National Health Insurance Program Research Articles

Association between Nonalcoholic Fatty Liver Disease and Colon Polyps: A Case-Control Study in Taiwan

Objective. To investigate the potential association between nonalcoholic fatty liver disease (NAFLD) and colon polyps in Taiwan. Methods. We utilized 2006–2015 claims data of the Taiwan National Health Insurance Program as a data source. A case-control study was conducted, involving individuals 20 years or older with and without colon polyps. Cases comprised individuals diagnosed with colon polyps, identified through diagnosis codes. Controls were selected from individuals without colon polyps, matched to cases based on sex, age, and comorbidities. NAFLD was identified based on diagnosis codes. The logistic regression model with odds ratio (OR) and 95% confidence interval (CI) was employed to assess the association between NAFLD and colon polyps. Results. The study included 16,890 cases with colon polyps and 67,560 matched controls without colon polyps. The mean age was 57 years old and about 61% of study subjects were males. Among cases with colon polyps, 1.0% had a diagnosis of NAFLD, whereas only 0.4% exhibited NAFLD in the control group. After adjustment for confounding variables, a multivariable logistic regression model revealed a statistically significant association between NAFLD and colon polyps, with an odds ratio of 2.32 (95% CI = 1.91–2.82). Conclusion. This case-control study suggests a positive association between NAFLD and colon polyps. These results contribute to our understanding of the potential links between NAFLD and gastrointestinal health.

Cost-Effectiveness Analysis of Digital Breast Tomosynthesis and Mammography in Breast Cancer Screening: A Markov Modeling Study.

Mammography (MG) has demonstrated its effectiveness in diminishing mortality and advanced-stage breast cancer incidences in breast screening initiatives. Notably, research has accentuated the superior diagnostic efficacy and cost-effectiveness of digital breast tomosynthesis (DBT). However, the scope of evidence validating the cost-effectiveness of DBT remains limited, prompting a requisite for more comprehensive investigation. The present study aimed to rigorously evaluate the cost-effectiveness of DBT plus MG (DBT-MG) compared to MG alone within the framework of Taiwan's National Health Insurance program. All parameters for the Markov decision tree model, encompassing event probabilities, costs, and utilities (quality-adjusted life years, QALYs), were sourced from reputable literature, expert opinions, and official records. With 10,000 iterations, a 2-year cycle length, a 30-year time horizon, and a 2% annual discount rate, the analysis determined the incremental cost-effectiveness ratio (ICER) to compare the cost-effectiveness of the two screening methods. Probabilistic and one-way sensitivity analyses were also conducted to demonstrate the robustness of findings. The ICER of DBT-MG compared to MG was US$5971.5764/QALYs. At a willingness-to-pay (WTP) threshold of US$33,004 (Gross Domestic Product of Taiwan in 2021) per QALY, more than 98% of the probabilistic simulations favored adopting DBT-MG versus MG. The one-way sensitivity analysis also shows that the ICER depended heavily on recall rates, biopsy rates, and positive predictive value (PPV2). DBT-MG shows enhanced diagnostic efficacy, potentially diminishing recall costs. While exhibiting a higher biopsy rate, DBT-MG aids in the detection of early-stage breast cancers, reduces recall rates, and exhibits notably superior cost-effectiveness.

Progress toward universal health coverage in Vietnam: Evidence on dispensing trends of diabetes medications from 2015 to 2021

AimsThis study aims to investigate the trends in treatment coverage through dispensing diabetes medications in Vietnam from 2015 to 2021. The findings will serve to inform health policies to mitigate the health burden of Type 2 diabetes mellitus (T2DM). MethodsWe collected information on major antidiabetic medicines from General Department of Vietnam Customs and payments for antidiabetics via the National Health Insurance Program. We applied ordinary least squares models, accounting for economic and health outcome characteristics, to estimate the association between the annual mass of medications and related factors. ResultsNationally, the total mass/doses of all antidiabetic drugs increased rapidly from 2015 to 2021, based on both databases. Metformin was the most frequently prescribed medicine, with the total mass increasing nearly threefold over the study period. Gliclazide, a Sulfonylureas drug, ranked second. In the multivariate regression analysis, a one-unit increase in adults with diabetes (in 1,000 s) was associated with 0.11 % (95 %CI = 0.0005; 0.0076) and 0.13 % (95%CI = 0.0007; 0.0242) higher mass of Metformin and Glimepiride, respectively. ConclusionOur data suggested that policies changes were related to significant increase in antidiabetic medication dispenses in Vietnam. The high treatment coverage indicates impressive progress in achieving universal health coverage in Vietnam, meeting the UN Sustainable Development Goal (SDG).

