Jurnal Jaminan Kesehatan Nasional

Lifestyle Factors of Low Birth Weight: Evidence from the 2023 Indonesian Health Survey

Nancy Marhadi — 2025-06-30

The stagnant prevalence of low birth weight (LBW) in Indonesia creates challenges for the National Health Insurance (Jaminan Kesehatan Nasional/JKN), as it often needs more medical care with higher inpatient claim costs and affects the long-term growth and development of the country’s future generations. The objective of this study was to identify significant maternal lifestyle factors associated with LBW by analyzing the data from the Indonesian Health Survey (SKI) 2023. A total of 30,516 mothers who had given birth at least once during the five-year period preceding the SKI 2023 were included in the study. Bivariate and multivariable logistic regression analyses were used to identify key maternal factors associated with the outcome. Living in urban areas (AOR: 1.228; 95% CI: 1.038–1.453), exposure to second-hand smoke (AOR: 1.383; 95% CI: 1.149–1.664), infrequent consumption of energy drinks (AOR: 2.501; 95% CI: 1.015–6.161), and frequent vegetable consumption (AOR: 1.217; 95% CI: 1.030–1.437) were significant contributors. Additionally, the effect of low-frequency instant food consumption was more pronounced among mothers with only primary education (AOR: 4.740; 95% CI: 1.438–15.623). To lower LBW rates, healthcare providers should focus on educating expectant mothers about the risks of second-hand smoke and unbalanced nutrition through quality antenatal care.

Effectiveness of BPJS Kesehatan Service Quality Transformation Implementation

Rizky Fajar Prasetyo — 2025-06-30

BPJS Kesehatan has implemented Service Quality Transformation to enhance service accessibility, speed, and equity for National Health Insurance (JKN) participants. This transformation represents a collaborative effort between BPJS Kesehatan and the broader JKN ecosystem, including the Ministry of Health, Health Professional Associations, and Central and Regional Governments, primarily focusing on JKN participant satisfaction. This research aimed to evaluate the effectiveness level of service quality transformation implementation conducted by BPJS Kesehatan. The study employed quantitative methodology. The research used a population of 10.198 BPJS Kesehatan employees, 244 billion JKN participants, and 7.562 stakeholders (Central and Regional Governments, Professional Associations, and Healthcare Facilities). The analysis of service quality transformation implementation effectiveness encompassed two principal indicators: process indicators and impact/outcome indicators. Survey results indicated that the Service Quality Transformation Process Index achieved 87.40%, while the Service Quality Transformation Impact Index on customer perception reached 90.88%. Additionally, the impact of transformation implementation (TML) on Service Performance was measured at 1.94. This research generated recommendations for continuous improvement in service quality implementation, emphasizing the necessity for ongoing training and enhanced collaboration with stakeholders. These findings are expected to contribute significantly to developing health service policies and practices in Indonesia.

Analysis of Factors Affecting Referral Rates in Community Health Centers: A Scoping Review

Nanda Elok Juwita — 2025-06-30

The implementation of the National Health Insurance (JKN) in Indonesia has gone well, with the strengthening of primary care functions. One health facility that provides primary health care services owned by the government is the Community Health Center (Puskesmas). The target referral rate for Puskesmas in 2024 is a challenge to control. The high number of referrals can increase hospital visits and costs. Special efforts are needed to achieve these targets. This study aims to determine the factors affecting referral rates in community health centers. The study used a scoping review method. The literature search was conducted in the 2021-2024 range using Researchgate, PubMed, Google Scholar, and other sources. The keywords used were Primary Care, Referral Rate, and Community Health Centers. Literature selection resulted in eight articles that met the criteria for analysis. Some factors found were facilities and infrastructure, human resources, disease complications, drug availability, patient perceptions, location of community health centers, Standard Operating Procedures (SOP) for referrals, and applicable regulations. Fulfillment of these factors is necessary to achieve referral rates.

Analysis of Factors Affecting Medical Cost and Insurance Reimbursement Gaps in Hypertension Heart Failure Patients

Nurma Suri — 2025-06-30

Hypertension with congestive heart failure (CHF) results in high disease-related costs, placing a burden on patients, families, and healthcare facilities. Direct medical costs are known to be the highest proportion. This study aims to identify factors associated with direct medical costs in patients with hypertension and CHF and the difference in payment amounts compared to insurance reimbursements. This research uses a cross-sectional design at Hospital X in Lampung Province. The study population consists of patients diagnosed with hypertension and CHF within the period 2020-2022, with samples selected using total sampling. From 101 samples, the total direct medical cost for all cost components was IDR 908,700,216, with an average direct medical cost of IDR 8,997,032. The highest cost component was cardiac catheterization, with a total IDR of 473,081,000 and an average IDR of 36,390,846. The lowest cost component was additional medical expenses, with a total IDR 16,348,780 and an average IDR 166,824. Bivariate analysis showed a significant relationship between direct medical costs and length of hospital stay, insurance classes, and comorbid conditions. In addition, bivariate analysis showed a significant difference between direct medical costs and insurance reimbursement, with a positive discrepancy of IDR 4.437.619. This study concludes that length of stay, insurance classes, and comorbidities are significantly associated with direct medical costs. There is also a significant difference between direct medical costs and the amount of insurance reimbursement.

