Social Insurance Administration Organization Research Articles

Evaluation of the Health Policy Implementation of Indonesian Social Insurance Administration Organization in Primary Health Care Facilities

Evaluation of the Health Policy Implementation of Indonesian Social Insurance Administration Organization in Primary Health Care Facilities

EFFECT OF BPJS (Social Insurance Administration Organization) RECEIVABLES MANAGEMENT AND INACTION OF BPJS CLAIM REPAYMENT ON PRIVATE HOSPITAL FINANCIAL FUNDS FLOW IN SURAKARTA

This study aims to examine the effect of BPJS (Social Insurance Administration Organization) receivable management, and the inaction of BPJS (Social Insurance Administration Organization) claim repayment, on private hospitals funds flow in Surakarta. The independent variable used is BPJS receivable management, the disbursement of payment of BPJS (Social Insurance Administration Organization) claims and the dependent variable is the flow of financial funds of private hospitals. The population in this study is a private hospital in collaboration with BPJS (Social Insurance Administration Organization) in Surakarta City. Samples were taken by purposive sampling method. The data analysis was performed using multiple linear regression, t test, F, and R2. Based on the results of the classical assimilation test analysis shows that this study is normally distributed and there is no multicollinearity, autocorrelation and heteroscedasticity in the regression model. The results of multiple linear coefficient equation Y = -3,551 + 1,019X1 + 4,018X2 + e. The results of the t test show that the BPJS (Social Insurance Administration Organization) receivable management variables and the inaction in repayment of BPJS claims partially have a significant effect on the flow of financial funds of private hospitals in Surakarta. And the F test results show that BPJS (Social Insurance Administration Organization) accounts receivable management variables and the repayment inaction of BPJS claims simultaneously affect the financial flow of private hospitals in Surakarta. Whereas, the R2 test results (determination coefficient) obtained R Square value of 0.990, which means that BPJS accounts receivable management variables and inactions in paying BPJS claims contribute 99% to the private Hospital financial flow funds, while the remaining 1% is influenced by other variables not examined in this research.
 
 Keywords : BPJS receivable management, repayment inaction of BPJS claims, and the financial funds flow of private hospitals.

Fraud in Healthcare Service

In Indonesia, the fraud of healthcare service implementation occurs widely in hospitals, thereby harming the participants of social insurance. The objectives of research were to find out, to analyze, and to give solution to the fraud in the healthcare service. This research was taken place in several hospitals in Central Java Indonesia using non-doctrinal or empirical method on stakeholders related to national health insurance. The result of research showed that the substance of the ratification of Health Minister’s Regulation Number 36 of 2015 about Fraud Prevention in National Health Insurance in National Social Insurance System becomes the government’s attempt in suppressing fraud in healthcare service. In its structure, healthcare service occurs due to the pressure of enacted costing system, limited supervision, and justification in committing fraud and the imbalance between health service system and burden among clinicians, service provider not giving adequate incentive, inadequate medical equipment supply, system inefficiency, less transparency in health facilities, and cultural factor. Those who are responsible for the attempt of eradicating fraud such as Health Ministry, Regency/City Health Service, Hospital’s Board of Directors, Hospital Supervision Agency and Council, Social Insurance Administration Organization, professional organization, and Social Insurance participants should walk in the cycle starting from building awareness, reporting, detecting, investigating, sanction imposing, to building awareness.

Legal Issues in The Implementation of National Social Security System on Labour in Indonesia

The Social Security System in Indonesia has been regulated by the government, and the program is managed by an agency called Social Insurance Administration Organization (BPJS). Associated with the existence of social security functions for workers, its practice presents a gap between what is expected and what is regulated. For this reason, it is therefore necessary to examine, firstly, what kind of legal protection of workers is covered by this national social security system managed in BPJS program and, secondly, what constraints are encountered in its implementation. This research is Juridical Normative one, with normative qualitative data analysis. The research finds that the social security is correlated not only with the welfare of employees who are assessed by the level of wages provided by the organization, rather it is also correlated with other factors in the form of health and safety assurance. In the broader context, social welfare is measured not only when the person is at work and gets social security benefits, rather the measure of his welfare is also applicable when the worker is not working and/or when they retire. On the basis of these, the social security program is an integral aspect of social security to which the government should give a legal protection.

Dental Health Service Seeking Behavior on Indonesian Social Insurance Administration Organization

Background: Health insurance for Indonesian people is run by a government agency for social insurance administration organization known as Badan Penyelenggara Jaminan Sosial (BPJS). However, still, some people are reluctant to use this agency's service for dental care. The Objective: The purpose of this study was to analyze the factors affecting dental health care seeking behavior of health care facilities at the Indonesian Social Insurance Administration Organization in Semarang, Central Java. Methods: This research is an explanatory research with the cross-sectional design. Data have been obtained in this study then performed statistical tests to test bivariate analysis, conducted by analysis of relationships using the t-test to assess whether the mean and the diversity of the two groups (those using the service and not) were statistically different from each other. Result: The results showed that accessibility of patients concerning distance affect the use of dental health service covered by the insurance agency to overcome the problem of oral health. A convenience to get follow-up services and the compatibility between the functions obtained in the hope affect the use of dental health service with the insurance agency to overcome the problem of oral health. Conclusion: The most influential factor in the use of dental and oral health services at the health services insurance agency in Semarang to address oral health problems is accessibility regarding the distance