, and physical facilities. This case study demonstrates how well the marketing mix is being conducted. The study results show that the Mabarrot AlMustasyfa Clinic has not succeeded due to several obstacles, namely the lack of health services and inadequate facilities with an inappropriate management system. The clinic must be able to face the challenge of increasing patient satisfaction to survive in the JKN era.

Utilisation of Hospital Outpatient Services by Diabetes Mellitus Sufferers, Analysis of BPJS Kesehatan Sample Data

Erfan Chandra Nugraha — 2024-12-30

Diabetes mellitus is a catastrophic disease that burdens the financing of the National Health Insurance or Jaminan Kesehatan Nasional Program, and sufferers continue to increase. Specific participant segments still widely use access for participants with diabetes mellitus to utilise health services at advanced-level referral health facilities. Various factors also influence access to health services at advanced-level referral health facilities. This research aims to analyse utilisation based on membership type and examine the factors that affect the utilisation of advanced outpatient services by JKN participants with DM. This research uses secondary data from the 2022 DM contextual BPJS Health sample data. The data was analysed univariately, bivariately, and multivariately with the Zero Inflated Negative Binomial regression model. The results of statistical tests showed that in outpatient care, age, type of participant, gender, treatment class, and province of participants were significantly different in terms of health service utilisation. The influence of the type of participation in the JKN program significantly affects the utilisation of services in outpatient care; the utilisation of non-recipients of contribution assistance participants is 1.16 times greater than that of the recipient of contribution assistance participants in outpatient care.

Referral Healthcare Services and Efficiency of Indonesian Health Insurance on Patient Satisfaction and Life Quality

Muhammad Alfarizi — 2024-12-30

The UN's Sustainable Development Goals (SDGs) target Universal Health Coverage (UHC) to ensure equitable access to health without financial burden. The National Health Insurance Program-Healthy Indonesia Card (JKN-KIS) by BPJS Kesehatan seeks to meet the health needs of the Indonesian people, especially vulnerable groups, including in East Java, which faces many cases of catastrophic diseases. This study aims to analyse the impact of the quality of referral health services and the efficiency of insurance administration on the satisfaction and quality of life of catastrophic patients in East Java. This study uses a positivist quantitative approach with a questionnaire-based Cross-Sectional design to collect data from outpatient catastrophic patients in East Java. Two hundred sixty-three responses were analysed using the PLS-SEM technique through SmartPLS 4.0 software to test hypotheses regarding the quality of referral services, insurance administration, patient satisfaction, and quality of life. The results showed that the ease of JKN-KIS administration significantly affected participant satisfaction, corroborating previous findings regarding the importance of easy access and simple administrative procedures in increasing the positive perception of services. In addition, the quality of referral health facility services also increases satisfaction, especially in meeting the care needs of catastrophic patients. Satisfaction with JKN-KIS also significantly impacts patients' quality of life, improving their physical health, emotional stability, and social satisfaction. These findings encourage optimising JKN-KIS services through digitisation and improving the quality of special services for catastrophic patients to maintain participant satisfaction and trust

Sentiment Analysis of National Health Security Mobile Application Review Using Machine Learning

Deta Novian Anantika Putra — 2024-12-30

It is widely acknowledged that digital transformation provides the opportunity for business process improvements. We can see many businesses, specifically in Indonesia's private and public sectors, leveraging technology to provide better service to their stakeholders. This research seeks insight into stakeholders’ engagement in digital transformation in the Indonesian healthcare system, namely the National Health Security Mobile application (Mobile JKN). This study employs a quantitative method to analyze user sentiment from Google Play reviews. Firstly, user reviews are extracted, preprocessing steps are applied, and machine learning-based sentiment labeling is employed afterward to categorize them into positive, neutral, and negative sentiments. The machine labeling process is carried out in document-level analysis, meaning user reviews represent their overall sentiment. Subsequently, we study the most prominent words using Word Cloud to determine the topics mainly discussed in positive and negative sentiments. The result is that 56.10% of reviews from 7 June 2016 to 14 July 2024 contain positive sentiments, while 43.17% contain negative sentiments. Neutral reviews contribute the most minor proportion, making up only 0.73%. The most prominent words in positive sentiment reviews, such as easy, sound, and helpful, suggest the user perception of the National Health Security Mobile as being easy to use and successfully accommodating the user's needs. In contrast, the words application, update, complex, login, code, verification, register, open, use, and error dominate the negative reviews, indicating users had difficulties logging in and registering user accounts, mainly related to frequent updates and Time Password errors.

