Show simple item record

dc.contributorid-ID
dc.creatorKusnali, Asep; Puslitbang Humaniora dan Manajemen Kesehatan
dc.creatorLaksmiarti, Turniani; Pusat Penelitian dan Pengembangan Humaniora dan Manajemen Kesehatan, Badan Penelitian dan Pengembangan Kesehatan RI
dc.creatorEffendi, Diyan Ermawan; Pusat Penelitian dan Pengembangan Humaniora dan Manajemen Kesehatan, Badan Penelitian dan Pengembangan Kesehatan RI
dc.date2017-06-02
dc.date.accessioned2019-12-17T02:20:51Z
dc.date.available2019-12-17T02:20:51Z
dc.identifierhttp://ejournal.litbang.depkes.go.id/index.php/hsr/article/view/6296
dc.identifier10.22435/hsr.v19i4.6296.250-257
dc.identifier.urihttp://r2kn.litbang.kemkes.go.id:8080/handle/123456789/82125
dc.descriptionThe Healthcare BPJS (BPJS-Kesehatan) is one of the Financial Services Institutions that is supervised by the Financial Services Authority (OJK). According to the OJK Regulation No. 1/POJK.07/2014 on Alternative Dispute Resolution Institution in Financial Services Sector, Financial Services Institution must be a member of the Alternative Dispute Resolution Institution in the fi nancial services sector. However, there is a difference in the dispute resolution mechanism in the National Health Insurance (JKN) program. The difference is related to the existence of the government’s role or intervention as the organizer of JKN. The method of the study was normative juridical with qualitative data analysis. The potential disputes in JKN from the complaints basis are caused by the existence of direct connections between the members (patients) and the BPJS-Kesehatan as well as connection between the members (patients) and the Health Facilities. Meanwhile, the disputes that are originated from the basis other than complaints occur because of the connection between Health Facilities and BPJS-Kesehatan as well as the connection between Health Facilities Association and BPJS-Kesehatan. This varied pattern of relationships needs to be accommodated in an independent institution to oversee the implementation of JKN in the fi eld such as the late payment on claims, diagnosis coding, independent participants who could not ascend the treatment class, cooperation agreement with BPJS-Kesehatan, and other issues. The existence of independent institutions is essential as a form of alternative dispute resolution system strengthening and minimizing the infl ux of the disputes to the court. The establishment of an independent institution that also functions as an arbiter in the JKN disputes needs to be reorganized to facilitate the government’s regulatory and supervisory functions.  ABSTRAK BPJS Kesehatan merupakan salah satu Lembaga Jasa Keuangan yang diawasi oleh Otoritas Jasa Keuangan (OJK). Berdasarkan Peraturan OJK No. 1/POJK.07/2014 tentang Lembaga Alternatif Penyelesaian Sengketa di Sektor Jasa Keuangan, Lembaga Jasa Keuangan wajib menjadi anggota Lembaga Alternatif Penyelesaian Sengketa di sektor jasa keuangan. Namun terdapat perbedaan mekanisme penyelesaian sengketa dalam program JKN yaitu adanya peran atau intervensi negara sebagai penyelenggara JKN. Kajian yang digunakan adalah yuridis normatif dengan menggunakan analisis data secara kualitatif. Potensi sengketa dalam JKN yang bersumber pengaduan terjadi karena adanya hubungan antara Peserta dengan BPJS Kesehatan dan Peserta dengan fasilitas kesehatan. Sedangkan sengketa yang bersumber di luar pengaduan terjadi karena adanya hubungan antara fasilitas kesehatan dengan BPJS, dan asosiasi fasilitas kesehatan dengan BPJS Kesehatan. Pola hubungan yang beragam tersebut perlu diakomodasi dalam suatu lembaga yang independen untuk mengawasi pelaksanaan JKN di lapangan, seperti pembayaran klaim yang terlambat, pemberian kode diagnosa atau coding, peserta mandiri yang tidak bisa naik kelas perawatan, kontrak kerja sama dengan BPJS Kesehatan, dan masalah lainnya. Keberadaan lembaga independen adalah penting sekaligus sebagai bentuk penguatan sistem penyelesaian sengketa alternatif dan meminimalisir masuknya sengketa ke pengadilan. Pembentukan lembaga independen yang sekaligus berfungsi sebagai wasit dalam sengketa JKN perlu di tata ulang untuk memudahkan Pemerintah menjalankan tugas dalam fungsi pengaturan dan pengawasan.   id-ID
dc.formatapplication/pdf
dc.languageid
dc.publisherPusat Penelitian dan Pengembangan Humaniora dan Manajemen Kesehatanen-US
dc.relationhttp://ejournal.litbang.depkes.go.id/index.php/hsr/article/downloadSuppFile/6296/15563
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 19, No 4 (2016); 250-257en-US
dc.sourceBuletin Penelitian Sistem Kesehatan; Vol 19, No 4 (2016); 250-257id-ID
dc.subjectDispute resolution, JKN, Independentid-ID
dc.titleFungsi Kelembagaan Independen Dalam Penguatan Mekanisme Penyelesaian Sengketa Jaminan Kesehatan Nasionalid-ID
dc.typeen-US


Files in this item

FilesSizeFormatView

There are no files associated with this item.

This item appears in the following Collection(s)

Show simple item record