The Influence of National Health Insurance Participant Satisfaction in Mediating the Relationship of Service Quality and Brand Image Towards Participant Loyalty at RSU Balimed Denpasar

The irregularity of participants in paying National Health Insurance contributions shows that participants lack loyalty in paying contributions which are their routine obligations as participants in the National Health Insurance program. The aim of this research is to reveal the mediating impact of satisfaction on service quality and brand image on loyalty. This research is quantitative research conducted using a survey, using data samples from National Health Insurance participants with active membership and receiving services at the Bali Med Denpasar General Hospital, totaling 82 people with PLS-based SEM analysis. The research results showed that service quality had a positive and significant effect on satisfaction, brand image had no significant effect on satisfaction, service quality and brand image had a positive and significant effect on loyalty, and patient satisfaction was able to mediate the effect of service quality and brand image on patient loyalty. It is hoped that the results of the research can provide advice to related parties to improve the quality of health services, such as how to respond to existing complaints and communicate well with patients and this is expected to have a positive impact on the quality of services

Funding Pattern Comparison Pre- and Post-Ayushman Bharat National Health Scheme (AB-PMJAY) in Active Females Undergoing TKA for Advanced Knee Arthritis with Clinical, QoL Analysis and AB-PMJAY Technical Data.

Patients visiting for Knee Arthroplasty have often been treated at neighborhood clinics and bonesetters. India floated world's largest publicly funded national health insurance program -AB-PMJAY covering Knee Arthroplasty. AB-PMJAY's data for Arthroplasty has not been published. A Prospective study from Jan 2016- Jan 2023 on females undergoing TKA. Age, DEXA Score, Walking Ability, KSS, 10MWT, SF36 Scores, Funding Pattern before and after AB-PMJAY, Time to Approval, Time to discharge, Time to Query reply and Rejection Rates were documented. 790 patients (91.86%) received treatment previously. 650 (78.54%) patients lived with family & 32 patients lost to follow-up. 37.67% & 62.32% patients had Grade. 3 & 4 osteoarthritis respectively. Commonest comorbidity was Vitamin D deficiency followed by Menopause and Hypertension. Post-treatment Vitamin D deficiency reduced from 68.59% to 2.17% at 3 months. Post-surgery, Functional Scores improved significantly at 1st and 6th month. VAS dropped significantly from 7.8 to 3.6 at 1st month follow up. At 6 months, 81.52% patients were independent outdoor walkers compared to 9.42% (baseline). Average hospital stay-54 hours and Return to work- 42 days. Central health scheme beneficiaries rose significantly from 12% (pre-PMJAY) to 42% (post-PMJAY). With AB-PMJAY, no rejection for surgical procedures, Time to surgery approval was 16 hours (mean) and Time to Discharge was 8 hours (mean). Time to reply was 6 hours (mean). Evident rise in patients getting TKA done through AB-PMJAY. TKA has become an affordable and achievable target for financially deprived patients, post regulation of knee implant prices & AB-PMJAY.

Association between amiodarone use and risk of cataract: a population-based active-comparator study.

Despite previous concerns about ocular side effects related to amiodarone, the relationship between amiodarone and cataract remains uncertain. Therefore, this study aimed to assess the potential association between amiodarone use and the subsequent risk of cataract, taking into account potential confounders. This population-based, active comparator-controlled cohort study utilized the data from the Taiwan National Health Insurance program and involved adults over 40years old between 2001 and 2013. We analyzed 12 055 new amiodarone users and contrasted them with a propafenone user cohort. The primary outcome was the incidence of cataract. Inverse-probability treatment-weighting (IPTW) was further used to eliminate the potential confounding effects, and Cox proportional-hazard regression analyses were performed to calculate the risk of cataract. Serial subgroup analyses were also performed. In the main analysis, amiodarone users did not exhibit a significant causal relationship in both full cohort [adjusted hazard ratio (aHR): 0.994, 95% confidence interval (CI): 0.913-1.082] and IPTW cohort (IPTW-aHR 0.977, 95% CI: 0.900-1.060). Furthermore, it is important to highlight a significantly reduced risk of cataract among patients with heart failure (IPTW-aHR 0.708, 95% CI: 0.554-0.905) and during the 2-year follow-up period (IPTW-aHR 0.889, 95% CI: 0.794-0.996), implying potential advantages linked to the use of amiodarone. The study found no increased risk of cataract with amiodarone, one of the most frequently used antiarrhythmic medications, compared to the use of propafenone. Future research is recommended to explore potential mechanisms and their implications for clinical practice.

