National Health Insurance Era Research Articles

Continuous Ambulatory Peritoneal Dialysis Cost-Effectiveness in National Health Insurance Era of Indonesia

Essential treatments for patients with end-stage renal disease include Renal Replacement Therapy (RRT) consisting of hemodialysis, peritoneal dialysis, and kidney transplantation. In 2014, dialysis coverage in Indonesia was more than 1.5 trillion, making it the second highest expense in the National Health Insurance (BPJS) expenses. This study compared the cost-effectiveness between Continuous Ambulatory Peritoneal Dialysis (CAPD) and Hemodialysis (HD) in patients treated in Dr. Hasan Sadikin General Hospital. Data were collected from the Urology Department from 2014 to 2017. This was a retrospective observational study on 3 groups of patients: patients with effective CAPD each year as the first group; patients who had experienced repair of CAPD and continued to use it as the second group; and patients who discontinued CAPD due to complications and returned to hemodialysis as the third group. Each group expense was calculated with standard cost insurance for one year in the hospital. The expense was then be compared to the expense of hemodialysis for one year. A total of 89 patients in the CAPD program from 2014–2017 were treated at the department. When compared to HD, the first, second, and third group of CAPD patients experienced a cost reduction of IDR 23.227.857/person, IDR 18.127.857/person, and IDR 1.661.972.000, respectively. Total savings from the CAPD program in the hospital was IDR 1.661.972.000 from 2014. It is then concluded that CAPD could reduce the burden of government insurance in a cost-effective manner and is considered a treatment of choice in the National Health Insurance Era.

Unit Cost Perawatan Gigi di Klinik Fanisa Kota Pariaman dengan Metode Activity Based Costing

Objective: To find out unit cost of dental health service in Pariaman City Fanisa Clinic using the Activity Based Costing method in era of national health insurance. Method : This research was a quantitative descriptive study that used was Activity Based Costing (ABC) used mathematical calculations. Results : The results of this study indicated there was 8 dental health service in Fanisa Clinic in Pariaman City in 2018 and the unit cost for each service was consultation Rp.55.945, permanent tooth extraction Rp.127.825, extraction of deciduous teeth Rp.79.311, composit resin patching Rp.156.384, GIC patching Rp.145.843, scalling Rp.131.358, premedication Rp.61.291 and pulp capping Rp.107.729. Conclusion: The highest unit cost for dental health services at the Fanisa Clinic in Pariaman City was composite resin patching service and the lowest was consulting services. The average unit cost of dental health services at the Fanisa Clinic in Pariaman City was Rp.108.211. The biggest cost in the production unit was the cost of employee salary.

The Role of Stress and Job Satisfaction Among Frontline Nurses in the National Health Insurance Era: The Mediating Role of Self-Efficacy

The study aimed to analyze the effect of role stress (role ambiguity and role conflict) on the self-efficacy and job satisfaction of nurses implementing the National Health Insurance (JKN) era at Panembahan Senopati Hospital, Bantul. The research design used was an analytic survey design using a cross-sectional study approach. The population of this study was all nurses at the Panembahan Senopati Hospital, Bantul, with a sample size of 105 executive nurses. Data analysis used Spearman correlation analysis to see the effect of the independent variables on the dependent variable with a significance limit (α) of 5%. The results indicated no effect of role ambiguity on nurses' self-efficacy in the JKN era at Panembahan Senopati Hospital, Bantul (p=0.236). Further, there was an effect of role conflict on the self-efficacy of nurses in the JKN era at Panembahan Senopati Hospital, Bantul (p=0.000). There is an effect of self-efficacy on the job satisfaction of nurses in the JKN era at Panembahan Senopati Hospital, Bantul (p=0.000). It can be concluded that there is a complex relationship between role ambiguity, role conflict, self-efficacy, and nurse job satisfaction. Although not all relationships have a significant effect, this study provides an initial understanding of the factors that influence the self-efficacy and job satisfaction of nurses at Panembahan Senopati Hospital, Bantul, in the JKN era.