Effectiveness of Installment Payment Plan Program through Face-to-Face Service Channels and Non-Face-to-Face Service Channels

Enggartyas Bagaskara — 2024-12-30

This study evaluates the effectiveness of registration services for BPJS Kesehatan's REHAB (Installment Payment Plan) program through face-to-face channels at branch offices and non-face-to-face channels via the Mobile JKN application. Employing a qualitative descriptive design, data were collected from 33 informants, including frontline coordinators, frontline staff, UP3KC staff, and 30 participants using purposive sampling. Data collection methods comprised interviews, observations, and documentation, with data validity ensured through triangulation. Analysis followed Miles, Huberman, and Saldana’s interactive model, involving data reduction, presentation, and conclusion verification. Results indicate that the Mobile JKN application is the preferred registration channel due to its convenience and practicality. At the same time, face-to-face services are utilized as a backup option during technical disruptions. However, challenges such as incorrect participant data and system reliability hinder registration. This study underscores the need for improvements in the Mobile JKN system, particularly in data validation and technical stability, to enhance service accessibility and ensure seamless participant registration

Improving Health Clinic Performance through the Role of Entrepreneurial Leadership and Dynamic Capabilities

Chandra Nurcahyo — 2024-12-30

This study aims to analyze the effect of entrepreneurial leadership on organizational performance by considering the mediating role of dynamic capability in the context of the digital era. This study employs a quantitative approach utilizing structural equation modeling (SEM) based on Partial Least Squares (PLS). A survey was used to gather data from 385 respondents from top management or owners of Small and Medium Enterprises (SMEs) Healthcare Clinics in Indonesia. Data was processed using SmartPLS software version 3.0. The results showed that entrepreneurial leadership has a positive and significant influence on dynamic capability (path coefficient = 0.777; t-statistic = 26.792; p = 0.000), entrepreneurial leadership has a positive and important impact on organizational performance (path coefficient = 0.306; t-statistic = 5.232; p = 0.000), dynamic capability has a positive and significant influence on organizational performance (path coefficient = 0.510; t-statistic = 8.994; p = 0.000),. In addition, dynamic capability acts as a mediator that strengthens the influence of entrepreneurial leadership on organizational performance, highlighting the importance of adaptation and innovation to face the challenges of the digital era. This study provides insights for clinical SME leaders to develop entrepreneurial leadership skills that can drive the organization's dynamic capabilities and improve performance amid the dynamics of the digital era. This study contributes to the literature on entrepreneurial leadership and dynamic capabilities by highlighting their relationship to organizational performance in the context of SME Clinics in digital transformation.

Medical Audit of Hemophilia Services for National Health Insurance Participants in Bogor: A Case Report

Marselly Pharadiba — 2024-12-30

BPJS Kesehatan is a legal entity established to implement social security programs, provide health service benefits through regulations, and manage (purchasing and investing) carefully, prudently, transparently, efficiently, and effectively. One of the health service benefits provided by BPJS Kesehatan is for hemophilia. Hemophilia is a hereditary blood clotting disorder that is currently the most prevalent globally and is based on X-linked recessive genetic inheritance. Since the Regulation of the Minister of Health of the Republic of Indonesia Number 3 Year 2023, claims for hemophilia services, including the top-up of anti-hemophilia factor drugs in 2023, have increased. The method used to write this article is quantitative descriptive with a case report approach in the form of a report from BPJS Kesehatan, which conducted an administrative claim audit on the potential fraud committed in an attempt to inflate costs, which is then followed by a medical audit. The result of the medical audit indicated that there were inaccuracies in the financing of hemophilia services based on medical service standards that were not yet met, leading to sanctions that the hospital must undergo, namely the recovery of financing losses.