Holistic Evaluation of the National Health Insurance Program in the Local Context of Indonesia

This article reviews the evaluation of the National Health Insurance policy, exploring various aspects such as effectiveness, efficiency, adequacy, leveling, responsiveness, and accuracy in its implementation. Researchers use the case study method with a qualitative approach to describe and analyze phenomena, events, attitudes, social activities, and perceptions of individuals and groups related to the National Health Insurance program. This study analyses the effectiveness, efficiency, adequacy, leveling, responsiveness, and accuracy of National Health Insurance program policies in a region. The results showed that 1) The effectiveness of the National Health Insurance policy is still not optimal due to the lack of employee commitment in implementing the work agreement mechanism between the Regional Government and BPJS Kesehatan Boroko Branch. 2) In terms of efficiency, the implementation of standard operating procedures has shown optimality, but there are still obstacles related to administrative requirements for eligible prospective National Health Insurance policy participants. 3) The adequacy of the National Health Insurance policies have not been effective due to an increase in new participants, that is, not balanced with the available budget, resulting in delays in service claims for health workers. 4) The leveling of the National Health Insurance policy has not been effective due to constraints in recipient data, which resulted in a reduction in the quota from BPJS Kesehatan, leaving deserving community groups without assistance. 5) The responsiveness of this policy is disrupted by the validation of the criteria for recipients of contribution assistance which is not synchronized with the regional budget and the lack of direct data submission when applicants submit a poor statement letter at the village level. 6) The accuracy of this policy is still limited by the limitations of the regional budget in reaching all communities covered by this program in North Bolaang Mongondow Regency.
 Keywords: policy, evaluation, national health insurance

Discrepancies Among Hospitals and Regions in the Provision of Low-Value Care.

Low-value care is a critical issue in terms of patient safety and fiscal policy; however, little has been known in Asia. For the purpose of better understanding the extent of low-value care on a national level, the utilization, costs and associated characteristics of selected international recommendations were assessed in this study. This retrospective cohort study used the National Health Insurance claims data during 2013-2017 to evaluate the low-value care utilization. Adult beneficiaries who enrolled in the National Health Insurance program and received at least one of the low-value services in hospitals were included. We measured seven procedures derived from the international recommendations at the hospital level, and a composite measure was created by summing the total utilization of selected services to determine the overall prevalence and corresponding cost. The generalized estimating equation model was adopted to estimate the association. A total of 1,970,496 episodes of low-value care was identified among 1,218,146 beneficiary-year observations and 2,054 hospital-year observations. Overall, the utilization rate of the composite measure increased from 150.70 to 186.23 episodes per 10,000 beneficiaries with the growth in cost from US$5.40 to US$6.90 million. Low-value care utilization was proportional to the volume of outpatient visits and length of stay. Also, hospitals with a large volume of outpatient visits (aOR [95% CI], 2.10 [1.26 to 3.49] for Q2- Q3, 2.88 [1.45 to 5.75] for ≥Q3) and a higher proportion of older patients (aOR [95% CI], 1.06 [1.02 to 1.11]) were more likely to have high costs. The utilization and corresponding cost of low-value care appeared to increase annually despite the relatively lower prevalence compared to other countries. Multicomponent interventions such as recommendations, de-implementation policies and payment reforms are considered effective ways to reduce low-value care. Repeated measurements would be needed to evaluate the effectiveness of interventions.

Association between chronic prostatitis and the subsequent benign prostatic hyperplasia: a population-based national cohort study.