The Role of Organizational Culture in Mediation Dimensions of Good Corporate Governance in The Era of National Health Assurance on Performance the Blud of Hm Djafar Harun Hospital Kolaka Utara District

This study aims to look at the role of organizational culture in mediating the dimensions of GCG in the era of national health insurance on performance at the BLUD HM Djafar Harun Hospital, North Kolaka Regency, using quantitative research. The population of this study was civil servants and non-PNS employees who worked at the BLUD of the HM Djafar Harun Hospital, North Kolaka Regency, Southeast Sulawesi Province, namely 286 people who were selected based on Presidential Decree No. 77 of 2015. A Result the transparency dimension is formed by seven indicators and patient rights is the strongest indicator in forming the transparency dimension. In the accountability dimension, there are four indicators and the one that contributes the most to this dimension is the responsibility indicator. The dimension of responsibility has three indicators and the strongest in shaping this dimension are the indicators of obligation, ethics and rational decisions. The independence dimension is formed by five indicators and the strongest form of independence is the indicator of not having personal interests. In the fairness dimension, there are five indicators and the strongest form of this dimension is the cost balance indicator. Organizational culture in this study is composed of three indicators and the strongest in shaping this dimension are innovative and supportive. The performance in this study is composed of seven indicators, where the claim return indicator gives the greatest contribution to this variable. Good Corporate Governance based on the transparency dimension has an indirect effect on hospital performance in the JKN era. Good Corporate Governance based on the dimension of accountability has an indirect effect on hospital performance in the JKN era. Good Corporate Governance based on the dimension of responsibility besides having a direct influence is also a dimension that strengthens organizational culture on hospital performance in the JKN era. Good Corporate Governance based on the independence dimension has a direct effect on hospital performance in the JKN era. Good Corporate Governance based on the dimension of fairness has an indirect effect on hospital performance in the JKN era. Organizational culture directly has a significant effect on hospital performance.

Evaluation of Outpatient Satisfaction with Pharmaceutical Services in the Era of National Health Insurance

Background: The National Health Insurance (JKN) system has been able to improve the health status of the Indonesian people. However, efforts are still needed to accelerate the achievement of health indicators to catch up with other countries. Therefore, the researchers were interested in conducting research related to evaluating outpatient satisfaction with pharmaceutical services in the era of national health insurance at the PKU Muhammadiyah Gamping Hospital. Aim: The purpose of this study is to determine the profile of outpatient satisfaction and at what dimensional pointes outpatients are less satisfied with pharmaceutical services by using national health insurance at PKU Muhammadiyah Gamping hospital Method: This research is a non-experimental descriptive study with a cross sectional approach. Sampling is carried out prospectively by the purposive sampling method through questionnaires given to the target population. The number of statement items in this study is 29 satisfaction items and 29 expectations items in terms of 5 dimensions. Findings: The level of satisfaction of outpatients with pharmaceutical services in national health insurance users at PKU Muhammadiyah Gamping included the responsiveness dimension of 95.52%, the empathy dimension of 90.49%, the assurance dimension of 90.32%, the reliability dimension of 87.12%, and the tangible dimension of 86.40%. The result of the average value of the respondent's overall satisfaction level was 89.97%. Based on the average results of the value of the outpatient satisfaction level with the pharmaceutical services of national health insurance users at PKU Muhammadiyah Gamping Hospital, this value is included in the category of "very satisfied."

