Implementation Of National Health Insurance Research Articles

Comparative Politics, Political Settlements, and the Political Economy of Health Financing Reform Comment on "Health Coverage and Financial Protection in Uganda: A Political Economy Perspective".

Nannini et al analyze barriers to national health insurance reforms in Uganda using a political economy approach primarily rooted in stakeholder analysis. This approach is valuable, not only for its clear description of the interest-based politics at play, but also for its extension of stakeholder analysis to include consideration of the role of ideas and institutions in the policy process. However this analysis, and others like it, could be further strengthened by adding insights from two different sources. The first is the comparative politics literature on the Ugandan regime. The second is a related approach which analyzes public service delivery in the context of a country's underlying "political settlement." Stakeholder-based approaches to health financing reform emphasize interest group conflict about the contents of policy reforms. By contrast, these complementary approaches imply distinct barriers to successful implementation of national health insurance in Uganda, rooted in the regime's de-industrialization and the personalization of politics and resource allocation. They also suggest possible leverage points or avenues for progress which differ from those suggested by stakeholder analysis.

Willingness to pay for a National Health Insurance (NHI) in Saudi Arabia: a cross-sectional study

BackgroundHealthcare services in Saudi Arabia are provided free of charge to its citizens at the point of use. Recently, however, the government has realized that this model is unsustainable in the long run. Therefore, Saudi decision-makers are seeking to have a sustainable health system through the introduction of a contributory National Health Insurance that require making regular financial contributions from its members.ObjectiveThis study aims to explore the people’s willingness to pay for a National Health Insurance system in Saudi Arabia. The study also aims to understand the factors affecting their willingness or unwillingness to pay NHI, such as, their demographic and socio-economic characteristics, the type of their usual health care provider, and their satisfaction with the current healthcare services.MethodsA cross-sectional study design with Contingent Valuation (CV) technique was used to measure the value of National Health Insurance based on an individual’s willingness to pay. The data were collected from 475 participants using an online survey via Google Forms between March 2021 and April 2021. Frequencies, logistic regression, and linear regression, were conducted to answer the research questions.ResultsThe number of individuals who was willing to pay for NHI was higher than those who were not willing to pay (62.9, 95% CI = 58.4-67.3%) vs (37.1, 95% CI = 32.7-41.6%). A binomial test found this difference was statistically significant (p < 0.001). There was a significant association between the likelihood of paying for NHI and type of usual healthcare provider (OR = 3.129, 95% CI = 1.943-5.039, p < 0.001); as individuals using public health services were more likely to pay for NHI. Also, with satisfaction with health services (OR = 14.305, 95% CI = 3.240-63.153, p < 0.001), as individuals who were very satisfied with the healthcare services were more likely to pay for NHI. The median amount of money the people were willing to pay as a monthly contribution for NHI was 100 SAR (26.5 USD) with the average being 152 SAR (40 USD). There was a significant association between the maximum amount the participants were willing to pay and age, region, and education. Specifically, 30–39-year-olds were willing to pay more for NHI compared to participants aged 50 or older (ß = 103.55, 95% CI = 26.27- 199.29); participants from central region more than participants from northern region (ß = 70.71,95% CI = 2.14- 138.58); and participants with masters degree more than participants with PhDs (ß = 227.46, 95% CI = 81.59- 399.28).ConclusionThis study provided some evidence that more people were willing to pay for NHI than those who declined. Individuals who frequently used public health services and were very satisfied with these services were more willing to pay for NHI. Younger population, those with master’s degree, and from the central region were willing to pay more amount of money for NHI. These results could help policy makers shape their decisions and anticipate problems that may arise with NHI implementation.

