National Social Security System Research Articles

Emotional branding, corporate image and its effect on the loyalty of JKN-KIS participants

Health as a basic necessity of life, the ownership of health insurance is very important and very influential in ensuring a safe and secure life. The National Health Insurance as part of the National Social Security System aims to meet the basic health needs of the Indonesian people. This study aims to analyze the role of satisfaction in mediating the influence of emotional branding and corporate image on customer loyalty. Independent participants of JKN-KIS BPJS Health Malang Branch as the sampling in this study. The sampling technique used purposive sampling with a sample of 130 respondents. Data analysis in this study used Structural Equation Modeling-Partial Least Square (SEM-PLS). The results of the study concluded that emotional branding affects loyalty and satisfaction; the corporate image has an effect on loyalty and satisfaction; satisfaction affects loyalty; satisfaction mediates the effect of emotional branding and corporate image on loyalty. Satisfaction acts as a partial mediating variable.

The Public Policy Dynamics of Increasing Health Insurance Rates in a Developing Country

Health insurance plays an important role in the COVID-19 pandemic. As a part of public policy, examining increasing health insurance contributions in developing countries is important to understand the dynamics, formulation processes, pros and cons, and implications for public participation. This study considered the increasing contributions of Indonesia Health Insurance (BPJS) and the findings indicated that the government faces a dilemma. On one side, the income of citizens is relatively diminished due to the restrictions on mobility as a result of the pandemic. On the other side, during the pandemic, health services need to perform well. Considering that health insurance is part of a national social security system, which is a common feature in developing countries, public health costs should be the responsibility of the State. Therefore, the increase in the BPJS Kesehatan rate needs to consider the ability of the citizen, and also ensure a positive impact on improving health services for the citizen.
 Keywords: public policy dynamics, public participation, positive impact

ANALISIS PELAKSANAAN PROGRAM JAMINAN KESEHATAN NASIONAL DI DINAS KESEHATAN KABUPATEN ROKAN HILIR

The National Health Insurance is part of the National Social Security System organized by the Health Social Security Administration (BPJS) through a mandatory social health insurance mechanism. The Social Security Administering Body. is a legal entity established to administer social security programs. Participants of the Health Social Security Administering Body are divided into 2 groups based on the origin of the funding. The first group is Contribution Recipients, participants in the category of those with economic difficulties. The second group of BPJS Health participants are those who belong to the Non-PBI (Contribution Recipients) group. The Health Service is an office that facilitates health and provides technical implementers of public health services that provide non-specialist individual health services for observation, diagnosis, treatment, treatment and or other health services. The formulation of the problem in this study is why the management of the National Health Insurance budget by the Health Social Security Administration at Balai Jaya Health Center, Rokan Hilir Regency has not been maximized. planning for the National Health Insurance in the working area of ​​the Rokan Hilir Health Service. This research method uses a qualitative approach with a descriptive type of research. The results of this study indicate that the planning of the National Health Insurance at the Health Office of Rokan Hilir Regency has not been implemented properly. This is based on the fact that there are still many people who have not been integrated into the National Health Insurance . Based on the Minister of Social Affairs Regulation Number 170 of 2015 the quota for JKN PBI Rokan Hilir participants is 184,419 people, but for JKN PBI Rokan Hilir participants it is only 1,762 people.  Keywords        : Planning, National Health Insurance

Fraud Issues in the National Health Insurance (Causes, Legal Impacts, Dispute Settlement and Preventive Measures)

National Health Insurance which covers all financing of health services in terms of national insurance. This causes the National Health Insurance to manage a very large amount of money and has an impact on many challenges regarding overcoming fraud committed by various parties. This research is a literature search that analyzes the concept of fraud, legal impact, dispute resolution, and preventive actions in dealing with and preventing fraud. The legal basis used is very diverse, starting from the regulations governing national health insurance, as stated in Presidential Regulation no. 12 of 2013 concerning Health Insurance and the Law of the Republic of Indonesia Number 24 of 2011 concerning the Social Security Administering Body; The legal implications contained in the criminal code of law; and prevention of fraud as regulated in PERMENKES RI 269/MENKES/PER/III/2008 concerning Medical Records and Regulation of the Minister of Health of the Republic of Indonesia Number 36 of 2015 concerning Prevention of Fraud in the Health Insurance Program in the National Social Security System