To explore the association between chronic prostatitis (CP) and the subsequent development of benign prostatic hyperplasia (BPH). Data analyzed were medical claims of Taiwan's National Health Insurance program. From 2010 to 2017, 3571 patients ≧20years with CP diagnosed by certified urologists were enrolled. Patients with past BPH diagnosis and diagnosis of prostate cancer, inguinal hernia, interstitial cystitis, and urethritis in the past and within one year after the first CP diagnosis were excluded. Age-matched controls were randomly selected from all non-CP individuals of the same exclusion criteria in the study period with a CP/non-CP ratio of 1:4. The follow-up was made from the first CPdiagnosis to death or the end of 2018. The endpoint was the newly diagnosed BPH. Cox proportional hazard regression model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) of BPH in association with CP. Over a maximum of 8years of follow-up, 287 (8.03%) and 258 (0.43%) BPH events were noted for the CP and non-CP group, respectively, representing a covariate adjusted HR (aHR) of 4.30 (95% CI, 3.61-5.13). Younger patients tended to suffer from higher aHRs, especially those aged 20-39years (aHR: 11.45, 95% CI, 5.12-25.64). The Taiwan national health database indicated that CP patients had a significantly higher risk of developing BPH later than non-CP patients. Interestingly, the younger the CP is diagnosed (under 40), the greater the risk.

A Bayesian Analysis of Two-Stage Randomized Experiments in the Presence of Interference, Treatment Nonadherence, and Missing Outcomes

Three critical issues for causal inference that often occur in modern, complicated experiments are interference, treatment nonadherence, and missing outcomes. A great deal of research efforts has been dedicated to developing causal inferential methodologies that address these issues separately. However, methodologies that can address these issues simultaneously are lacking. We propose a Bayesian causal inference methodology to address this gap. Our methodology extends existing causal frameworks and methods, specifically, two-staged randomized experiments and the principal stratification framework. In contrast to existing methods that invoke strong structural assumptions to identify principal causal effects, our Bayesian approach uses flexible distributional models that can accommodate the complexities of interference and missing outcomes, and that ensure that principal causal effects are weakly identifiable. We illustrate our methodology via simulation studies and a re-analysis of real-life data from an evaluation of India’s National Health Insurance Program. Our methodology enables us to identify new active causal effects that were not identified in past analyses. Ultimately, our simulation studies and case study demonstrate how our methodology can yield more informative analyses in modern experiments with interference, treatment nonadherence, missing outcomes, and complicated outcome generation mechanisms.

Evaluation of National Health Insurance Program Policies by Ketapang District Health Social Security Administration Body

This research aims to evaluate the process of implementing the National Health Insurance program policy by the Ketapang District Health Social Security Administering Agency, based on a compliance perspective relating to compliance with implementing agents, implementation of policies and facilities and resources, and based on what happening Perspective, which is related to factors that influence implementation and short-term outcomes. The results of this research show that the Evaluation of the National Health Insurance program policy implementation process by the Ketapang District Health Social Security Administration Agency has yet to be implemented optimally. This can be seen from the following indicators: Compliance perspective, which includes compliance by policy implementing agents, has not been carried out objectively according to regulations and is not by standards and procedures established by policy. Policy implementationNational Health Insurance Program by the Ketapang District Health Social Security Administering Agency has not been able to improve the quality of health services in Ketapang Regency, the availability of health facilities and resources has not met the criteria for capitation payment norms, and there is a lack of health workers both in terms of quality and quality. Meanwhile, the What is Happening Perspective includes factors that influence the implementation of policies, namely the actors involved, clarity of policy objectives, program complexity, support from all units involved, and other factors such as human resources, which include the quality and quantity and weak authority and legitimacy of health workers and short-term results have not been achieved due to contact data on the online application of the Social Security Administering Agency for Health.

Risk of gout flare after medication: prescription symmetry sequence analysis.

