Optimization of Fraud Potential Prevention in Implementation of National Health Insurance at Puskesmas Abeli

Abstract

Fraud actions at institutions can catapult health costs. Globally, the potential loss due to fraud is estimated at 7,29% every year. Increasing the number of referrals in advanced health facilities FKTL is an indication of fraud behavior. In Southeast Sulawesi, the referral rate is high, reaching 17% with the maximum ideal standard for the average referral rate of first level health facilities(FKTP) to advanced health facilities(FKTL), not more than 5%. While in Kendari City in 2015, the referral rate from Puskesmas to Abunawas General Hospital was also still high at around 9.5% in 2015 and an increase of 15.3% in 2016. One of the puskesmas that provided referrals was Abeli ​​Community Health Center. This study aims to analyze the potential for fraud prevention in the implementation of National health insurance(JKN) at Abeli ​​Health Center. This study using observational analytic using one group pre test and post test design. Research was conducted at Abeli ​​Health Center and technique used was cluster random sampling with 28 respondents. From the statatistic test results obtained, there were differences in knowledge before and after the intervention with a mean gap value of 0, 21429 with a lower limit of 0.05226 and an upper limit of 37631 and a p value<α (0.011 <0.05). The suggestion in this study is to the health centers and hospitals to increase more understanding of fraud in the implementation of the JKN program by having socialization.