Cost Analysis of Therapy of Chronic Kidney Disease Inpatient In Indonesia

Impaired kidney function is one of the main public health problems in Indonesia. In the era of National Health Insurance (JKN) health financing at Advanced Level Referral Facilities (FKRTL) used the Indonesian Case Based Group (INA-CBGs) rate, but hospital costs were often higher than the costs of INA-CBGs. This study aims to determine the difference in costs. in real terms with INA-CBGs rates for hospitalization in Indonesia. This study used a cross-sectional analytic study design with a hospital perspective. Collecting data using a retrospective method with data collection in the form of medical records of patients with chronic kidney failure on hemodialysis and data on patient treatment costs. The study was conducted in regional I and regional III, each region represented by class A, B, and private hospitals so that a total of 6 hospitals were involved in this study. The data is presented descriptively. The difference between the real cost and the cost of INA-CBGs using the Mann-Whitney test SPSS analysis. The results showed that the average real cost in class A hospitals was higher than the average real cost in class B and private class hospitals. Of the 6 hospitals studied, 5 hospitals showed that the total real cost for treating chronic kidney disease in Indonesia was still higher than the INA-CBGs rates. The highest average real cost for hospitals in regional 1 is in class A hospitals with a value of up to Rp. 13,709,812 per patient/year, these costs are in accordance with the INA-CBGs rates. Meanwhile in regional 3, the highest average real cost of Rp. 33,000,450 patients/year is in a class A hospital. This cost is much higher than the INA-CBGs rate. The results of statistical tests showed that there was a significant difference between the average real cost and the INA-CBGs tariff (p=0.000). The total difference caused is Rp. 13,851,798 so that it becomes a loss and a burden for the hospital.

The ethical dilemma of medical specialists in the era of national health insurance in Semarang

Purpose: The National Health Insurance (JKN) implemented by the Indonesian government since 2014 has brought Indonesia to a new phase in realizing the right to health for its people. The social insurance system managed by Social Health Insurance Administration Body (BPJS) is felt to bring many benefits to the community despite many obstacles in its implementation. This study seeks to find the ethical dilemmas experienced by surgical and non-surgical specialists in implementing the JKN program in hospitals. Methods: The study was conducted using the qualitative method with the phenomenological approach by conducting in-depth interviews with five surgical specialists (an obstetric and gynecology, an otolaryngologist specialist, a surgeon, an eye specialist, and an anaesthesiologist) and six non-surgical specialists (children, mental health, internal medicine, medical rehabilitation, nerves, and skin specialists) in Semarang, Indonesia. In each specialization, there are two respondents interviewed. The data were analyzed using a qualitative approach. Results: Some problems still exist when specialist doctors treat BPJS patients in hospitals, which include: 1) lack of socialization, making doctors as implementers find it difficult to implement the rules; 2) different implementations in various hospitals, making doctors find it difficult to adjust when they practice at type C hospitals because the number of claims is often insufficient to provide services to patients; 3) the JKN program that has increased the number of patients, resulting in doctors' concerns about lawsuits if they make mistakes; moreover, doctors also have to adjust to existing cost claims; and 4) doctors still trying to uphold the doctor's oath and The Indonesian Medical Ethics Code (KODEKI) and always do the best for patients whatever the problem. Conclusion: The implementation of JKN must always be evaluated continuously, and the government still has to pay attention to the obstacles faced by doctors in the field. In carrying out their practice full of dilemmas, doctors must always receive adequate legal and ethical protection.

Breast, cervical, and lung cancer: A comparison of real healthcare costs and INA-CBGs rates in the era of national health insurance.

In Indonesia, the cost of cancer treatment has been determined by the Indonesian Case Base Groups (INA-CBGs) based on a code called the INA-CBG's rates. However, a fair claim should be based on the severity of the disease and the class of treatment in the hospital, not on the rates of code. In fact, the real cost of therapy for cancer is influenced by several factors including stage, comorbidity, and severity (INA-CBGs coding, type of hospital, hospital class, treatment grade, side effects, and length of stay), so in many cases, there are reported differences between the real costs and the INA-CBGs rates charged to patients. This study aims to investigate the difference between real treatment costs and INA-CBG's rates for cases of lung cancer, cervical cancer, and breast cancer at a cancer center hospital in Indonesia. This work uses an observational study, and the data were taken retrospectively from hospital financial data and patient medical records. The data were then analyzed using a one-sample t-test to determine the difference between real costs and INA-CBGs costs. The results showed that there was no significant difference between real costs and INA-CBG's cost on stage II lung cancer treatment in grade 2 with a sig. value of 0.683; code C-4-13-II in grade 3 with a sig. value of 0.151; and code C-4-13-III in grade 3 with a sig. value of 0.650; where the significance level (t alpha) is more than 0.05. Furthermore, the treatment costs for cervical cancer with codes C-4-13-I and C-4-13-II in grade 1 had sig. values of 0.155 and 0.720 respectively. Lastly, the treatment cost for breast cancer patients with codes C-4-12-II in grade 3 had a sig. value of 0.145 and code C-4-13-II in grade 3 showed a sig. value of 0.091. Although statistical evaluation showed a significant difference for some cases and not significant for other cases, in real conditions, there is a difference between the INA-CBGs and the real costs that must be evaluated by the government and stakeholders to provide justice for cancer patients.

