National Health Insurance Participants Research Articles

Perceived importance of structural factors are associated with the selection of primary care by national health insurance participants

Background and purpose: Primary health care services (PHCS) are the entry point for health services in an insurance-based health financing system, including the National Health Insurance Program or Jaminan Kesehatan Nasional (JKN) in Indonesia. This study aims to understand the association between structural factors in health service management with PHCS selection among JKN participants.Methods: The study used a cross sectional analytic design, conducted with 273 JKN participants in Denpasar as respondents. The samples were selected using multistage random sampling. Data was collected from April to May 2018 with interviews using a questionnaire covering the characteristics of respondents and perceptions on the importance of health care facilities, the capabilities of health providers, service distance, operational time, availability of drugs and medical equipment. Data analysis was carried out with multinomial logistic regression to determine the structural factors of health service management associated with the selection of PHCS.Results: Most respondents (65.9%) chose private clinics, 21.3% chose public health centres (PHCs) and 12.8% chose general practitioners. Multivariate analysis showed that the variables which significantly associated with the selection of PHCS among JKN participants were the perceived importance of the health care facilities at PHCs and private clinics, each with AOR=7.83 (95%CI: 2.72–22.54) and AOR=7.18 (95%CI: 2.76–18.68), the perceived importance of the capability of health workers in private clinics with AOR=0.29 (95%CI: 0.12–0.77), the perceived importance of health service time in private clinics with AOR=2.67 (95% CI: 1.05–6.74) and a history of examinations at private clinics with AOR=4.51 (95%CI: 1.86–10.96).Conclusion: Structural factors are associated with the selection of PHCS among JKN participants. Attention to the quality and quantity of structural factors in the management of health services is important to improve the equitable distribution of JKN membership in the registered PHCS.

Factors Affect the Quality of Health Services of National Health Insurance Participants (Studies Public Health Center Benteng in The City Palopo)

Factors Affect the Quality of Health Services of National Health Insurance Participants (Studies Public Health Center Benteng in The City Palopo)

Switching of primary health care providers among self-paid health insurance participants in Denpasar, Bali, Indonesia

Background and purposes: The number of Jaminan Kesehatan Nasional or National Health Insurance (NHI) participants switching their fasilitas kesehatan tingkat pertama or primary healthcare (PHC) providers is increasing and dominated by self-paid participants. This switching could result in unequal distribution of NHI participants and amount of capitation among PHC providers. This study aims to explore the reasons underlying self-paid NHI participants to switch PHC providers.Method: This is a qualitative study using in-depth interviews with a total of 14 participants recruited purposively, consisted of ten NHI self-paid participants who had switched and four participants who intend to switch PHC providers. Semi-structured interview guide incorporated the aspects of Consumer Switching Behavior Model. The interviews explored four aspects of participants’ intention to switch providers including inconvenience, service encounter failures, core health service failures, and attraction by competitor. The verbatim transcripts were analyzed thematically.Results: Self-paid NHI participants in this study cited four main reasons for switching PHC providers. The first reason is inconvenience in accessing PHC provider’s services due to long distance, long waiting times, unsuitable opening hours, and poor facilities. Secondly, patients cited the poor interaction between healthcare providers and patients specifically, lack of attentiveness, poor eye contact, poor delivery of health information, lack of consideration of patients’ opinions, and lack of responsiveness to patients’ complaints. The third reason is core healthcare service failures, including hasty examinations, inaccurate diagnoses, and errors in prescribing medication. Finally, informants reported that they wished to switch PHC providers due to the attractiveness of other providers, in terms of facilities availability, professionalism of healthcare providers, additional health programs, and ease of access to fasilitas kesehatan rujukan tingkat lanjut or referral healthcare facilities.Conclusion: Self-paid NHI participants’ intention to switch PHC providers was mainly attributed to the perceived poor healthcare quality of the provider and superiority of the others. Continuous quality improvement should be undertaken by PHC providers to increase participants’ loyalty.

Role of Nurse as Care Giver and Advocator In The Ward, Era National Health Insurance (NHI) Program

Background: There are many National Health Insurance (NHI) participants who do not yet understand the mechanism of NHI services, including clients who are hospitalized. The phenomena that exist on the field, that the client will enlist the help of health professionals who are always in the ward, especially nurses, to provide information on all matters, including NHI. On the other hand, nurses have a major role in caring for clients, based on their duties and functions.
 Purpose : This study aims to determine if there is expansion of the role of nurses as care giver and advokator in the inpatient unit, era NHI program.
 Methods : This research is a descriptive study of the role of nurses as care giver and advokator in inpatient era NHI program, employing triangulation method. Respondents were 64 inpatient clients registered as NHI participants in the Hospital Semarang assigned by proportional simple random sampling, and four nurses.
 Result : The results showed that there are expanding the role of nurses as care giver and advocator in the inpatient unit, era NHI program.
 Conclusion : With the implementation of NHI program, the roles of nurses as care giver and advokator has expanded in the inpatient unit. BPJS/NHI parties need to disseminate information relating to NHI to nurses, as well as the need to be given compensatory reward for nurses

Analysis of Partnership of Private Practice Midwife in The National Health Insurance Program in District Bungo Jambi Province

On January 1, 2014, the government began to implement the National Health Insurance (NHI) program to realize social welfare for the whole community. Midwifery and neonatal care in the NHI program involves Puskesmas/family doctors and Private Practice Midwife (PPM) as its network. PPM participation in the NHI program in Bungo District was still lacking, only 12 (54.5%) PPM have cooperated with family doctors from 22 existing PPM. This study aimed to get an overview of PPM participation in the NHI program in Bungo District, Jambi Province. The study used qualitative research approach with Rapid Assessment Prosedur design, purposive sampling, and conducted in-depth interview to 10 PPM, Head of Health Office, MPKP BPJS Health Manager, and Chairman of Bungo Regency Section of Indonesian Midwife Organization (IMO). The study was conducted from January to July 2017. The study found that the knowledge, perceptions and attitude towards NHI program were good, but the perceived toward the claim and predetermined tariff procedures were not so good. PPM motivated to join the NHI program as many patients had become NHI participants. Support from the Government, NHI, and IMO were low, either in the form of socialization, or policies. Therefore, the study suggest an improvement in claims procedures, tariffs, and an increase of socialization from government, NHI and IMO on NHI program related to obstetric and neonatal care.

The role of management function to the achievement of puskesmas indicator as a gatekeeper of national health guarantee in Bengkulu City

The financing of national health insurance for referral health services is amounted to 45.47 trillion, while the cost of primary health care is amounted to 11.5 trillion. The largest capitation cost was received by the Public Health Center 73.6% with the number of cases referred to the hospital as much as 11.9 million and non-specialist referral 1.54 million cases. Capitation policy based on service commitment fulfillment is a performance indicator in first-level health facility/FLHF (FKTP), so it can be measured periodically. Public Health Center as one of the government-owned in first level health facility that provides the most services for the national health insurance participants (JKN) should be sought controlling referral. The purpose of the study is to analyze the role of management function on the control of referral from Public Health Center in Bengkulu City.