Jurnal Jaminan Kesehatan Nasional

Comparison of Operating Costs and LOS of Cesarean Section Patients Using ERACS and Non-ERACS Method

Cinthya Dwi Cahyani Puspitasari — 2024-06-30

The rate of births with cesarean section delivery in Indonesia is increasing. Along with the increasing rate, various clinical methods are used to reduce maternal morbidity and mortality, one of which is the Enhanced Recovery After Cesarean Section (ERACS). ERACS aims to speed up recovery, reduce postoperative complications, shorten length of stay (LOS) and lower patient care operational costs of cesarean section. The purpose of this study is to compare operational costs and LOS of cesarean section patients with ERACS and non-ERACS methods.The reseach used was case-control study which was carried out at RSUD dr. Rehatta Kelet from October-December 2022. This study involved 71 patients who met the inclusion criteria. Data were obtained from the patients’ medical records. The data were analyzed by mann Whitney Test using SPSS software. The result shows that the difference in LOS and operational costs using ERACS and non-ERACS was statistically significant at P=0.0001. The study concludes that ERACS method reduces LOS and operational costs compared to non-ERACS methods. The authors recommend that the association of obstetricians and gynaecologists should encourage its members to apply EARCS whenever possible.

Fraud Prevention System with Whistleblowing System in Health Services: A Systematic Review

Ridwan Ridwan — 2024-06-30

The objective of this study is to ascertain the strategies employed in mitigating fraudulent activities within the realm of health services through the utilization of a whistleblowing mechanism. Methods: The present study employed a systematic review approach to examine relevant literature by utilizing specific keywords such as "whistleblowing system" and "fraud Healthcare." These keywords were then used to search for publications in the Scopus database, focusing on journals that mostly relied on secondary data. The search was conducted using the publish or perish tool. 8. Subsequently, a curation of scholarly publications and articles was conducted, employing a criterion centered on the thematic relevance of their titles. The selected publications have the objective of mitigating fraudulent activities within the healthcare industry and other interconnected industries that contribute to research endeavors. The findings of this study suggest that the implementation of a fraud reporting system is vital inside an organization, particularly within the context of health services. To enhance the caliber of healthcare services, internal healthcare staff and participants may report well, it is imperative to establish a system that ensures the preservation of reporter confidentiality, hence facilitating an increase in the volume of reports.

An Overview of the Simplification of the Flow and File of Membership Administration Services on the Satisfaction of JKN Participants at the BPJS Health Kupang Branch

Ariasto Bau — 2024-06-30

The Social Insurance Administration Body for Health (BPJS Health), the institution administering national health insurance in Indonesia, has an important role in ensuring people have access to quality health services. The method taken by The Social Insurance Administration Body for Health to minimize complaints and reduce waiting times for services is by simplifying administrative service flows and files. This research design is quantitative and descriptive to describe the effect of simplifying participant service flows and files at branch offices on the satisfaction of the National Health Insurance participants at the Kupang Branch Office. The research sample consisted of 50 people using the Simple Random Sampling technique. Research data analysis was carried out univariately. The research results show that a simple flow and file of service requirements will make it easier for the National Health Insurance participants to obtain administrative services and simplifying services for participants will have an impact on achieving participant satisfaction with services at the Social Insurance Administration Body for Health office. The Social Insurance Administration Body for Health is expected to pay attention to the satisfaction of the National Health Insurance participants by committing to implementing simplification of service flows and processes to achieve good service quality.

Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome Inpatient Claims at Mojokerto Hospitals

Gustina Fajarwati Sihombing — 2024-06-30

This study aims to see and analyze the inpatient claims of Human Immunodeficiency Virus/ Acquired Immunodeficiency Syndrome at Mojokerto Hospitals. The research design used is a type 2 case study, namely an embedded single case and uses a qualitative approach. The results of the study show that the largest proportion of HIV/AIDS inpatient JKN patients is the type of Beneficiaries of Contribution Assistance (PBI) membership which is a segment of the underprivileged community. Until now, the Global Fund still contributes significantly to the efforts of the Indonesian government in terms of spending on HIV/AIDS programs. The Indonesian government has not yet had any serious regulations and efforts that lead to optimizing financing independently.

Sectio Caesarean Delivery Claims of National Health Insurance Patients at Advanced Referral Health Facilities in East Java Region

Tika Rahhmatillah Mustofa — 2024-06-30

WHO (2015) sets the standard for sectio caesarea at 10-15%. The proportion of SC deliveries in East Java was 22.4% in 2018, higher than the national average of 17.6%. The burden of JKN financing on childbirth is increasing and is among the top 10 most CBGs cases nationally. As an effort to control quality and control costs, BPJS Health in coordination with the Quality Control Cost Control Team (TKMKB) issued guidelines and self-assessment instruments for cesarean section (SC) in 2020. This study was conducted to explore the picture of SC before and during the implementation of the SC Self-Assessment Instrument in National Health Insurance patients in East Java. Of the 837,809 study subjects, 247,508 (60.5%) had SC delivery. Sectio Caesarea delivery of National Health Insurance patients at FKRTL in East Java is associated with individual factors, namely age and type of JKN membership and service factors, namely SC Self-Assessment Instrument, class of care, severity level, and hospital type. Implementation of the SC Self-Assessment Instrument has not been optimal in reducing the SC rate. A comprehensive strategy is needed to reduce the rate of sectio caesarean delivery, including interventions for pregnant women and families; health workers, health facilities, and professional organizations.

Analysis of JKN Mobile Application Service Quality (Case Study Participants of BPJS Health Surakarta Branch Office)

HADI SAPUTRA — 2024-06-30

Mobile JKN is an application facilitating remote access to services under the national health insurance program managed by BPJS Kesehatan, offering numerous features for participant convenience. As of June 2023, registrations in the Surakarta area reached 92,101. This study evaluates the service quality of the Mobile JKN application using e-service quality, Customer Satisfaction Index (CSI), and Importance-Performance Analysis (IPA) methodologies. A quantitative approach focused on 100 participants visiting the Surakarta BPJS Kesehatan branch. The results of this research are that participants who use the Mobile JKN application are satisfied with the Mobile JKN application service, with an average gap value of 0.06 (positive value), and a CSI value of 81.4%, which indicates that participants are satisfied with the Mobile JKN service. IPA results identified three indicators as top priorities for further enhancement and quality improvement.

Inefficiency CT Scan Simulator Billing as an Audit Initiative of National Health Insurance Claims Administration at Vina Estetica General Hospital

Rahayu Yusti — 2024-06-30

A CT Scan Simulator is a tool used to determine the size, shape, and location of a tumor to help the radiotherapy team determine the next treatment plan. Vina Estetica General Hospital is a public hospital that provides CT Scan Simulator services based on the permission of Perka BAPETEN as radiotherapy management and follow-up in malignancy cases. This study uses a descriptive method through a quantitative approach, aiming to describe the inefficiency of CT-Scan Simulator billing used as a support for diagnosis enforcement based on the Indonesian-Case Based Groups (INA CBGs) tariff costs. The technique used was purposive sampling with inclusion and exclusion criteria. Secondary data collection was carried out retrospectively in the form of claim files for the period January 2020 - November 2023 as many as 308 samples were taken randomly. The results showed that there were 283 (83%) CT Scan Simulator billing claims aimed at supporting diagnosis enforcement and resulting in billing inefficiencies in the INA CBGs claim rates being higher