STUDY OF THE PATTERNS OF HEALTH FINANCE UTILIZATION IN THE NATIONAL HEALTH SECURITY (JKN) ERA OF NON-PBI PARTICIPANTS AT H. ABDUL MANAP HOSPITAL

The National Health Insurance is a mechanism designed to protect individuals and families in providing health services to their citizens, especially the poor, in order to reduce financial barriers to obtaining health services. It is known that Non-PBI Mandiri participants who have been late paying premiums for at least six months show that 70.5% of respondents register as BPJS participants on the grounds that they need health financing guarantees in the near future, either on their own or according to directions from doctors or paramedics. Therefore, the aim of this research is to look at the pattern of health financing utilization in the era of National Health Insurance (JKN) for non-PBI participants at H.Abdul Manap Hospital. This study uses a qualitative research method with a phenomenological approach. Data were obtained from 9 informants by conducting in-depth interviews at H.Abdul Manap Hospital with qualitative data analysis. The results of this study (1) Psychological factors found a pattern of moral hazard phenomena with a tiered referral system, because there was a tendency to use BPJS membership benefits only to finance expensive or high-cost health services identified in research informants, (2) Personal factors found an alleatory pattern , because they feel they have benefited from the sustainability of the program and there are differences in understanding from the demand side.
 

Quality Control of Health Services of The National Health Insurance Era in East Java - Indonesia: Barriers and Strategy

The National Health Insurance ( JKN) system is designed to provide the availability of quality health services, but until now JKN participant have not felt the quality health care. The purpose of this study is to identify threats and weaknesses in health care quality control and formulate the implications of its strategy. The study was conducted at four Regional General Hospital (RSUD) in East Java - Indonesia, namely RSUD IbnuSina Gresik, RSUD NgudiWaluyoWlingiBlitar, RSUD dr. H. SlametMartodirdjoPamekasan, and RSUD dr. H. KoesnadiBondowoso. The sampling of research samples was conducted by purposive sampling and data retrieval with questionnaires and interviews. Analysis techniques used are external factor analysis, internal factor analysis, and SWOT analysis. The results of the study found that the barriers to quality control of JKN health services are the delay in payment of hospital claims by the Social Security Regulatory Agencyof Health (BPJS Health), INA-CBGs rate, BPJS Health Regulations and low people awareness for a healthy lifestyle. In terms of internal hospitals, fraud prevention systems have not been affective. The implication of the strategy is that hospitals must develop and implement fraud prevention information systems properly.
 Keywords: JKN; BPJS; quality control; health services

Implementation of lean thinking in healthcare services: Why is it importance

Background: : Indonesia has implemented National Health Insurance since 2014 through quality improvement and cost efficiency strategy. In the early implementation, many hospitals suffered a loss due to the absence of efficiency in operational health services. In the other hand, few hospitals have implemented lean as an attempt of quality improvement and cost efficiency in National Health Insurance era. There is not enough evidence in Indonesia to support management tools implementation such as Lean for improving efficiency. Aims: This study aims to develop scientific knowledge and goodwill of Lean implementation in healthcare services in many countries. This study also becomes evidence-based to implement lean in Indonesia. Methods: This study used a systematic literature review and searched PubMed, Scopus, Clinical key, Sciencedirect, EBSCO, and other related journals from 2009 to 2018 with syntax keywords for each database. Twenty-two articles were included in the reviewed. Results: The result showed that most journals discussed Lean reducing lead time and ALOS to improve the patient value and patient safety, as well as the amount of journal discussed about Lean made cost reduction in healthcare operational to improve efficiency. Conclusion: Lean implementation should be adopted by Indonesian hospitals as quality improvement and cost containment strategy and enhance patient safety under National Health Insurance era.

