Implementation Of JKN Research Articles

Can a National Health Insurance Policy Increase Equity in the Utilization of Skilled Birth Attendants in Indonesia? A Secondary Analysis of the 2012 to 2016 National Socio-Economic Survey of Indonesia.

The Indonesian government has been implementing the National Health Insurance (Jaminan Kesehatan Nasional [JKN]) policy since 2014. This study aimed to evaluate JKN based on equity indicators, especially in skilled birth attendants (SBAs) use. The data were obtained from National Socio-Economic Survey of Indonesia during 2012 to 2016. To analyze the data, χ2 and logistic regression tests were applied. The respondents were married mothers from 15 to 49 years who had delivered a baby. Deliveries by SBAs increased at the national level, but this achievement showed significant variation according to geographical location. The coverage of deliveries by SBAs in the eastern areas of Indonesia was still much lower than those in the western areas. All factors determining SBAs utilization (health insurance ownership, education, household economic status, and geography factor) indicated the positive correlation (P < .05). The inequity of SBA use in differences in geographical location and socioeconomic status continues to occur after the implementation of JKN.

The Impact of Pharmaceutical Policies on Medicine Procurement Pricing in Indonesia Under the Implementation of Indonesia’s Social Health Insurance System

BackgroundIndonesia’s social health insurance (Jaminan Kesehatan Nasional, JKN) has been implemented since 2014. To support medicine provision, the government launched policies reform on medicine pricing, procurement and reimbursement; hence, the system might affect medicine prices in the country. ObjectiveTo evaluate the effects of the pharmaceutical policies reforms on medicine procurement prices. MethodsThis was a pre-post observational study. Medicine price data were collected retrospectively from the 2013 Ministry of Health procurement price list, the 2017 e-catalogue procurement system, and the procurement departments at 2 hospitals in Jakarta and Cilegon (both categorized as region I). The 2013 national procurement price was compared with the 2017 e-catalogue price. The hospitals’ procurement prices were collected from the data 3 years before and 3 years under Indonesia’s social health insurance JKN (2011-2016), and the data were used to assess the medicine procurement prices in real conditions. The outcome measure was the difference in procurement prices before and under the JKN. ResultsThe results showed that the procurement prices of 429 (79.6%) of 539 medicines listed in the 2017 e-catalogue decreased, of which 210 items (39.0%) showed over a 50% decrease. Nevertheless, the procurement prices of 104 items (19.3%) increased, especially those that were still under patent or those with a few brands registered in Indonesia. The procurement prices in public and private hospitals showed a similar trend, that is, a significant decrease. Interestingly, non–e-catalogue medicine prices also decreased quite steeply, although the prices of the branded generic category in the private hospital remained unchanged. ConclusionThe pharmaceutical policies under the JKN implementation had a profound impact on decreasing medicine procurement prices in Indonesia.

Factors Affecting Intensity Whistleblowing of Employees on The Potential Fraud of The National Health Insurance Program

The National Health Insurance Program (Jaminan Kesehatan Nasional /JKN) is an effort by the Government to fulfillment of the basic needs of public health. However, this program is also susceptible to fraud. Hospital as the Secondary Level Reference Facility that collaborates with the Social Security Agency (Badan Penyelenggara Jaminan Sosial/ BPJS) should establish a fraud prevention system in the JKN implementation. Employees’ positions are at the forefront to reveal various forms of fraudulence including those related to JKN by means of whistleblowing. The ‘Planned Behavior Theory’ analyzes the attitude, subjective norms and behavior control perception factors that affect the intention of JKN-claim related employees' to whistleblow. The purpose of this study was to determine and analyze the influence of attitudinal factors, subjective norms and perceptions of behavioral control on the intention of employee whistleblowing behavior on JKN fraud programs in Hospital X Central Java Province&#x0D; This study is a mixed-method study with a ‘sequential explanatory design’ approach. The study was started by using a quantitative method and then continued by means of qualitative method in order to produce a hopefully more complete study result.&#x0D; The results of the study prove attitudes (p-value 0.038), subjective norms (p-value 0.040) and perceptions of behavioral control (p-value 0.005) jointly influence the intention of employee whistleblowing. From the results of the OR it can be seen the order of the three independent variables that have the largest to the smallest influence on employee whistleblowing intentions, namely perceptions of behavior control, attitudes and subjective norms. This can be a reference to the management priority scale to make efforts to increase the intention of employee whistleblowing in Hospital X and is expected to be able to change the "silent culture" into and "culture of openness”.&#x0D; Jenis penelitian ini adalah penelitian mixed method dengan pendekatan sequential explanatory design. Diawali menggunakan metode kuantitatif dilanjutkan dengan metode kualitatif sehingga diharapkan diperoleh hasil penelitian yang lebih lengkap.&#x0D; Hasil penelitian membuktikan persepsi kontrol perilaku, sikap, norma subyektif secara berurut paling berpengaruh terhadap intensi whistleblowing pegawai. Namun masih perlu dilakukan upaya untuk meningkatan persepsi kontrol perilaku, sikap, norma subyektif agar intensi whistleblowing dapat menjadi perilaku whistleblowing pegawai sehingga dampak negatif adanya fraud JKN bagi organisasi dapat dicegah.