Efficacy and Safety of Topical Urea for Treatment Atopic Dermatitis as a Reference in the National Drugs Formulary

Atopic dermatitis (AD) is a chronically relapsing skin disease that occurs most commonly during early infancy and childhood. One of the most important clinical features of AD which results from a dysfunctional epidermal barrier (EB) is very dry skin (xerosis). Moisturizers are often used as supplements to topical and/or systemic anti-inflammatory drugs in various types of skin conditions and disorders. Humectan, this class of moisturizer is used to improve the appearance and texture of skin by filling in the crevices between corneocytes. One of the humectant included in the list of the National Drugs Formulary that is needed and must be available at health service facilities as a reference in the implementation of National Health Insurance (NHI) is urea. The literature searches using Pubmed, Academia, Google scholar and published in the last 10 years. Urea is effectively increasing skin hydration as well as niacinamide, significantly reducing local Scoring Atopic Dermatitis (SCORAD) and stratum corneum (SC) hydration. Urea had a decrease in transepidermal water loss (TEWL) which was not significantly better than lanolin and ceramide. The ceramide had a lower mean Visual Analogue Scale (VAS) score for irritation compared with the urea. More participants also preferred the ceramide-based cream over the urea. Urea is an effective and safe treatment although not as well as ceramide. Ceramide has been shown to be more effective and less irritating than urea. Ceramid can be quite expensive, while urea is a moisturizer that is easily found and accessible to the public.

Evaluation of National Health Insurance Program Implementation in Jakarta Province, Indonesia

The implementation of National Health Insurance in several regions in Indonesia faces challenges, such as health service providers, health insurance management , and the community. The outcome that occurs may vary depending on the implementation of different aspects of governance, equity or social justice, and aspects of service quality. Therefore, research was conducted by evaluating the implementation of the national health insurance in DKI Jakarta Province. The evaluation is carried out based on the 2019 JKN road map target indicators, grouped into three aspects: including governance, achievement of equal distribution of health services (equity), and quality of service. This research used a mixed-methods design that combined the approach of quantitative and qualitative elements. Quantitative data were collected from secondary data from Health Social Security Agency (BPJS Kesehatan), the National Social Security Council Monitoring and Evaluation System (Sismonev DJSN). The qualitative data comes from in-depth interviews with selected informants using the purposive sampling technique. The result was that DKI Province had achieved the JKN membership target. There are still JKN participants who are inactive / in arrears from participants in the government and private wage-earning segments. Health facilities and human health resources have met the standards, but related to the package of benefits for heart diseases services, the availability of cardiac specialists and cath lab facilities has not been evenly distributed, especially in the Seribu Islands. Patient preferences in choosing the desired health service resulted in implementing a tiered referral system and back-referral still having problems in health facilities.

The views of public service managers on the implementation of National Health Insurance in primary care: a case of Johannesburg Health District, Gauteng Province, Republic of South Africa

BackgroundThe South African government is implementing National Health Insurance (NHI) as a monopsony health care financing mechanism to drive the country towards Universal Health Coverage (UHC). Strategic purchasing, with separation of funder, purchaser and provider, underpins this initiative. The NHI plans Contracting Units for Primary healthcare (PHC) Services (CUPS) to function as either independent sub-district purchasers or public providers and District Health Management Offices (DHMOs) to support and monitor these CUPS. This decentralised operational unit of PHC, the heartbeat of NHI, is critical to the success of NHI. The views of district-level managers, who are responsible for these units, are fundamental to this NHI implementation. This qualitative study aimed to explore district and sub-district managerial views on NHI and their role in its implementation.MethodsPurposive sampling was used to identify key respondents from a major urban district in Gauteng, South Africa, for participation in in-depth interviews. This study used framework analysis methodology within MaxQDA software.ResultsThree main themes were identified: managerial engagement in NHI policy development (with two sub-themes), managerial views on NHI (with three sub-themes) and perceptions of current NHI implementation (with six sub-themes). The managers viewed NHI as a social and moral imperative but lacked clarity and insight into the NHI Bill as well as the associated implementation strategies. The majority of respondents had not had the opportunity to engage in NHI policy formulation. Managers cited several pitfalls in current organisational operations. The respondents felt that national and provincial governments continue to function in a detached and rigid top-down hierarchy. Managers highlighted the need for their inclusion in NHI policy formulation and training and development for them to oversee the implementation strategies.ConclusionsIt appears that strategic purchasing is not being operationalised in PHC. NHI policy implementation appears to function in a rigid top-down hierarchy that excludes key stakeholders in the NHI implementation strategy. The findings of this study suggest an inadequate decentralisation of healthcare governance within the public sector necessary to attain UHC. District managers need to be engaged and capacitated to operationalise the planned decentralised purchasing-provision function of the DHS within the NHI Bill.