Utilization Review (Preadmission) Dental Services Before And After Implementation Online Referral System

Problem statement : The online tiered referral system is a digitalized referral system which has been implemented since October 1, 2018. The objective of this research is to find a general overview of the dental and oral health services in the era of national health insurance, before and after the online tiered referral system is implemented by looking at the diagnoses of Social Security Administrator for Health patients at Raden Mattaher Regional Hospital in Jambi Province. Method : Descriptive analytic research was conducted in this research by analyzing preadmission form and referral data of Social Security Administrator for Health patients at Raden Mattaher Regional Hospital in Jambi Province, which were received before and after the implementation of online tiered referral system. Results : Based on the distribution of patient referral data that came to Raden Mattaher Regional Hospital, it was shown that the number before the implementation was higher compared to after, with a total of 135 referrals and 85 referrals. In addition, the value of p 0.05 showed that there was no effect of the online tiered referral system on dental and oral health services at Raden Mattaher Regional Hospital which had been tested by SPSS Paired T-test with a significance value of 0.311 ( 0.05). Conclusion : The conclusion of this research is that the implementation of the online tiered referral system does not affect the dental and oral health services, especially in Raden Mattaher Regional Hospital in Jambi Province Keyword : Online Tiered Referral System; Utilization Review; Preadmission Certification

Health Workers' Job Satisfaction in the Era of National Health Insurance: Services and Working Conditions

Background: A person's perception of their level of justice (equity) at work is reflected in their level of job satisfaction. The nature of the work, salary, supervision, and relationships among coworkers are all factors that affect how satisfied one is with one's job. The number of patients treated by the Puskesmas in the National Health Insurance (JKN) is rising, with 586,893 persons (94.55%) in Jambi City enrolled as JKN participants at the Puskesmas. This study aimed to ascertain the relationship between services and working circumstances and the job satisfaction of healthcare professionals at the Jambi City Health Center in 2021 during the National Health Insurance (JKN) era. Methods: A cross-sectional design method was used in this investigation. The study's population comprised six hundred fifty-three healthcare professionals, and 92 respondents were nurses. Services and working circumstances are the study's independent variables, while job conditions are its dependent variable. Questionnaires are measurement devices. Univariate and bivariate data analyses were performed (using the chi-square test = 0.05). Results: Determine the association between the independent and dependent variables using bivariate Chi-Square analysis. The findings indicated that the relationship between job satisfaction and services had a p-value of 0.037, where 0.05. The correlation between favourable working conditions and job satisfaction is 0.023, with 0.05 as the reference value. Conclusion: In conclusion, there is a correlation between the services provided and the job happiness of healthcare professionals at the Jambi City Health Center and between working circumstances and job satisfaction.

User Expectations on Telemedicine Financing in the National Health Insurance Era

Telemedicine users have increased during the Covid-19 pandemic. Telemedicine can provide alternative solutions to improving quality, and access, and reducing disparities in health services, especially in urban and remote areas. However, in the era of national health insurance, not all telemedicine is covered by Healthcare and Social Security Agency (BPJS Kesehatan). This study aims to determine user expectations of telemedicine financing in the national health insurance era. This research is quantitative research with a descriptive approach which was conducted in February-April 2022. The respondents were 102 people who had used telemedicine services in Indonesia that were selected through the quota sampling method. The results showed that 95.1% of respondents agreed that telemedicine services were covered by the National Health Insurance (NHI), either fully or by sharing costs. As many as 31.95% of respondents expect 25% of cost-sharing with NHI, 35.05% of respondents expect 50% of cost-sharing with NHI, 12.37% of respondents expect 80% of cost-sharing with NHI, and 20.63 % hope 100% will be covered by NHI. Further and specific regulation related to telemedicine is needed. The type of telemedicine service covered communication with the telemedicine service provider, and the amount of the service fee covered needs to be communicated between the relevant parties