The research aimed to study the following questions: (1) five well-known gout-related medications were selected to test the validity of the prescription symmetry sequence analysis in Taiwan; (2) four exploratory medications were selected to test their relation to gout flares. We utilized the 2003-2017 dataset of the Taiwan National Health Insurance Program containing all claims data with 2 million beneficiaries as a data source. In order to explore the temporal association, we designed a scenario of medication-induced gout flares. Nine medications were selected as the index agent, including aspirin (low-dose), thiazide diuretics, loop diuretics, ethambutol, pyrazinamide, metformin, pioglitazone, fenofibrate, and losartan. The gout flare was defined as subjects with use of the marker agent for treatment of gout flares. The observation-window period between initiation of the index agent and initiation of the marker agent was 1year. Subjects who used an index agent and a marker agent on the same day were excluded. The prescription symmetry sequence analysis was carried out to compare the observed number of persons who took an index agent prior to starting a marker agent with the observed number of persons who took a marker agent before starting an index agent. The adjusted sequence ratio (adjusted SR) with 95% confidence interval was applied to estimate the relation between an index agent and the marker agent. Among five medications including aspirin (low-dose), thiazide diuretics, loop diuretics, ethambutol, and pyrazinamide, the adjusted sequence ratio ranged from 1.15 to 3.35 and all reached statistical significance. Fenofibrate use and losartan use were associated with a lower probability of gout flares, with reaching statistical significance (adjusted SR = 0.60 for fenofibrate and adjusted SR = 0.92 for losartan). Metformin use was associated with a greater probability of gout flares, with reaching statistical significance (adjusted SR = 1.14). Pioglitazone use did not reach statistical significance. Based on the confirmatory analysis including five well-known gout-related medications, this study supports that the prescription symmetry sequence analysis can be used to detect an adverse drug event associated with one potential offending agent. The exposure to fenofibrate or losartan might be a protective factor against gout flares. Metformin use could be associated with a greater probability of gout flares, but this finding should be validated by other studies. • What is already known about this subject? 1. The prescription symmetry sequence analysis is a useful method for detecting an adverse drug reaction associated with one potential offending drug. 2. Numerous medications are found to induce gout flares. • What does this study add? 1. The prescription symmetry sequence analysis supports the evidence that aspirin (low-dose), thiazide diuretics, loop diuretics, ethambutol and pyrazinamide are associated with a greater probability of gout flares. 2. The exposure to fenofibrate or losartan might be a protective factor against gout flares. 3. Metformin use could be associated with a greater probability of gout flares. • How might this impact on clinical practice or future developments? 1. Clinicians should always consider the possibility of medication-induced gout flares. If gout flares develop, discontinuation of risky medications is the first step. Then prescribing cascades can be eliminated.

ANALISIS BIAYA MEDIS LANGSUNG DAN TARIF INA-CBG’s PASIEN DIABETES MELITUS TIDAK TERGANTUNG INSULIN DI RSUD ANUTAPURA PALU

Diabetes mellitus is a long-term disease with an increasing prevalence. Diabetes mellitus is one of the main causes of human morbidity and death and has a significant impact on health financing. Indonesia itself has implemented a national health insurance program that prioritizes effectiveness and cost efficiency. This study aims to determine the average direct medical costs, INA-CBG's rates, the suitability of direct medical costs and INA-CBG's as well as the influence of treatment class, severity, number of secondary diagnoses, and length of stay on the direct medical costs of diabetes mellitus patients at Anutapura Hospital Palu. This research is a descriptive observational study with retrospective data collection from medical records and files detailing patient care costs at Anutapura Hospital Palu in 2020 from the hospital's perspective. The sample used was BPJS inpatients with a primary diagnosis of type 2 diabetes or non-insulin dependent diabetes mellitus (DMTTI) who met the inclusion and exclusion criteria, totaling 132 patients. Data were analyzed descriptively and to see the influence of variables on total costs, the Independent sample t-test and Mann-Whitney test were used. The research results show that the average direct medical costs are IDR 2,751,449, the average INA-CBG's rate is IDR 4,505,508, so there is a mismatch between direct medical costs and INA CBG's. There is a significant influence partially or simultaneously and in a positive direction from the variables treatment class, severity, number of secondary diagnoses, and length of stay on direct medical costs.

Health Expenditure and Utilisation of Poor Families in a Low-Income Community under the Philippine Conditional Cash Transfer Program

Pantawid Pamilyang Pilipino Program (4Ps) is the Philippine version of the conditional cash transfer (CCT) program that measures human development through the provision of conditional cash grants to the poorest of the poor. This research determines the health expenditure and utilisation of the poor families in a low-income community under the CCT program. A cross-sectional research design was adopted using mixed methods of data collection from 177 households between May and June 2017. Results reveal that most families under CCT devote the largest portion of household health expenditure for inpatient health seeking. About 40% of the total expenditure is covered by the National Health Insurance Program and the cost for hospitalisation mostly comes from the out-of-pocket source. Moreover, the common problems encountered during health utilisation and spending are poor customer service of healthcare facilities and uncompensated hospital bill by health insurance.