Myeloproliferative neoplasms – a global view

Myeloproliferative neoplasms – a global view

Peranan Promosi dalam Meningkatkan Keikutsertaan Masyarakat dalam Program Penyelenggaraan Jaminan Sosial Ketenagakerjaan Studi Kasus di BPJAMSOSTEK Kantor Cabang Palembang

The purpose of this study was to determine how the effect of promotion in order to increase community participation in the program of administering employment social security. The BPJS Employment Program is a social security program provided to workers. Based on Article 4 of Law no. 24 of 2011 concerning Social Security Administering Bodies, BPJS Organizes a national social security system based on the principles: mutual cooperation, non-profit, openness, prudence, accountability, portability, mandatory membership, mandated funds, and the results of the management of the Social Security Fund are used entirely for program development and to the greatest extent possible. The Central Statistics Agency of South Sumatra Province noted that for the population of South Sumatra there were more than 8.5 million, as of February 2020 consisting of a workforce of 4.33 million, who worked as many as 4.16 million in the formal sector, while in the informal sector in the micro-enterprise sector. small and medium enterprises (MSMEs) as many as 163,291. Looking at data from BP Jamsostek Palembang Branch, currently participants who follow the BPJamsostek program have only reached 2.3 million workers (27%) of the total number of potential workers reaching 8.5 million workers (in Sumbagsel), both Wage Recipients (PU), Non-Wage Recipients (BPU) and Construction Services (Jakon). Specifically for the coverage share participation for the province of South Sumatra with details of 2,916,275 participants, and the total participation in South Sumatra 7,952,597 (this figure includes the provinces of South Sumatra, Lampung, Bengkulu, Jambi, and Bangka Belitung).

DAMPAK KAPITASI KHUSUS TERHADAP CAPAIAN KINERJA FASILITAS KESEHATAN TINGKAT PERTAMA DI KABUPATEN

Background: Payment patterns at health facilities are an important component of the National Social Security System. Payment systemapplied by BPJS Kesehatan to primary health care is the capitation payment system and the establishment of special capitation paymentsfor primary health care in remote areas. The effort was made with the aim of improving the quality of service and primary healthcare performance. One of the districts receiving special capitation is Donggala, it is necessary to conduct research on the impact of thespecial capitation policy on the performance of primary health care in Donggala.Objective: This study aims to evaluate the impact of the special capitation policy on the performance of primary health care in Donggala.Methods: This study uses a quantitative observational study with a cross-sectional design. This study uses secondary data from theBPJS Kesehatan Palu branch and primary health care located in Donggala. Primary health care that are the subject of researchare 16 with a month as research unit for one year so that the total observations are 192 observations. Data analysis was carried outin stages, univariate, bivariate with chi square, and multivariate with logistic regression analysis.Results: Primary health care with special capitation have better performance outcomes compared to regular capitation in a certainperiod of time (OR = 3.67). Factors of human resource availability, namely general practitioners, dentists, and nurses will increase theprobability of achieving performance targets (OR = 5.32).Conclusion: The performance achievements of primary health care with special capitation is better than the regular capitation, the availabilityof human resources (i.e availability of general practitioners, dentists and nurses) have contributed to the performance improvementsof primary health care.

JURIDIC REVIEW ON THE MAINTENANCE OF LABOR HEALTH THROUGH THE BPJS PROGRAM

Health Care Insurance is a form of health protection guarantee, with the intention that participants get health benefits or protection to meet health needs for everyone who has paid their dues or whose contributions have been borne by the government. National Social Security is a government and community plan designed to determine the amount of social welfare protection for all people in order to meet their needs and social welfare. The Social Security Administering Body (BPJS) is the institution that manages or operates the National Social Security System Plan (SJSN). But the form of implementation in BPJS is that many health insurance services are provided to participants whose needs are limited. This health service is needed by the community to overcome their health problems. With this research aims to be able to determine the health care insurance for workers associated with optimal health services for workers. In addition, it is also known the form of services provided by BPJS in protecting some rights to the health of workers.