Information Security Management System (ISMS) at BPJS Kesehatan Tondano: Implementation of ISO 27001:2022 Standard

RANDA MATTHEW IROTH — 2025-06-30

Information security is crucial for organizations managing sensitive data in the digital era. This is especially true for institutions like the Social Security Administrative Body for Health (BPJS Kesehatan), which organizes social health security for the Indonesian people and handles various important information, including participant, medical, and financial data. However, as threats to information security increase, organizations need to implement an effective information security management system. This research examines the implementation of the Information Security Management System (ISMS) based on the ISO 27001:2022 standard at the Tondano BPJS Kesehatan Branch Office. The methodology of the research is descriptive qualitative. The research results indicate that implementing the ISMS has improved overall data security. This is achieved through regular data backups and storing servers in locked rooms. In addition, implementing the ISO 27001:2022 standard reduces information security risks by providing clear guidance on data security management, including antivirus updates, access restrictions, and password management. The main challenges in implementing the ISMS are limited IT infrastructure resources and employee resistance to changes in IT security procedures. Despite these challenges, implementing the ISO 27001:2022 standard at the Tondano BPJS Kesehatan Branch Office has improved information security and strengthened the trust of customers and business partners

Evaluation of Staged Payment Plan Program to Improve Collectability of Independent Participant Contributions

Sri Ayu Ningtiyas — 2025-06-30

The main problem causing high arrears among Independent Participant and Non-Employee participants is the lack of a strong mechanism to ensure continuous payment of contributions. This study aimed to explore the Staged Payment Plan Program (REHAB) as an effort to increase the collectability of contributions from independent participants at BPJS Kesehatan Yogyakarta Branch Office in 2023. This research uses with program evaluation method. there were 251,494 (11,65%) Independent Participant and Non-Employee participants, with 109,280 (62,33%) in arrears as of February 2023. However, only 6.53% of them registered for the REHAB program. The input component shows that many participants still do not know about this program. The REHAB process shows that digitalization in the implementation of the REHAB program has not been maximized; there is no data update and notification for the billing process to participants. Internal monitoring is carried out regularly however, there is no monitoring of participants. The results component shows that Independent Participants contributions is 80.89%, but this collectability includes all forms of revenues owned by BPJS Kesehatan. The conclusion is the REHAB program has not yet achieved its goal of helping independent participants pay off contribution arrears. Socialization carried out is still not optimal because it has not reached all levels of society. There has been no regular update of participant data or direct evaluation of participants. The implementation of the REHAB program has not been proven to contribute to collectability because there is no data on collectability achievements sourced from the REHAB program

Influencing Factors in Patient Referrals: A Doctor’s Perspective on Primary Health Care Facilities (FKTP)

Ridwan Ridwan — 2025-06-30

An effective and efficient referral system is essential for ensuring patients receive the appropriate treatment for their medical conditions. Primary Health Care Facilities (FKTP) play a critical role in addressing the healthcare needs of patients at the first level. Despite receiving 100% Performance-Based Capitation (KBK), FKTPs exhibit a high referral rate, as indicated by referral rates, referral ratios, and Non-Specialist Referral (RNS) metrics. This quantitative study explores the factors influencing patient referrals in FKTPs, as perceived by doctors. A structured questionnaire was used to gather data from 69 doctors across 148 FKTPs in the BPJS Kesehatan Branch of Banda Aceh in July 2024. The survey addressed various aspects, including doctors' competence, patient behavior, FKTP capabilities, and referral mechanisms. The results revealed that the location of health facilities significantly impacts referral rates and healthcare costs, with facilities located closer to villages reducing the need for referrals and enhancing healthcare accessibility for remote populations. BPJS Kesehatan can improve collaboration with FKTPs by identifying strategic locations in rural areas and leveraging the Aplicares web to map and optimize health services. Furthermore, the government could enhance healthcare access by creating maps to develop public health centers in rural areas or collaborating with private and family doctors to expand services in underserved regions. This study provides valuable insights for policymakers, suggesting that improving FKTP accessibility and addressing resource limitations could significantly reduce unnecessary referrals, lower healthcare costs, and improve the efficiency of the healthcare system in rural areas.