The views of public service managers on the implementation of National Health Insurance in primary care: a case of Johannesburg Health District, Gauteng Province, Republic of South Africa

The views of public service managers on the implementation of National Health Insurance in primary care: a case of Johannesburg Health District, Gauteng Province, Republic of South Africa

The perceptions of professional nurses regarding factors affecting the provision of quality health care services at selected rural public clinics in the Capricorn district, Limpopo Province.

BackgroundDespite many initiatives made by the National Department of Health through the Minister of Health, the provision of quality health care services remains a serious challenge in South Africa, especially in public rural clinics.AimThe study aims to determine the perceptions of professional nurses on the factors affecting the provision of quality health care services at selected public primary health care clinics in rural areas of the Capricorn District, Limpopo Province.SettingThe study was conducted at selected public primary health care clinics in rural areas of the Capricorn District, Limpopo Province.MethodsThis study utilised a quantitative method, descriptive and a cross-sectional study conducted for three months at the selected public primary health care clinics. A structured self-administered questionnaire was used to collect data from 155 professional nurses who met the selection criteria. Data were analysed using Statistical Package for Social Sciences programme version 26.0.ResultsThe results of 155 professional nurses were only 116 (74%) and reported that the use of modern technology such as electronic blood pressure, sonar machines and pulse reading computers improves the quality of health care services. Also 129 (84%), 124 (77%) and 118 (76%) reported that they were overwhelmed by the workload, the staff attitude and cleanliness of the clinic, respectively, which all affect the quality of health care services rendered. Moreover, only about 29 (19%) were satisfied with the salary they earned.ConclusionDespite the effort and interventions put in place by the Department of Health with regard to the Ideal Clinic Realisation and Maintenance in response to the current deficiencies in the quality of primary health care services and to lay a strong foundation for the implementation of National Health Insurance. The quality of health care services is still hindered by several factors such as an overwhelming workload, the attitude of the staff and cleanliness in the work environment, poor infrastructure and the professional nurses perceive the environment as lacking equipment.

Analysis Of Prescription of National Formularium Medicines Based on The Adjustment of Restriction in Public Hospitals of Sawah Besar 2018

Health services provided to the public in the implementation of the National Health Insurance (NHI) includepromotional, preventive, curative and rehabilitative. In supporting the implementation of NHI, it is necessaryto make eff orts to ensure the availability, aff ordability and accessibility of medicines through the application of the National Formulary (Fornas) as a reference in health services in all health facilities. The purpose of this study was to determine the percentage of prescription drugs in accordance with the National Formulary at Sawah Besar Hospital in 2018. The research design descriptive analysis and data collection was carried out retrospectively in the form of prescribing drugs and from the Hospital Management Information System and Patient Medical Record data. This research was conducted with a sample size of around 19.690 recipes and a length of 6 months of research from July 2018 to December 2018. From the results of the study pattern of prescription writing against the suitability of the National Formulary was 71.22%. Compatibility of 75% antihyperlipidemic drugs with atorvastatin as the drug with the most non-conformity of restrictions. The conformity of antihypertension drugs 54.11% with Valsatran as one of the inconsistencies in restriction and insulin drugs, 70.03% the antihyperglycemia drug restriction inconsistencies.

Is the routine health information system ready to support the planned national health insurance scheme in South Africa?