Analisis Peran Program Jaminan Kesehatan Nasional (JKN) dalam Mengurangi Beban Finansial Pasien

Insurance or coverage is an agreement in which an insurer binds himself to the insured by accepting a premium, to provide compensation to him for losses, damages, or loss of profits that may be suffered due to uncertain events (Commercial Law Book (KUHD) of the Republic of Indonesia Article 246). The interesting thing analyzed is first, the form of protection for workers in the National Health Insurance (JKN) program and second, the issues in its implementation. The model used in this work is a literature review, where information suitable for the problem being investigated is sought from various references and sources. Here is the selection of scientific articles: The selection of scientific articles was done by searching the PubMed, ScienceDirect, and Google Scholar databases for relevant articles published in the period 2019-2023. The selected articles must meet the established inclusion and exclusion criteria. Determination of Inclusion and Exclusion Criteria: The inclusion criteria used in this study include articles on "Analysis of the effectiveness of health insurance in reducing the financial burden of patients" and studies conducted at the provincial or national level. The exclusion criteria are articles that do not meet the inclusion criteria, articles that are not related to the research topic, and articles published before 2019.

Analisis Prinsip Pembiayaan Kesehatan dalam Mendukung Cakupan Kesehatan Semesta di Indonesia

Health financing is an essential component of the health system, particularly in the pursuit of universal health care. The primary role of universal health care is financial risk protection, which includes the availability of national health insurance as well as access to safe and inexpensive essential health services. The goal of this study is to learn about the concepts of health financing in order to attain universal health care. This article employs a qualitative approach, drawing on secondary data sources such as books, scientific journals, linked internet websites, official government papers, and others. According to the findings, the effectiveness of raising income for health care finance cannot be quantified. In terms of income collection, there is still some overlap in health financing sources, particularly in the national health insurance programme (JKN). Aside from that, the JKN program's procurement of services and distribution methods are encountering difficulties due to a shortfall in the JKN budget, as well as the community's lack of discipline in making JKN contributions. Furthermore, despite the notion of decentralisation, local governments continue to rely on the central government for health financial planning and budgeting. Keywords: health systems, health financing, universal health coverage

Efisiensi dan Produktivitas BPJS Kesehatan Tahun 2014 – 2021 (Metode Data Envelopment Analysis dan Malmquist Index)

Badan Penyelenggara Jaminan Sosial Kesehatan (BPJS Kesehatan) is a legal entity formed to administer the National Health Insurance program (named JKN) with the principles of social health insurance. Management of social security funds (named DJS) carries high risks. To measure the sustainability of the JKN program, BPJS Kesehatan is required to perform efficiently and productively. This study aims to measure Badan Penyelenggara Jaminan Sosial Kesehatan (BPJS Kesehatan) 's efficiency and productivity from 2014 to 2021. The calculations in this study are relative, not absolute. This non-parametric quantitative research uses Data Envelopment Analysis (DEA) and Malmquist Productivity Index (MPI) methods. This study uses an intermediation approach with BPJS Operational Expenses (X1) as input variables, then Contribution Income (Y1) and Health Insurance Expenses (Y2) as output variables. The results showed that BPJS Kesehatan had inefficiencies in 2014, 2016, 2017 and 2018. As for 2015, 2019, 2020, and 2021, BPJS Kesehatan has achieved an optimal efficiency value of 100%. The Malmquist Index measurement shows that BPJS Kesehatan has experienced an increase in productivity with a score of > 1, except in the second year (2015 – 2016).