Analysis of Factors that Influence the High Reference Rate in the Health Center in the Era of National Health Insurance

The number of patient visits at the Tampo Health Center in Kendari City is known to be 30,540 patients in 2019 and in 2020 it decreased to 45.38% or 16,679 and in 2021 as of November it decreased from the previous number of 14.67%, namely 14,232. and it is known that the number of visits by BPJS participants until November 2021 is 28,350 participants who are registered at the first level health facility, namely at the Tampo Health Center, it is known that the population in the Tampo sub-district which is the working area of the Tampo Health Center is 34,366, thus there are only 17.50% still available. people who did not choose the first health facility at the Tampo Public Health Center. The total number of referrals in 2020 is 5336. From the data above, it is known that the number of referrals every month exceeds the set standard, which is above 15% and does not match the JKN referral standard. The purpose of this study is to determine the effect of the JKN Era Health services by increasing the number of referrals with the factors that cause referrals. This type of research is quantitative research with explanatory survey methods, research that explains causality and hypothesis testing. There is a significant influence with the existence of the JKN Era where the number of referral cases is known to be large and exceeds the reference standard, which is 15 percent.

Trends in Using Antibiotics in the Era of National Health Insurance in the City of Manado

Introduction: Antibiotic use needs to be monitored. Its irrational use causes resistance. Research aims to determine trends in antibiotic use. Methods: Observational research with retrospective data collection. Cross-sectional research design. Data about the availability of antibiotics from 2014 to 2017 in hospitals, health offices and PHCs in the city of Manado. Results: Trends of antibiotics used in PHC and health office in 2014–2017 were betalactam, macrolide, sulfamethoxazole-trimethoprim, and quinolone groups. Trends in secondary hospital were betalactam, sulfamethoxazole-trimethoprim, and quinolone groups. Trends in tertiary hospital are betalactam, quinolones, and other groups. Conclusion: Based on the data of five major antibiotics use in Manado City, there was a change in the pattern of antibiotic use, and this pattern tended to increase.

Hospital Business Strategy in the Era of National Health Insurance at Asysyifaa Leuwiliang Hospital

This research was conducted at Asysyifaa Hospital, Leuwiliang, Bogor Regency and in general this study aims to determine the right business strategy so that the hospital business can continue to grow and develop amid its support for the successful implementation of the National Health Insurance (JKN). BPJS Kesehatan is part of JKN which is a government policy in the health sector and aims to realize the implementation of providing decent health insurance for all Indonesians. The strategy that has been implemented by Asysyifaa Hospital Bogor needs to be developed based on the Business Model Canvas (BMC), IE Matrix, SWOT Analysis, and the four framework approach on the Blue Ocean Strategy, so that a new business model is obtained. Data were collected by interviews with informants. The selection of informants is determined through purposive sampling techniques. In addition data were obtained through questionnaires with the same informants, and a study of the literature. Several new strategies were successfully formulated and outlined in several elements of the business model of asysyifaa Hospital. Such improvements need to be developed and maintained in accordance with current conditions. Keywords: SWOT analysis, business model canvas, hospital industry, National Health Insurance (JKN), business strategy, blue ocean strategy.