Implementation of a National Health Insurance (NHI) in South Africa requires a reliable, standardized health information system that supports Diagnosis-Related Groupers for reimbursements and resource management. We assessed the quality of inpatient health records, the availability of standard discharge summaries and coded clinical data and the congruence between inpatient health records and discharge summaries in public-sector hospitals to support the NHI implementation in terms of reimbursement and resource management. We undertook a cross-sectional health-records review from 45 representative public hospitals consisting of seven tertiary, 10 regional and 28 district hospitals in 10 NHI pilot districts representing all nine provinces. Data were abstracted from a randomly selected sample of 5795 inpatient health records from the surgical, medical, obstetrics and gynaecology, paediatrics and psychiatry departments. Quality was assessed for 10 pre-defined data elements relevant to NHI reimbursements, by comparing information in source registers, patient folders and discharge summaries for patients admitted in March and July 2015. Cohen's/Fleiss’ kappa coefficients (κ) were used to measure agreements between the sources. While 3768 (65%) of the 5795 inpatient-level records contained a discharge summary, less than 835 (15%) of diagnoses were coded using ICD-10 codes. Despite most of the records having correct patient identifiers [κ: 0.92; 95% confidence interval (CI) 0.91–0.93], significant inconsistencies were observed between the registers, patient folders and discharge summaries for some data elements: attending physician’s signature (κ: 0.71; 95% CI 0.67–0.75); results of the investigation (κ: 0.71; 95% CI 0.69–0.74); patient’s age (κ: 0.72; 95% CI 0.70–0.74); and discharge diagnosis (κ: 0.92; 95% CI 0.90–0.94). The strength of agreement for all elements was statistically significant (P-value ≤ 0.001). The absence of coded inpatient diagnoses and identified data inaccuracies indicates that existing routine health information systems in public-sector hospitals in the NHI pilot districts are not yet able to sufficiently support reimbursements and resource management. Institutional capacity is needed to undertake diagnostic coding, improve data quality and ensure that a standard discharge summary is completed for every inpatient.

Willingness to pay for primary health care at public facilities in the Western Cape Province, Cape Town, South Africa

Background and objectives As facilities are being prepared for the implementation of National Health Insurance (NHI) in South Africa, there is a pressing need to understand how the public equates the provision of health services at Primary Health Care (PHC) centres with monetary value. Accordingly, this exploratory study was designed to ascertain the willingness to pay (WTP) for public primary healthcare services in South Africa and to identify factors that influence the WTP. Methods The study was conducted in Cape Town, South Africa, among 453 persons presenting at two public primary health care centres, namely Bothasig Community Day Centre (CDC) and Goodwood CDC. The study used the contingent valuation range methodology. Descriptive statistics, multiple logistic and tobit regression analyses were conducted to assess demographics, socio-economic, and health access factors that influence WTP. Results Overall, 60% of participants were willing to pay for services offered at the PHC facilities. The average willingness to pay for all participants was 49.44 ZAR, with a median of 25 ZAR. The multiple logistic regression for grouped facilities showed unemployment, public transport, and the facility attended to be significant while public transport, facility visits, and facility attended were the only significant variables in the tobit model. There was less willingness to pay for those unemployed in comparison with students, those using public transport rather than walking, those frequenting the facilities more than first-time visitors and those attending Goodwood facility in comparison with Bothasig. Conclusion This study revealed factors related to the participants’ WTP and to their willingness to contribute towards the health service, though at very low amounts. Understanding the economic value placed upon a service provided in a facility is essential in decision-making for quality care improvements, especially as the South African health system is making the facilities ready for NHI.

AN INVESTIGATION INTO STRATEGIC MANAGEMENT ADJUSTMENTS MADE BY AFROCENTRIC GROUP IN PREPARATION FOR THE NATIONAL HEALTH INSURANCE (NHI) IMPLEMENTATION IN GAUTENG PROVINCE