Compliance with Clinical Pathway for Cesarean Section Before and After the Implementation of JKN in Hospital X

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INDONESIAN PRIMARY CARE THROUGH UNIVERSAL HEALTH COVERAGE SYSTEMS: A FEELING IN BONES

Jaminan Kesehatan Nasional or JKN realized as the one of problem solving for equity of healthcare in Indonesian setting. At the same point, it has to compatible with all aspects in health financing issues by its newly adopted systems. This review aims to reveal JKN health financing policy since it implemented by 2014 in Indonesia. Several bibliographies databases were identified to conduct literature reviews that comprised of international and national/local journals. It founds that JKN principles focuses on mutual support, not-for-profit, good governance, and portability aspects. JKN enrollment consisted of two types polisholders including incapable polis insurance (PBI JKN) that bear by the Indonesian government, and capable polis insurance (none PBI JKN). JKN have to synergize with recent existing challenges including integration from previous regional health insurance (Jamkesda), healthcare facilities, package benefit, financing issue as well as the deficit issue which happened as lower dues that making by JKN polisholder than the high claim by the healthcare facilities particularly in hospitals. Although, JKN emerges to tackle the inequity of healthcare in all Indonesian regions, the existing settled Jamkesda in several regions, particularly regions with high regional income, made JKN integration as the setback health financing on its regions. Limited healthcare facilities that cooperated with BPJS-Kesehatan also challenged the JKN implementation as well as financial lose in affecting by mismatch between medical expenditures with JKN claimed as per package. It concludes that the political willing to choose several options including to prevent JKN deficit depend on the leader commitment to make JKN as not for another journey but it shall be the destination for health financing in Indonesia.

SWOT Analysis on JKN Implementation in Ngaliyan Health Center Semarang in 2016

ABSTRACT&#x0D; The position of Health Center (Puskesmas) as a first level health facility becomes the spearhead in good implementation of JKN (Jaminan Kesehatan Nasional or National Health Insurance). By using SWOT Analysis in 6M dimension (Men, Money, Method, Material, Machine, Market), it is expected to be an alternative for Ngaliyan Health Center to improve the work performance and become a reliable health facility for Ngaliyan citizens. And it can support the realization of totally covered insurance in 2019. This study aims to explore the strengths, weaknesses, opportunities, and threats to the Ngaliyan Health Center in organizing JKN service in 6M dimension (Men, Money, Method, Material, Market, Machine), to find the critical point and make KSF (Key Success Factor). The research is qualitative descriptive with structured in-depth interview approach. Using 15 informants selected by purposive sampling. The results of this study obtained a critical point that is on the dimension of money. There was a deficit between capitation and expenditure funds of the Health Center in the implementation of JKN.&#x0D; &#x0D; ABSTRAK&#x0D; Kedudukan puskesmas sebagai fasilitas kesehatan tingkat pertama menjadi ujung tombak pelaksanaan JKN yang baik. Dengan menggunakan Analisa SWOT dalam dimensi 6M (Men, Money, Method, Material, Machine, Market) diharapkan menjadi alternatif bagi puskesmas ngaliyan untuk meningkatkan prestasi kerja dan menjadi fasilitas kesehatan yang diandalkan bagi warga Ngaliyan. Serta bisa mendukung terwujudnya totally covered di tahun 2019. Penelitian ini bertujuan untuk mengeksplorasi Kekuatan, Kelemahan, Peluang, dan Ancaman bagi puskesmas Ngaliyan dalam menyelenggarakan pelayanan JKN dalam dimensi 6M (Men, Money, Method, Material, Market, Machine), untuk menemukan titik kritis, serta membuat FKK (Faktor Kunci Keberhasilan). Penelitian berupa kualitatif deskriptif dengan pendekatan wawancara mendalam terstruktur. Menggunakan 15 orang informan yang dipilih secara purposive sampling.Hasil penelitian ini didapatkan titik kritis yaitu pada dimensi money. Terdapat defisit antara dana kapitasi dan biaya yang dikeluarkan puskesmas dalam pelaksanaan JKN.&#x0D;