The use of antihypertension in hypertension patients with chronic kidney failure at the Universitas Gadjah Mada (UGM) Academic Hospital, Yogyakarta

According to the 2018 Indonesian Basic Health Research data, the prevalence of hypertension in the Yogyakarta Special Region (11.0%) is higher than the national average of 8.8%. Hypertension with chronic kidney failure is currently a prevalent and increasing issue. This study aimed to investigate the pattern and rationality of antihypertensive use in hypertension patients with chronic kidney failure (CKF) participating in the National Health Insurance (Jaminan Kesehatan Nasional/JKN) program at Universitas Gadjah Mada (UGM) Academic Hospital period of 2020 to 2022. The study was conducted using quantitative descriptive non-experimental methods. Data collection was carried out retrospectively through medical records of patients diagnosed with hypertension with CKF (ICD I12.0). Samples were selected using purposive techniques and analyzed by comparing the suitability of drug selection with standard hypertension therapy with CKF based on JNC 8 and NKF-K/DOQI, including the rationality of their use. A total of 68 patients over the age of 18 were used as samples. The The majority of drug groupsresults showed that a combination of 2 drugs is more dominant (52.9%) compared to monotherapy (29.4%) and a combination of 3 drugs (17.6%). The majority of drug groups used were angiotensin receptor blockers (ARBs), especially candesartan (45%). ARB and calcium channel blockers (CCB), especially candesartan+amlodipin (50%), and ARB +CCB+diuretic, especially andesartan +amlodipine + furosemide (33%).. The rationality of drug use showed that 66.2% in the right indications, 89.7% the right drugs, 100% in the right patients and 85% the right doses. Therefore, health workers still need to make efforts to encourage rational drug use.

Urgensi Kepesertaan BPJS Kesehatan Sebagai Syarat Peralihan Hak Atas Tanah Berdasarkan Instruksi Presiden Nomor 1 Tahun 2022 Tentang Optimalisasi Pelaksanaan Program Jaminan Kesehatan Nasional

The Health Social Security Implementation Agency (BPJS) is a legal entity formed to administer the Health Insurance program and is directly responsible to the president who has the task of administering National Health Insurance for all Indonesian people. In Presidential Instruction Number 1 of 2022 concerning Optimizing the Implementation of the National Health Insurance Program there is a regulation that authorizes the Minister of Agrarian Affairs and Spatial Planning/Head of the National Land Agency to ensure that every applicant for the transfer of land rights due to buying and selling is an active participant in the Health Insurance Program National (JKN) which is the government's effort to monitor the health conditions of the Indonesian people evenly. The aim of this research is to find out whether the Presidential Instruction is in accordance with Law Number 24 of 2011 concerning Social Security Administering Bodies. The method used in this research is Normative Juridical which examines various formal legal rules such as Laws, using a statutory approach (Statute Approach) and a conceptual approach (Conceptual Approach). In essence, Presidential Instruction No.1 of 2022 is in accordance with Law No.24 of 2011 concerning BPJS and does not violate the main rules in the BPJS Law, however, because the position of the Presidential Instruction is a policy regulation and there are no strict sanctions in it, the Instruction The president may not be implemented because there are no sanctions.

PP64 Cost-Effectiveness Of Fractional Flow Reserve As Diagnostic Tool In Coronary Artery Disease Versus Angiogram Alone In Indian context

IntroductionFractional Flow Reserve (FFR) is a diagnostic tool that aids decision-making in the treatment of coronary artery disease (CAD). FFR provides an objective measurement and is used as an adjunct to an angiogram. The clinical and cost-benefit of using FFR have been well established across published literature. This research was aimed at evaluating the economic impact of using FFR as an adjunct to angiogram versus an angiogram alone, in the Indian healthcare context.MethodsA study from a tertiary care public hospital in India estimated the impact of using FFR as an adjunct to angiogram in management of CAD. This study was used to create a mathematical simulation model to estimate cost-effectiveness and economic impact of using FFR over seven years’ time horizon, from the Indian health systems perspective. A targeted literature review was performed to collect the clinical inputs for the model, and the national public health insurance program data was referenced to obtain the cost inputs.ResultsA hypothetical cohort of 100,000 patients in the model reported 30 percent reduction in unnecessary stenting. Moreover, 14,025 deaths were averted with the adoption of FFR. In addition, there was a cost-saving of INR46,986 (574USD) per death averted and INR5,169 (63USD) per patient treated over a seven-year time horizon. The analysis demonstrated that FFR inclusion in the current clinical practice saves INR2,651 (32USD) per patient in overall upfront cost and INR2,518 (31USD) per patient in overall follow-up cost over a seven year follow-up period owing to improved diagnosis and prognosis.ConclusionsIn conclusion, FFR prevents unnecessary stenting, reduces overall mortality, and proves to be a cost-saving intervention in the long-term when used as a decision-making criterion in CAD patients in the Indian context.