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dc.contributorBadan Litbangkes Kemenkesid-ID
dc.creatorTarigan, Ingan Ukur; Pusat Penelitian dan Pengembangan Sistem dan Kebijakan Kesehatan, Jakarta
dc.creatorIndriasih, Endang; Pusat Penelitian dan Pengembangan Sistem dan Kebijakan Kesehatan, Jakarta
dc.date2012-11-18
dc.date.accessioned2019-12-17T02:18:13Z
dc.date.available2019-12-17T02:18:13Z
dc.identifierhttp://ejournal.litbang.depkes.go.id/index.php/hsr/article/view/1898
dc.identifier10.22435/bpsk.v11i4 Okt.1898
dc.identifier.urihttp://r2kn.litbang.kemkes.go.id:8080/handle/123456789/81758
dc.descriptionThe main goal of health development in lndonesia is providing quality health care and assuring community access to equal health services for all citizen (universal coverage). In assuring the access to health services for the poor. Ministry of Health has launched special health insurance program for the poor (Askeskin). PT Askes was assigned by MOH to manage this program. Therefore, it is very important to improve facilities and management capabilities of health insurance administering bodies and health care providers. These include, improvement in case management, hospital accounting system, medical record, etc. This will be very useful for verification process and reducing the fraud and abuse. This study was conducted in order to provide valuable input for the Improvement of financing mechanism and payment system of referral providers in health insurance program for the poor (Askeskin). The objectives of this study are to calculate hospital claim on case management of Askeskin members and its real payment by PT Askes and to calculate the differences between claim and reimbursement (real payment) based on hospital components. The study design is cross-sectional. A Stratified Random Sampling method was conducted to select the study sites based on Human Development Index (HOI) and Fiscal Capacity (refers to Ministry of Finance Data) of district and city. Districts and cities were then classified into high, middle, or low level. The 3 selected study sites were: Kampar District (HPI 34,1) in Riau Province which represent high HOI; North Bengkulu District (HPI: 30.4) in Bengkulu province which represent middle HOI, and Pontianak City (HPI: 27.7) in West Kalimantan Province which represent low HOI. The results show that tariff agreement of case management for Askeskin members was not in accordance with local real condition. Therefore, clear operational and technical Askeskin guidelines are needed to gain similar perception between PT Askes and health care providers· beside Improvement of socialization activities to the community. The amount of differences between claim and reimbursement varied among study sites. The difference was influenced by following factors: (1) existed guidelines that were not suitable with local specific real demand and (2) disparity among hospital facilities. Hospital with limited facility has difficulty to refer patient to another closed hospital which doesn't have contract with PT Askes. Furthermore, in some cases hospital with good facility cannot optimalize using their advanced equipment for treatment, because not stated in the contract with PT Askes. Contract review, tariff adjustment, and re-negotiation between hospitals and PT Askes should be encouraged to provide better services for Askeskin members. Key words: health insurance, the part of community, financing mechanism, referral providersid-ID
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dc.languageid
dc.publisherPusat Penelitian dan Pengembangan Humaniora dan Manajemen Kesehatanen-US
dc.rightsThe Authors submitting a manuscript do so on the understanding that if accepted for publication, copyright of the article shall be assigned to Bulletin of Health System Research, and Center of Research and Development for Humaniora and Health Management as publisher of the journal.Copyright encompasses exclusive rights to reproduce and deliver the article in all form and media, including reprints, photographs, microfilms and any other similar reproductions, as well as translations. The reproduction of any part of this journal, its storage in databases and its transmission by any form or media, such as electronic, electrostatic and mechanical copies, photocopies, recordings, magnetic media, etc. , will be allowed only with a written permission from Bulletin of Health System Research, and Center of Research and Development for Humaniora and Health Management.Bulletin of Health System Research, and Center of Research and Development for Humaniora and Health Management, the Editors and the Advisory International Editorial Board make every effort to ensure that no wrong or misleading data, opinions or statements be published in the journal.
dc.sourceBuletin Penelitian Sistem Kesehatan; Vol 11, No 4 Okt (2008)en-US
dc.sourceBuletin Penelitian Sistem Kesehatan; Vol 11, No 4 Okt (2008)id-ID
dc.titleANALISIS KESESUAIAN KLAIM DENGAN REALITAS PEMBAYARAN PPK RUJUKAN DALAM JAMINAN KESEHATAN MASYARAKAT MISKINid-ID
dc.typeen-US


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