Stakeholders’ Perceptions of Performance-Based Capitation Design Using Chronic Disease Indicators at Primary Health Care Facilities

susy hartati novintry sitorus — 2025-06-30

Based on BPJS Kesehatan’s utilization review data (Social Security Administrative body for Health) until December 2023, only 32% of 273 primary healthcare facilities met the fourth level for the Controlled prolanis participant ratio (RPPT) indicator. This indicator reflects the percentage of Prolanis-registered patients diagnosed with Diabetes Mellitus (DM) or Hypertension (HT) who have achieved controlled fasting blood glucose (for DM) or controlled blood pressure (for HT), with a performance target of ≥ 5%. Meanwhile, 42% of facilities reached the Angka Kontak (AK/Contact Number) target, which measures the number of participants who contacted Primary Health Care Facilities (FKTP) compared to the total registered participants, multiplied by 1,000; the target is ≥ 150 per mille. However, 83% of facilities achieved the Non-Specialist Referral Ratio (RRNS) target, which compares the number of non-specialist case referrals to total referrals; the target is ≤ 2%. These findings highlight the need for stronger motivation mechanisms, such as financial incentives, to support FKTP in achieving better scores in the Performance-Based Capitation (KBK) model. This study explores stakeholder perceptions regarding an incentive-based KBK model using the RPPT indicator in FKTPs in Medan. Stakeholders shared several key perspectives: (1) RPPT targets should range between 5% and 10%, with incentives tied to rating levels; (2) intermediate outcome indicators should include HbA1c for DM and blood pressure for HT; (3) incentive payments should be allocated to FKTPs and managed to strengthen chronic disease services; and (4) these payments must be consistent and sustainable.

Employee Engagement, Satisfaction, and Commitment among BPJS Kesehatan Employees in 2024: A Quantitative Study

Rizky Fajar Prasetyo — 2025-06-30

This study analyzes employee engagement, satisfaction, and commitment among BPJS Kesehatan employees through an employee opinion survey in 2024. The survey conducted at BPJS Kesehatan showed positive results in several aspects but also identified areas that require attention. The Employee Engagement Index (EEI) reached 86.88%, indicating a high level of engagement, particularly among managerial positions. The Employee Satisfaction Index (ESI) also reached 87.77%, reflecting a very positive work environment for most employees. However, the survey found that 28.8% of employees experienced dissatisfaction, with excessive workload, policy changes, and organizational structural adjustments as the primary causes. Meanwhile, the Employee Commitment Index (ECI) reached 90.88%, showing strong commitment to the organization. This study emphasizes the importance of addressing employee welfare and recognition issues to significantly improve job satisfaction, especially in entry-level and mid-level positions. The survey reflects positive sentiment among BPJS Kesehatan employees regarding engagement, satisfaction, and commitment. However, it also highlights critical areas that need improvement to address dissatisfaction and enhance job readiness. By focusing on these areas, BPJS Kesehatan is expected to improve the overall work experience and productivity and create a more supportive work environment for all employees.

Implementation of the JKN-Mobile Application at the Mangkubumi Health Center Tasikmalaya City in 2024

Aisah Nindiani Putri Putri — 2025-06-30

The implementation of technology and information is currently starting to be applied in the health sector. The JKN Mobile Application is an effort to improve services for BPJS Health participants. The largest number of JKN Mobile users in Tasikmalaya City is at the Mangkubumi Health Center, which has 3,528 users. However, there are problems, namely a lack of communication with patients, no resources in the form of pamphlets or banners, patients having never used the doctor consultation feature, and no Standard Operating Procedure (SOP) for doctor consultations being available. This research aims to determine the supporting and inhibiting factors influencing the JKN Mobile Implementation process. The benefits of this study are that it provides insight and public interest in the features of the JKN Mobile and a means of implementing the electronic medical record, a type of qualitative research with a phenomenological approach. The sampling technique is purposive sampling with a total of 5 (five) subjects. The data collection techniques were interviews, observation, and documentation. Implementing JKN Mobile has supporting factors, including Two-way communication, JKN Mobile information posters, adequate technological facilities and infrastructure, an integrated information system, good response from staff and patients, and online registration SOPs. Meanwhile, inhibiting factors include system and user constraints, the lack of human resources managing JKN Mobile, and the absence of an online registration flow banner.

Enhancing The Quality and Cost Control Team's Role in Improving Primary Care Referrals in Bantaeng.

Muhayyina Wahidah — 2025-06-30

This study evaluates how well the Quality and Cost Control Team (TKMKB) can improve referral quality by reviewing and medically auditing Non-Specialist Referral Rasio (RRNS) indicators with the First Level Health Facility (FKTP). The quantitative descriptive approach compares RRNS data with Time, Age, Complication, and Comorbidity (TACC). It evaluates the appropriateness of TACC criterion selections before and after implementing the medical audit and RRNS indicator review with TACC at FKTP in Bantaeng Regency. The FKTPs that were sampled were those that met RRNS indicators at Ulugalung Health Center, Kota Health Center, and Pabentengang Health Center in Bantaeng Regency, had KBK compensation, and achieved 100% KBK for six consecutive months. The study results show that non-specialist referrals (RNS) with TACC were lower than those with RRNS TACC before the review and medical audit intervention. In Bantaeng District, 92.05% of referrals were Specialist Referrals, while 7.95% were Non-Specialist Referrals (0.92% RNS without TACC and 7.03% RNS with TACC). Additionally, following the TKMKB intervention, TACC criteria for Time were also reduced, suggesting an increase in the quality of referrals, particularly in selecting TACC criteria at FKTP in compliance with current norms and guidelines. Thus, the Branch Quality and Cost Control Team's contribution to enhancing referral quality via the medical audit and assessment of RRNS indicators with TACC at FKTP is deemed successful.