Ponte Academic JournalDec 2021, Volume 77, Issue 12 AN INVESTIGATION INTO STRATEGIC MANAGEMENT ADJUSTMENTS MADE BY AFROCENTRIC GROUP IN PREPARATION FOR THE NATIONAL HEALTH INSURANCE (NHI) IMPLEMENTATION IN GAUTENG PROVINCEAuthor(s): Jeremiah Madzimure ,Anton M. Pillay, M.M. XimbaJ. Ponte - Dec 2021 - Volume 77 - Issue 12 doi: 10.21506/j.ponte.2021.12.7 Abstract:This study aimed to explore and understand strategic adjustments that had been made by the largest medical scheme administrator in South Africa, Afrocentric Group to prepare for the NHI implementation in the Gauteng province. The study followed an exploratory qualitative approach and data was collected through semi-structured interviews in which 10 participants occupying middle to senior management positions in their various organisations took part. The most predominant theme that emerged from the interviews was that of partnerships and collaboration between the public and private healthcare sectors to make NHI a success. The findings revealed the significant role that medical schemes and medical scheme administrators such as the Afrocentric Group can play before and after the initial implementation of NHI. Private healthcare organisations already have the knowledge, expertise and digital systems needed to make NHI a reality. In addition, medical schemes and administrators could play a key role in providing public education and creating products and services that are based on the primary healthcare concept. This would help contribute towards expanding healthcare access to more members of the community and would expedite the general understanding of NHI. Download full text:Check if you have access through your login credentials or your institution Username Password

Multicentre survey of retinopathy of prematurity in Indonesia

BackgroundThe incidence of retinopathy of prematurity (ROP) is higher in Indonesia than in high-income countries. In order to reduce the incidence of the disease, a protocol on preventing, screening and...

Outpatient Care Utilization among Elderly in South Sumatra Based on National Social-Economic Survey Data

Implementation of National Health Insurance is thought to be the cause ofincreasing number of visits to health facilities, especially in elderly peoplewho tend to be in sick. This study aims to analyze the outpatient utilizationby elderly in South Sumatera region. Study design was cross-sectional.Samples was elderly in South Sumatra (n = 2,833 people). Study done on2016, using data from Survei Sosial Ekonomi Nasional (Susenas) at 2015. Dataanalysis used chi-square test and multiple logistic regression. Based on thestudy known that outpatient utilization of elderly in all health facilitiesduring the past month amounted to 29.2%. Providers selected when elderlyneeded of outpatient treatment, most often visited to the doctor&amp;#39;spractice/midwife&amp;#39;s practice (46.2%), and puskesmas (24.2%). Elderly whohas private health insurance have a tendency was 1.9 times greater (OR=1.9)to utilize outpatient compared to elderly who do not have insurance. Itsconcluded that variables associated with outpatient care utilization are:health insurance membership (OR=1.9) and work activity (OR=1.5). It isrecommended for elderly to remain active in their activities so that they canrealize the healthy and active aging and reduce the sick visits to healthfacilities.

Distribution of students admitted to dental schools of general universities in Taiwan in 2020

Background/purposeIn Taiwan, the average income of a dentist increases after the implementation of national health insurance in 1995. Thus, the domestic departments of dentistry become a popular choice of university departments for high school graduates. The purposes of this study were to evaluate the distribution of students admitted to dental schools of general universities in each city or county in 2020 and to further compare the differences in regional distributions of dental freshmen accepted by three admission ways in 2020. Materials and methodsThis study collected the number of dental freshmen of general universities in each city or county in 2020 for further evaluating the differences in regional distributions of dental freshmen accepted by three admission ways in 2020. ResultsThe distribution of dental freshmen in 2020 did have a big urban-rural gap. These dental freshmen were more concentrated in municipalities than in non-municipalities in Taiwan. The execution of three admission ways did play a role in balancing the urban-rural gap in the distribution of dental freshmen. ConclusionThe urban-rural gap of the distribution of dental freshmen was not larger than that of dentists. The increased guaranteed enrollment quota of dental freshmen for the high school graduates in the offshore islands do cause unequal opportunities of admission to dental schools. If these extra-enrolled dentists do not return to their hometowns to practice, this may worsen the surplus of dentists and may fail to improve the uneven distribution of dentists in Taiwan.