Factors Affecting Participation in the Regional Government-Subsidized National Health Insurance on Sumba Island

Angela Yunita Tanggu Bore — 2024-12-30

The community's preference for registering in the Regional Government-Subsidized Sumba segment rather than the informal workers segment may be influenced by several factors, such as income, family size, occupation, education, and the premium amount. This quantitative study uses a cross-sectional approach with a questionnaire and a minimum sample size of 415 participants selected through convenient sampling. The data were analyzed using binary logistic regression analysis. The results indicate that factors affecting participation in the Regional Government-Subsidized Sumba segment include education (OR = 0.53; p-value < 0.05), occupation (OR = 0.75; p-value < 0.05), family size (OR = 4.85; p-value < 0.05), and income (OR = 0.99; p-value < 0.05). However, the perception of premiums did not have a statistically significant effect (OR = 1.54; p-value > 0.05). This study's binary logistic regression model has a pseudo R² of 0.57, meaning that participation in the Regional Government-Subsidized Sumba segment is influenced by the independent variables by 57%. In comparison, 43% is influenced by other variables not examined in this study. Local governments must continue allocating health insurance funding each year. BPJS Kesehatan should also adopt a comprehensive approach and establish strong relationships with local governments to sustain Universal Health Coverage (UHC) in Sumba Regency

Reform of the Calculation of Premium Contributions for State Administrator Participants

Ar Razaq Subhan Jath — 2024-12-30

This study aims to assess the impact of the reform of the calculation of premium contributions from state administrators collecting based on Presidential Regulation Number 64 of 2020 with Local Government Contribution Reconciliation Application (ARIP), which involves a collaboration with stakeholders, namely the regional government, which is related to increasing the receipt of contributions from regional civil servants in revenue and stakeholder involvement for the sustainability of the National Health Insurance Program. ARIP is an information system that aims to ensure accountability in calculating contributions from regional officials through reconciling contributions between local governments and BPJS Kesehatan. The research used a population of 547 regional governments that used ARIP during 2020-2023. Each sample was analyzed before and after using ARIP quantitatively and descriptively based on receiving contributions from regional civil servants. The hypothesis was tested using paired samples t-test, with significance 0.001< 0.05 and value of t-count = 6.973> t-table = 1.964, then Ha was accepted. Thus, the acceptance of contributions from regional civil servants differs before and after the implementation of ARIP. According to the Cohen classification table, ARIP had a medium impact on accepting the receipt of contributions from regional civil servants, with an effect size of 0.298. Based on the analysis, implementing ARIP increases the receipt of contributions from regional officials, which was 41.303 billion rupiah and increased by 3.234 billion rupiah to 44.537 billion rupiah

Effectiveness of Diabetes Mellitus Type 2 Management in Prolanis Participants at the BPJS Kesehatan Sibolga

ester sitompul — 2024-12-30

BPJS Kesehatan aims to improve the health of participants suffering from Type 2 DM through the Chronic Disease Management Program “Prolanis” (Program Pengelolaan Penyakit Kronis) strategy implemented at Primary Health Care (PHC). Program success is measured by the outcomes of controlled Fasting Blood Sugar status and the cost-effectiveness of Prolanis. This research was conducted to determine the cost-effectiveness of Prolanis in treating Type 2 DM. Analytical cross-sectional research using secondary data from BPJS Kesehatan in the Sibolga Branch Office work area in 2020-2022 on Type 2 DM participants who took Prolanis and Non-Prolanis. The analysis used univariate, bivariate, multiple logistic regression, and ICER cost analysis. Characteristics of Prolanis participants, age, number of visits, and Body Mass Index showed a significant relationship with the achievement of controlled fasting blood sugar. The average fasting blood sugar of Prolanis and Non-Prolanis participants in 2021-2022 did not significantly differ. Still, the proportion of controlled fasting blood sugar of Prolanis participants was greater than that of Non-Prolanis participants. The total cost of Prolanis in a row for 2020-2022 is IDR 1,437,411,273, IDR 2,706,895,281, and IDR 2,751,510,452. The total cost of Non Prolanis for 2020-2022 is IDR 5,861,773,361; IDR 7,807,455,547,-; IDR 10,291,812,544,-. The ICER for each controlled fasting blood sugar proportion varies from 2020-2022 IDR 462,489; IDR 201,473; IDR 362,856. Prolanis expenditure at the Sibolga Branch Office is higher, but the clinical effectiveness of the proportion of controlled fasting blood sugar participants is better than that of non-Prolanis participants