STRATEGI SWITCHING PREMI DALAM PENGUMPULAN DANA MASYARAKAT SEKTOR INFORMAL SEBAGAI UPAYA PENCEGAHAN KETERLAMBATAN PEMBAYARAN PREMI JAMINAN KESEHATAN NASIONAL

The increase in the budget deficit BPJS in the first 3 years of implementation JKN require special attention. One of the problems in the implementation of JKN is high late payment of premiums by the participants of the Non PBI Mandiri.&#x0D; The purpose of this study was to determine the participants' perceptions of Non PBI Mandiri to the recommendations transition strategy JKN premium payer. &#x0D; This study is a policy with qualitative descriptive approach. The study design used policy aims to draw up a recommendation is the Case Study on the phenomenon of late payment of premiums. Depth interviews with 11 informants participants Independent Non PBI done with purposive sampling quota system. &#x0D; The result showed that the presence of positive consequences as the public response to the concept of a transitional strategy premium payer. Participants claimed to be greatly assisted if the program was held because it can ease the burden of their medical expenses when his advanced age and does not have income again, providing peace in the certainty of change of insurer premiums in non-productive age. &#x0D; Conclusion of the study were breakthrough made in a transitional strategy premium payer has received positive responses from the public policy goals.

STRATEGI SWITCHING PREMI DALAM PENGUMPULAN DANA MASYARAKAT SEKTOR INFORMAL SEBAGAI UPAYA PENCEGAHAN KETERLAMBATAN PEMBAYARAN PREMI JAMINAN KESEHATAN NASIONAL

The increase in the budget deficit BPJS in the first 3 years of implementation JKN require special attention. One of the problems in the implementation of JKN is high late payment of premiums by the participants of the Non PBI Mandiri.&#x0D; The purpose of this study was to determine the participants' perceptions of Non PBI Mandiri to the recommendations transition strategy JKN premium payer. &#x0D; This study is a policy with qualitative descriptive approach. The study design used policy aims to draw up a recommendation is the Case Study on the phenomenon of late payment of premiums. Depth interviews with 11 informants participants Independent Non PBI done with purposive sampling quota system. &#x0D; The result showed that the presence of positive consequences as the public response to the concept of a transitional strategy premium payer. Participants claimed to be greatly assisted if the program was held because it can ease the burden of their medical expenses when his advanced age and does not have income again, providing peace in the certainty of change of insurer premiums in non-productive age. &#x0D; Conclusion of the study were breakthrough made in a transitional strategy premium payer has received positive responses from the public policy goals.

The Implementation of National Health Insurance (JKN) in Kediri City

This article aims to implementation of National Health Insurance in Kediri City that was not going smoothly and to know about advantages and disadvantages of the implementation of national health insurance (JKN) in Kediri City. The implementation of JKN was not going well, because participant did not know their first health service and they did not know about procedure of JKN. So every stakeholder like BPJS (Social Security Administrative Bodies), Health Departement, and Health facility must give information to participant about the regulation. The advantages are: the new rules are immediate to implement, Puskesmas has adequate facility, P-care program, Identity card can use to get treatment in Puskesmas. The disadvantages are priority, lack of information, system information, lack information between health facility, and the 40% of capitation fund.

