Transformation Study of Implementation of National Health Insurance (NHI) at Mamuju Regency, Indonesia

Abstract

The National Health Insurance Program is generally created to facilitate the community in accessing the health services and obtaining the quality health services. Transformation became the important vocabulary since the last seven years in Indonesia, precisely since the enactment of the Social Security Acts on October 19th, 2004. The transformation will present the new identity in the social security program implementation in Indonesia. The Acts of Social Security Organizing Board (SSOB) establishes two Social Security Organizing Boards, namely the Health SSOB and Employment SSOB. The research aimed to identify the implementation of the National Security Insurance program viewed from the program transformation aspect. This was a qualitative research. Informants in the research were the Hospital Head, SSOB Head, Health Office, PHC at Mamuju Regency. Samples were taken by the Purposive Sampling Rational technique namely by selecting the informants who comprehended the problem clearly, were reliable, were able to be the data resources, were prepared and were able to express their opinion well and correctly. The research result indicates that the officials have no idea concerning the regulation of the national health insurance program implementation in the level of health service providers (HSP), participation administration in the online system in the level of HSP, they are not ready, the claim payment model has not been comprehended by the officials of HSP. Observing the transformation setting scope of the social security organizing board regulated in the social security acts and SSOB acts, the research concludes that the transformation success is dependent on the availability of the harmonious and consistent implementation regulation, and it is carried out effectively. The research suggests that the government increases the strong willingness and commitment to perform the transformation at least it is reflected in the seriousness to accomplish the agendas of the regulation, participation administration, budgeting system.