The impact of multilevel referral system in patients with peritonitis in Indonesia: A cross-sectional study

BackgroundPeritonitis requires emergency surgery, and delays in treatment can lead to death. We aimed to determine the correlation between the periods from onset to hospital admission with postoperative mortality for patients with peritonitis and to compare it with the effect of national health insurance implementation. MethodsThis study was a cross-sectional study conducted at a tertiary health center in Indonesia. We ascertained 150 patients with peritonitis from January 2012–December 2015. ResultsOne hundred and fifty patients were ascertained, including 72 patients before National Health Insurance (NHI) era and 78 patients after the NHI era (Males: 90 vs females: 60). The most frequent age group was age 46–65 years (44.67%). The period between onsets to hospital mainly occurred within 24–72 h (42%). Most of the patients had some comorbidity with one or more diseases (52.67%). Mortality was found in as many as 61 people (40.67%). The highest etiology of peritonitis was appendix perforation (28%) and gastric perforation (22%). Mortality was most common in the period between onset to time treated within 24–72 h (N:35; 23.33%) (P < 0.05). Before the NHI era, the period between onset to time treated was mostly after > 72 h (18.66%), whereas after the NHI era it was mostly within 24–72 h (25.33%) (p < 0.05). ConclusionThe multilevel referral system implemented in the NHI era significantly affects the time-to-treat and outcome of patients with peritonitis.

Analysis of integrated health referral systems in the era of regional autonomy in West Sulawesi

This research was conducted to find out and analyze the integrated health referral system in the era or region autonomy in Mamuju Regency, West Sulawesi Province. The literature review is carried out through international and national journal literature, government regulations. The search was carried out through Elsevier, DOAJ and the Google Scholar search engine for the period 2014-2018. The inclusion criteria for this study were the type of health insurance reference and regional autonomy. We include 14 journals. This developed referral system regionalization provides an opportunity for border communities and for primary level service providers to make referrals for patients to the nearest advanced-level health care provider. For example, people who are in the border health center area of the Majene Regency and Mamuju Regency can be referred to the District Hospital in the regency. Mamuju which is closer and easier in terms of accessibility. The implementation of national health insurance (JKN) in Indonesia since 2014 has provided a referral system to ensure public access to quality and accreted health services. However, there are various obstacles in its implementation considering the geographical area of the islands.

ANALISIS FAKTOR-FAKTOR KESIAPAN DAN DUKUNGAN STAKEHOLDERS TERHADAP PERUBAHAN STATUS MENJADI BADAN LAYANAN UMUM DAERAH (STUDI PADA PUSKESMAS-PUSKESMAS DI KABUPATEN KLATEN)

This research is motivated by Letter of Minister of Domestic Affairs number 440/8130/SJ dated November 13th, 2013 on Optimizing the Implementation of National Health Insurance that describes the acceleration of puskesmas (community health center) change to Public Service Agency (Badan Layanan Umum Daerah/BLUD). Meanwhile, Klaten Regency Government has planned policy implementation of full BLUD for all puskesmas starting in 2017, while the results of BLUD readiness questionnaire show that only 41% puskesmas confirmed their readiness. This study aims to analyze the influencing factors of puskesmas readiness to change to BLUD and to determine the extent of supports from stakeholders and organizational commitment in implementing BLUD policy in Klaten Regency. The theory of organization change readiness by Weiner (2009) is used as research framework to assess the extent to which organization members appreciate the three determinants of implementation ability, namely task demands, resource availability, and situational factors. Research method implemented in this study is descriptive qualitative, with the data is collected through in-depth interviews with respondents who answering the questionnaire with "ready", "doubtful" and "not ready". The results of data analysis can be concluded that there are five factors that affect puskesmas readiness to transfer to BLUD, namely commitment to task demands, availability of resources, managerial skills of puskesmas head, regulatory preparedness, and stakeholders’ support in the implementation of changes into BLUD status. All stakeholders in Klaten Regency support this program and organizational commitment of puskesmas constructed by understanding the work and advantage of BLUD program to puskesmas.