STATUS SOSIAL EKONOMI TERHADAP UTILISASI DAN OUT OF POCKET PESERTA ASURANSI KESEHATAN (ANALISIS DATA INDONESIAN FAMILY LIFE SURVEY 2007 DAN 2014)

Background: The government has guaranteed equal rights for each individual to access health services. It is mandated in the Law Number 40 of 2004 on National Social Security System (SJSN)
 which emphasizing social insurance program. The social insurance is expected to improve the access and utilization of health services and to minimize the risk of out of pocket.
 Objective: To provide empirical evidence related to the impact of health insurance ownership toward the outpatient utilization and out of pocket based on socioeconomic status. It also examines the
 factors influencing outpatient utilization and out of pocket.
 Methods: The study used 2007 and 2014 Indonesian Family Life Survey (IFLS) data. The representative data were collected from individuals aged more than 15 years in 13 provinces in Indonesia
 through questionnaire with cross-sectional design. The data were analyzed step by step covering univariable, bivariable, and multivariable through Fixed Effect Model (FE).
 Results: The outpatient utilization indicated that: 1) The socioeconomic status influences the level of outpatient visit, specifically quantile 2 (OR=1,6), quantile 4 (OR=2,0), and quantile 5 (OR=1,8);
 2) The outpatient utilization reached OR=1,8 for individual aged ≥60 years; 3) OR=3,6 for individuals completing junior high school and above; 4) OR= 2,7 for individual who was sick in the past one week;
 5) OR= 1,4 for married individuals; and 6) OR= 1,9 for individuals suffering from heart disease. However, the individuals with socioeconomic status in quantile 4 spent higher Out of Pocket (54%); individuals in quartile 5 spent 46%; and individual with hypertension spent 48%.
 Conclusion: Changes in socioeconomic status affect the increase in outpatient utilization and out of pocket cost. In addition to socioeconomic status, outpatient utilization and out of pocket are affected by hypertension.

Black swan theory: legal policy of the Indonesian national healthcare

The Indonesian National Health Service (NHS) is part of Indonesia’s national social security system. Its implementation is full of problems, such as the rejection of patients, the NHS payment which is lower than the real health cost, sanctions, fines, etc. The Indonesian National Social Security System, especially the NHS services, was established by the state to give social protection to its citizens. The Black Swan Theory is based on the presumption that all swans are white, thus in this case, the Indonesian NHS is truly a program aimed to give social security in the health sector, just as the general conditions of social securities applied in other countries. This research studies this theory to explore the paradoxes which happen in the Indonesian NHS to find the black swan. In this case, the black swan is a paradoxical symbol regarding the regulations and the problems of the Indonesian NHS. This research uses the juridical-doctrinal or the normative method and is descriptive research with a qualitative approach. Based on the Black Swan theory, this research tries to find paradoxical, extreme, and unpredictable discrepancies in the Indonesian NHS. It is found that the Indonesian NHS is a black swan or unpredicted according to black swan theory. The objectives, practices, and regulations of this NHS are truly different from the NHS which is supposed to be given to the Indonesians. It transfers the government’s burden in establishing the health service and the rights of the citizens to the citizens, coupled with the threat of sanctions which is unknown in NHS. The applied Indonesian NHS has an extensive impact on hundreds of millions of Indonesian citizens.

Old-Age Security Protection for Government Employees with Work Agreements Is Reviewed According to The National Social Security System

Government Employees with Work Agreements are required to provide public services, improve professionalism and competence, and performance in government agencies. For that, the government must provide protection. Based on the preceding, the authors will conduct research that includes the safety of government employees with work agreements and old-age insurance arrangements for government employees with work agreements. The research method used is a normative juridical method with descriptive-analytical research specifications and analyzed using qualitative juridical methods. Everyone has the right to social security to fulfill the basic needs of a decent life and increase his dignity towards the realization of a prosperous, just. For those Government Employees with a Work Agreement, Prosperous Indonesian society is given protection by the government in old-age insurance, health insurance, accident insurance, employment, death insurance, and legal aid. There needs to be an arrangement to protect old-age security as long as the contract is regulated based on a national social security system that is in line with the Employment Social Security Organizing Agency to provide welfare both during the employment relationship and after the termination of the employment relationship.