Analysis of First Level Health Care Facility (FKTP) Readiness as 'Gatekeeper' on The JKN Implementation in East Kalimantan and Central Java Year 2014

Background: FKTP as a gatekeeperhas four function such us: the fi rst contact, sustainability, comprehensive healthcare and coordination. Readiness from input aspects on health care involves health care facilities, fi nance, humanresources, medicines and medical devices. This research is to identify the FKTP readiness as a gatekeeper in the inthe implementationof JKN in East Kalimantan and Central Java. Methods: Data collection wasby conducting interviews,observation and documents’ review. The data analysis techniques were descriptive statistics for quantitative and Miles,Huberman and Spradley concept qualitative. There were 6 health centers, 2 primary clinics, 6 doctors and 3 private dentistryclinics for each province. Results: The numbers of FKTP availability were 23.7 health centers and 3.2 primary clinics perdistrict/city. The average was 51.7 FKTP per district/city. Not all of primary clinics facilited by inpatient care. There were44% primary clinics facilitated by laboratory and 56% in collaboration with privatelaboratory. The highest ratio of numberof members by the population was Surakarta i. e. 1 member by 1.98 population. While, the lowest was East Kutai with 1member by 4.65 population. All health centres had been implementing gatekeeper functions. Most of primary clinics had beendone the functions while less of them had not already implemented excellent service yet. Phycisians had implemented theirfunctions as the fi rst contact and coordination very well. Moreover, dentist did the same as the fi rst contact. Conclusion:Availability of health centers as FKTP was adequate. Health centers were also ready to function as a gatekeeper for JKNimplementation. Primary clinics were ready for the fi rst contact and coordination; and dentist as the fi rst contact were allready. Recomendation: The numbers of health facilities need to be build and improved according to district/city’s capability.Moreover, health workers’ distribution should be focussed to primary health care.

IMPLEMENTASI KEBIJAKAN TATAKELOLA PESERTA PROGRAM JAMINAN KESEHATAN NASIONAL DI JATIM

Health insurance system is one of the important components in ensuring theneeds of basic human rights, namely health. Government as theimplementing regulations in the fulfillment of basic rights such as healthhave been doing the development, guidance, and acceleration in organizinghealth care. So that the government is very strategic role in theimplementation of the National Health Insurance program (JKN). But thereis one problem JKN program implementation, namely the weakmanagement of the participants. It affects both services and financing JKNprogram. There have been several studies that analyze these problems,among others, the study of health care seeking behavior of participants ofpublic health insurance, the readiness of stakeholders in the implementationof JKN, and the program participant data JKN invalid and not targeted. Sothat in this research conducted a study which aims to analyze themanagement of participants through the method of interpretation, describe,analyze, and the build a model of the implementation of managementpolicies of insured people, and the synchronization of the health insuranceprogram regional level into the health insurance system nationwidemanaged by BPJS Health in the Province of East Java. The results showedthat participants in the program management JKN is not optimal, andcurrently poor people who can not be accommodated in the management ofContribution Recipient (PBI) has been well managed by the regionalgovernment, through the Regional Health Insurance program. Further theparticipant management implementation model is not effective as a modelof policy implementation of Van Metter and Van Horn due to weakoversight of the bureaucratic system and the human resources involved inthe implementation of the management of the participants. Keywords : Implementation of policy, National Health Insurance (JKN), management of participants.

Indonesia: On the Way to Universal Health Care

—Indonesia has been building a National Social Security System since 2004. Formal action to build the health component in the system (National Social Health Insurance Scheme, or JKN) started in 2005. In line with the JKN roadmap, full achievement of Universal Health Care is not expected until 2019. Preparations before the launch of JKN on 1 January 2014 involved multi-level and multi-sector efforts related to issues of equity of access, coverage, finance, quality of care (infrastructure, pharmaceuticals and medical devices, medical education), management information, and fees and tariffs. This commentary by Indonesia's Minister of Health examines the preparations and first eight months of JKN, and briefly discusses these various issues as well as the policy and practices in place at the time of launch. The article includes information on the early implementation of JKN and four lessons learned from the Indonesian experience of developing and launching national social health insurance: the importance of strong political commitment; the role of comprehensive analysis of the national health system; the use of multiparty participation in developing and implementing the plans; and the importance of systematic, continuous monitoring and evaluation from technical and administrative perspectives as well as patient satisfaction, to assure progress toward Universal Health Care.