Cases of Dispute and Pending Claims in Hospitals in the Era of National Health Insurance

Background: Indonesia began to implement a National Health Insurance System based on the National Social Security System in 2014 with the support of government regulations which states that Indonesia requires every citizen to have access to comprehensive and quality health services so that can continue their life through the National Health Insurance. Pending and dispute claims are problems that often occur in the era of national health insurance that can affect hospital budget allocation and planning policies, increasing the high cost burden for hospitals which will affect the quality of health services provided. The purpose of this study was to determine pending cases and dispute claims in hospitals in the Era of National Health Insurance.Methods: The study used a descriptive method with a qualitative approach. The data collection technique used is the observation method, namely directly to the e-claim file at several hospitals. 15 e-claim files taken in total from April – July 2021.Results: Obtained 13 cases of pending claims and 2 cases of dispute claims. Cases pending claims are caused by not complying with the code with evidence or resources, not in accordance with medical clinical practice guidelines and the rules of the health insurance provider.Conclusions: In coding, it is necessary to match the theory on the ICD-10, update the ICD-10. It is necessary to understand the rules and provisions made by the insurer and the related guidelines and rules. Please be aware of every latest code update.

ANALISIS RASIO LIKUIDITAS, RASIO PROFITABILITAS DAN SALES GROWTH PRA DAN PASCA BERLAKUNYA UNDANG-UNDANG BADAN PENYELENGGARA JAMINAN SOSIAL

The National Health Insurance Program is a compulsory social health insurance. This social security has good and bad effects. Its good effect is the community gets social protection in the form of health facilities. But it is estimated the adverse effects experienced by pharmaceutical companies. The price of the product in the era of the National Health Insurance has been determined by the government, where the price is below the company's production costs coupled with the deficit experienced by the Social Security Organizing Agency (BPJS) resulting in the company having to operate on a low profit and low margin basis. The purpose of this study is to identify financial conditions in the pre and post National Health Insurance era. The research method used is quantitative descriptive research method with financial ratio comparison analysis tools, namely liquidity ratios calculated through cash ratios, profitability ratios calculated through net profit margins and sales growth in the financial statements of PT Hexpharm Jaya Laboratories from 2009-2013 and 2014- 2018. The results showed that the liquidity ratio calculated by cash ratio and profitability ratio calculated with net profit margin was lower when the National Health Insurance was lower than the National Health Insurance. Sales growth experienced growth after the National Health Insurance.

Evaluation Managed Care Policy, Fraud Prevention and Commitment-Based Capitation in the Era of National Health Insurance in Bengkulu Province Used Realist Evaluation

Regulations related to health service quality policies in the era of National Health Insurance are needed to evaluate the effectiveness of programs based on sufficient evidence to become local as well as national policies. This research is important to do to support Universal Health Coverage (UHC) as issued by WHO. This study aims to evaluate the implementation of health service quality policy regulations and identify mechanisms of change and contextual factors that affect the implementation of regulations. Evaluation is carried out using a realist evaluation approach and analyzed in the form of a context, mechanism, and outcome configuration. The research was conducted in Bengkulu Province in 2018-2019 with the research subjects consisting of the director of the hospital, TKMKB, the fraud prevention team, the Health Office and the head of the Puskesmas. The sample selection used purposive sampling and data collection was carried out through in-depth interviews. Quality control and cost control (KMKB) programs, fraud prevention and Commitment-Based Capitation (KBK) are running in Bengkulu province. KMKB operates because of the SK which is always updated by BPJS Kesehatan every year, support from BPJS Kesehatan in the form of operational facilitation, coordination and incentives. The anti-fraud team in Bengkulu province in general has been formed at the district / city health office and hospital level, but not yet at the provincial level, this is because there is another team that has similar duties to the anti-fraud team at the provincial health office while at the health office district / city they are aware of the importance of the anti-fraud team. The KBK program shows that in general the target indicator for non-specialist referrals in Bengkulu province is achieved, namely 5%, but there are also city districts that have not been achieved, this is achieved because the Puskesmas has doctors in Bengkulu province, the competence of doctors is sufficient, adequate facilities and infrastructure, staff to receive capitation fund incentives, there is a JKN Monev team that is always active in conducting socialization, monitoring and evaluation at all Puskesmas, especially those that do not reach the target non-specialized referral indicator This study provides an overview of aspects of the context, mechanisms and outputs of health service quality policy regulations in the JKN era.