THE RELATED FACTORS TO NATIONAL HEALTH INSURANCE PARTICIPATION IN THE CATEGORY OF NON-WAGE WORKERS IN THE WORK AREA OF PUSKESMAS GILIRENG, PASELLORENG VILLAGE, GILIRENG DISTRICT, WAJO 2020

The National Health Insurance is a program launched by the Indonesian government since 2004 with the issuance of National Law No.40 of 2004 concerning the National Social Security System (SJSN) which mandates that social security is mandatory for all residents including National Health Insurance through a National Security Administration. Social as manager of the Health Insurance system. In Indonesia, data shows that in 2019 BPJS Kesehatan participants were 221,580,743 out of 267.6 million people in Indonesia.This research was conducted to determine the factors related to the level of JKN participation in the PBPU category in Paselloreng Village. This research is a quantitative study with an observational analytic approach with a cross sectional study design and a sample size of 204 respondents who were taken by means of Accidential Sampling.The results of the study using the chi square test showed that the factors associated with the JKN participation in the category of Non-Wage Workers were Knowledge (p-value = 0,000), income (p-value = 0.001), Number of Family Members (p-value = 0.024), Perception (p-value = 0,000) and motivation (p-value = 0,000), while the variable not related to JKN participation in the category of Non-Wage Workers in Paselloreng Village is Last Education (p-value = 0.187), Occupation (p-value = 0.760 , and distance of access to BPJS Health services (p-value = 0.097). Suggestions from this study are expected for the government and society to pay more attention to the things that cause the lack of public participation in JKN such as difficult access to services, equal distribution of contribution assistance. inaccurate, inadequate information, and encouragement for the public to participate in JKN.Keywords: Healthcare BPJS, JKN, Non-Wage Workers, Independent Participants, Non- Participants

Structuring Workers' Bargaining Power in Mexico's Strawberry Fields

Workers shut down production and transportation of strawberries during the peak of the 2015 harvest in San Quintín, Mexico, which supplies winter berries to US markets. In the years since the strike, strike-settlement wage increases have eroded, commitments to register workers in the national social security system fell far short, and no workers gained representation by a union in collective bargaining with their employer. This case analyses the limited strike outcomes and persistent gaps in labour law compliance based on interviews and observation in 2019 and 2020. Building on the power resources approach, it highlights the historical character of structural power. Falling short of achieving strike demands underscored constraints on workers’ disruptive capacity. The case suggests that reading structural power as a dynamic complex of actions by employers, national states and workers enhances the concept’s ability to predict effects of collective action on social relations of production. KEYWORDS: Mexico; agriculture; supply chains; bargaining power; structural power

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

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

National Health Security Policy in Indonesia: A Narrative Review from Law Perspective

BACKGROUND: The Republic of Indonesia’s 1945 Constitution Article 28H clause (3) on the Rights to Social Security, Law No. 40 of 2004 on the National Social Security System, and Law No. 24 of 2011 on the Healthcare and Social Security Agency stipulate that everyone has the right for social security to achieve an adequate standard of living and to increase their dignity. This is to create a prosperous and just society. AIM: This research aims to describe the current National Health Security (NHS) policy as well as the good governance-based NHS policy. METHODS: This is normative legal research by doing literature analysis and/or secondary data. This descriptive research uses the statute and conceptual approaches. RESULTS: Results show that the Indonesian NHS is based on Law No. 24 of 2011 on the Social Security Agency (Badan Penyelenggara Jaminan Sosial). It has not been implemented optimally due to lack of accommodation of the good governance principles, including legal certainty, benefit, non-partiality, prudence, non-abuse of authority, transparency, public interest, and good service. CONCLUSION: Thus, the government needs to optimize the application of these principles in managing the NHS policy to provide the best services for the people.

Some recommendations to improve the pension regime in Vietnam

Retirement is a major regime in the social insurance policy andincludes both compulsory and voluntary in the social security system in Vietnam and many other countries. Practice shows that the regime is in fact the core and important pillar in the national social security system, contributing to improving the life of laborers upon their end of working age and lightening the burden on welfare society. After 60 years of implementation, the retirement regime in Vietnam has gradually improved towards the benefit of workers. Through studying the implementation of modern regimes, the author points out some fundamental limitations in the regime such as: (i) low coverage; (ii) the salary paid to the retirement and survivorship fund is still very low, approximately equal to the average pension of people enjoying the pension scheme; (iii) imbalance between –funding and payment ratio causing liabilities for the fund; (iv) the imbalance between the systems of world participation, this is a burden to the young generation... These limits are preventing the effective implementation of the regime in particular and the preservation of social security in general. Hence, the author proposes some policies to contribute to the improvement of the regime in the future.