Potential of Hospital Fraud in the Indonesia National Health Insurance Era (A Descriptive Phenomenological Research)

Results of the Public Research Anti Corruption Clearing House The Corruption Eradication Commission submitted on December 2, 2016 that until mid-2015 there was a potential of 175,774 hospital claims of fraud that had been detected with a value of Rp. 440 M. In 2016 found an indication of 1 million fictitious claims from the hospital with a value of Rp. 2 trillion. The potential for fraud in hospitals in the era of National Health Insurance (NHI) in Indonesia will have an impact on health financing inefficiencies and at the same time a threat to the sustainability of the NHI program which is expected to reach Universal Health Coverage in 2019. This phenomenological study aims to explore understanding and meaning of the concept of fraud for parties who has had the potential to commit fraud at the hospital. The research method used qualitative research with a Descriptive Phenomenology Research approach. The informants were officers who served patients in administrative and medical matters and the hospital management was selected by purposive sampling. The focus of the study was the experience felt by informants in running the NHI program and how knowledge and attitudes of informants towards the phenomenon of fraud in hospitals. The results achieved in this phenomenological research were in the form of a reflection of the implementation of NHI in hospitals, especially relating to the phenomenon of potential fraud reflected in the knowledge and attitudes of the hospital about fraud and a description of the occurrence of fraud in the hospital. This is the basis for researchers to formulate indicators of potential fraud that still needs to be tested in a larger population.

Health insurance literacy: discussion and reaction of Facebook users' towards the National Health Insurance in Indonesia.

Universal Health Coverage always persevered as a pro poor policy in many countries, characterized by a major impact on higher out-of-pocket healthcare costs, with low-cost alternative prescription drugs and capitation payments made to physicians, in order to reduce inequity. These concerns have been discussed widely on social media, including Facebook, but social media are consistently neglected as a source of scientific information. The purpose of this study, therefore, is to analyze the thought process or feelings of individuals about the policies, also focusing on the possible reactions. Hence, a systematic review in the form of discussion forums on the Facebook page of the National Health Insurance Agency, Indonesia was conducted from 2015 to 2016, with regards to the implementation of National Health Insurance, within a year and half after the policy was launched. In addition, the contents of 148 discussions were deductively analyzed, and the findings showed the pragmatic disposition of most Facebook users towards health care utilization, the costs of Insurance, and the possible benefits of payment. Furthermore, the debate conducted in social media related with the policy and its practice issues ought to be countered through appropriate modification.Significance for public healthSocial media has been incorporated for the communication of health strategies in Indonesia, through the discussions related to National Health Insurance policies. Social media can provide opportunities to better understand the concept of health insurance literacy and facilitate growth in social norms and skills, as participants of online forums. Until now, there is a deficiency in studies related to the use of social media as source of news where people pay attention to specific issues. This study analyzes the thought process and feelings of individuals, as well as the reaction towards the National Health Policies implemented.

DOES MORAL HAZARD OCCOUR IN THE IMPLEMENTATION OF SOCIAL HEALTH INSURANCE? EVIDENCE FROM PUBLIC HOSPITALS IN A RURAL PROVINCE OF INDONESIA

Indonesia is now encountering moral hazard problems in the implementation of social health insurance. BPJS, as the administrator of Indonesia’s National Health Insurance, reported that there was an increase in deficit in the 4 years of the implementation of National Health Insurance from US$ 228 million in 2014 to US$ 470 million in 2016. Despite efforts conducted to overcome the problem, no evidence-based predictor that might be significantly associated with moral hazard in a rural province hospital in Indonesia. The purpose of this research is to identify the incidence of moral hazard in the implementation of National Health Insurance in Indonesia. Data consisting of 180 medical records obtained from three public hospitals in rural province of Indonesia were selected as samples in this study. These medical records were reviewed by Independent Senior Coder (ISC) who had more than 5 years experiences as a coder. The indicators of moral hazard in this study were upcoding, readmission, and possible unnecessary admission. Logistic regression was used to explore determinant of moral hazard from patient, coder, and physician side. The results show that rate of moral hazard cases for upcoding is 10%, readmission is 2.8%, and possible unnecessary admission is 18.9%. It can be seen from multivariate analysis that discharge status, severity level and LOS have a significant relationship with moral hazard. Illness severity level, Discharge against Medical Advice, and higher Length of Stay are risk factors for moral hazard incidence.