National Health Insurance Ownership and Utilization with Stunting in West Sulawesi 2021: An Overview of Recent Evidence

Introduction: One of the policies to inform health and nutrition issues is the National Health Insurance Program (JKN), organized by the Health Social Security Administration (BPJS) under Law Number 40 of 2004 concerning the National Social Security System (SJSN). Although the coverage of JKN participation is increasing, it has not yet reached the Universal Health Coverage (UHC) target in the National Medium-Term Development Plan (RPJMN), which is 98% of the Indonesian population. So, this impacts the high nutritional issues of children under five in Indonesia, especially the suffering of stunting. Objective: The purpose of this study was to describe the ownership and utilization of JKN on stunting in West Sulawesi Province. Methods: The method in this study was a descriptive research design using SSGI 2021 secondary data in West Sulawesi Province. Result: The results showed that the percentage of JKN ownership for stunting toddlers was 36.2%, while the utilization of JKN for stunting toddlers was 26%. Conclusion: The results of the study illustrate that JKN ownership is still high compared to JKN.

POSC392 Economic Impact of Multiple Sclerosis from Hospital and Social Security System Perspective in Italy

Multiple Sclerosis (MS) is a disease of the brain and spinal cord associating with a high economic burden. The objective of this study was to estimate the socio-economic burden of MS in Italy from National Health System (NHS) and Social Security System perspective.

URGENSI KEBIJAKAN HUKUM PEMENUHAN HAK KONSTITUSIONAL ATAS JAMINAN SOSIAL KETENAGAKERJAAN BAGI PARA PEKERJA RENTAN DALAM SISTEM JAMINAN SOSIAL NASIONAL

The title of this thesis is the URGENCE OF LEGAL POLICY FOR FULFILLMENT OFCONSTITUTIONAL RIGHTS ON SOCIAL SECURITY EMPLOYMENT OF WORKERS OFVULNERABLE GROUP IN THE NATIONAL SOCIAL SECURITY SYSTEM, the problems studied inthis thesis are regarding legal policy from the point of view of the prevailing regulations inIndonesia, especially those relating to the fulfillment of constitutional rights. employmentsocial security for workers and the urgency of Fulfillment of social security rights for workersof vulnerable groups who are unable to pay contributions.The research method used is juridical-normative research using an approach thatsynchronizes the applicable legal provisions in the legal protection of norms or other legalregulations with their relation to the application of legal regulations in practice in the field.The result of the study is that there is a conflict between Article 14 paragraph (1) of UU. NO.40 of 2004 concerning the National Social Security System and the mandate of the 1945Constitution. Social security only targets workers who are wage earners and those who areable to pay contributions, but vulnerable workers are not protected under the SocialSecurity.Keywords: Urgency, social security, vulnerable workers

ANALISIS PERBEDAAN BIAYA RIIL DENGAN TARIF INA-CBG’s DAN FAKTOR YANG MEMPENGARUHINYA UNTUK CHRONIC KIDNEY DISEASE PADA ERA JAMINAN KESEHATAN NASIONAL


 Background: The National Social Security System (SJSN) is a system in the health sector that aims to provide comprehensive social security in order to create a just, prosperous and prosperous society. According to WHO growth in the number of Chronic Kidney Disease in 2013 increased by 50% from 2012 even in Southeast Asia to the number of sufferers of Chronic Kidney Disease> 380 million people. While in Indonesia, it has increased by 10% every year. This study aims to determine the differences between INA-CBG rates and the real costs of JKN-era Chronic Kidney Disease patients in RSISA Semarang.
 Method: This research is an observational study with a retrospective analytic descriptive design with quantitative data. The method used is the Cross Sectional method that makes observations, and can describe the factors that influence the real cost of hospitals. The population was 589 patients with Chronic Kidney Disease and 238 patients and analyzed using the chi-square statistical test with p-value <0.05.
 Results: The results of the study that as many as 14 patients (5.9%) aged 18-28 years, as many as 50 patients (21.0%) aged 29-39 years, as many as 82 patients (34.5%) aged 40-50 years , as many as 68 patients (28.6%) aged 51-60 years, as many as 21 patients (8.8%) aged 61-70 years as many as 3 patients (1.3%) aged 71-80 years. The research results obtained a p-value of 0,000.
 Conclusion: There is a Difference between Hospital Real Costs and INA-CBG's Rates for Chronic Kidney Disease in JKN Era in Semarang Hospital in 2018. There are no factors that affect the real costs in chronic kidney disease patients JKN participants in 2018 both class of care, length of treatment (LOS), and disease severity.