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"ABSTRAKImplementasi Program Jaminan Kesehatan Nasional (JKN) memberikankemudahan masyarakat dalam menikmati layanan kesehatan yang disediakanoleh Pemerintah dan bertujuan mewujudkan Universal Health Coverage bagiseluruh rakyat Indonesia. JKN membawa perubahan sistem pembiayaan kesehatandari Fee For Service Payment (FFS) menjadi Prospective Payment System (PPS)dengan sistem paket INA CBG?s. Ketakutan bahwa JKN merugikan Rumah Sakittidak berlaku untuk 31 Rumah Sakit Vertikal Kementerian Kesehatan. setelahimplementasi JKN terjadi kenaikan pada pendapatan khususnya pendapatanlayanan secara rata-rata pada 31 Rumah Sakit Vertikal Kementerian Kesehatan.Terjadi penurunan yang drastis juga pada masa penagihan piutang. LikuiditasRumah Sakit Vertikal Kementerian Kesehatan sangat tinggi terlebih setelah JKNdiimplementasikan. Likuiditas tinggi belum tentu baik karena dapat diartikanlemahnya manajemen kas

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ABSTRACTNational Health Insurance (NHI) programe implementation giveseasiness to people for enjoying the health service from Govermance and aimed tocomplish the Universal Health Coverage for all Indonesian citizen. NHI bringsgreat change of health finance system that is from Fee For Service (FFS)Payment become Prospective Payment System (PPS) using INA CBG?s package.There?s a fearness that NHI gives a disadvantage for the hospital and it doesn?thappen on 31 State Hospitals Under The Ministry of Health. After theimplementation of NHI, there?s an increasing on average revenue especiallycomes from service activity of 31 State Hospitals Under The Ministry of Health .Theres also a decresing of collectible receivable periode. Liquidity of statehospital is very high especially after JKN implemented. High liquidity is notnecessarily good for hospital because it can be interpreted as weakness in hospitalcash management"

"Skripsi ini membahas terkait lessons learned dari pelaksanaan National health Insurance NHI di Taiwan bagi pelaksanaan Jaminan Kesehatan Nasional JKN Indonesia. Indonesia dengan pelaksanaan JKN yang masih berlangsung tiga tahun, masih memerlukan berbagai pembelajaran dan evaluasi sehingga dapat terus mengembangkan program ini sehingga dengan mempelajari negara dengan sistem yang mirip dapat menjadi masukan bagi pelaksanaan JKN. Metode yang digunakan adalah metode review kepustakaan secara sistematis dari berbagai sumber sekunder yang dipublikasikan dan dianalisis dengan menggunakan analisis anotasi bibliografi yang bersifat deskriptif analitik. Terdapat beberapa penerapan sistem pelaksanaan NHI di Taiwan yang juga dapat diterapkan di Indonesia seperti metode pendaftaran kepesertaan, metode perhitungan premi dengan premi dasar dan premi tambahan sesuai gaji dan kategori, serta sistem pelayanan yang terintegrasi melalui sistem informasi dengan kartu IC, serta website sehingga mempermudah proses pelayanan dan akses data kesehatan peserta.

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The purpose of this research is to get the lessons learned from the implementation of Taiwan rsquo s National Health Insurance NHI for Indonesia rsquo s Jaminan Kesehatan Nasional JKN . After three years of implementation, JKN still requires program evaluation and innovation in order to develop this program by studying other countries with similar system. This research used qualitative with systematic literature review method collected from secondary sources and analyzed by using analytic descriptive with bibliographic annotation analysis. There are several methods in Taiwan which can also be implemented in Indonesia such as membership registration method, premium calculation method with standards premium and supplementary premium according to salary and the categories, and the integrated service system through information system with IC Card and website to simplify the service process and make the access to medical record and utilization easier to track."

"Penelitian ini mengenai Implementasi Program JKN (Jaminan Kesehatan Nasional) di RSUD Pasar Rebo. Penelitian ini menggunakan pendekatan post-positivist yang bersifat deskriptif yang bertujuan untuk mengetahui Implementasi Program JKN (Jaminan Kesehatan Nasional) di RSUD Pasar Rebo yang diukur melalui Indikator-Indikator implementasi kebijakan. Jumlah Informan dalam penelitian ini berjumlah 15 orang, teknik pengumpulan data dengan menggunakan wawancara mendalam dan observasi. Hasil dari Implementasi Program JKN (Jaminan Kesehatan Nasional) di RSUD Pasar Rebo adalah masih banyak masalah yang disebabkan oleh minimnya SDM, kerumitan sistem INA-CBG's, masalah pembiayaan klaim dan sosialisasi JKN.

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This research is about the implementation of JKN Program (National Health Insurance) in Pasar Rebo Hospital. This study uses a post-positivist approach which aims to determine the Program Implementation JKN (National Health Insurance) in Pasar Rebo Hospital as measured by Indicators of policy implementation. Number of Informants in this study around to 18 people, the techniques of data collection using in-depth interviews and observation. Result of the Implementation of JKN Program (National Health Insurance) in Pasar Rebo Hospital is still having a lot of problems caused by the lack of human resources, the complexity of the system INA-CBG's financing problems and socialization JKN claims."

"Skripsi ini membahas tentang pelaksanaan National Health Insurance NHI di Thailand sebagai pembelajaran bagi pelaksanaan Jaminan Kesehatan Nasional JKN di Indonesia. Pelaksanaan JKN di Indonesia masih tergolong baru sehingga memerlukan berbagai evaluasi dan pembelajaran guna meningkatkan kualitas program JKN. Untuk meningkatkan kualitas program JKN, Indonesia harus belajar dari negara lain yang memiliki sistem kesehatan dan karakteristik yang hampir serupa dengan Indonesia. Metode yang digunakan dalam skripsi ini adalah metode telaah kepustakaan secara sistematis dari berbagai sumber sekunder yang dipublikasikan kemudian dianalisis dengan menggunakan analisis anotasi bibliografi yang bersifat deskriptif analitik. Terdapat beberapa penerapan sistem pelaksanaan NHI di Thailand yang dapat diterapkan di Indonesia, seperti perluasan kepesertaan, metode pembiayaan kepada penyedia pelayanan kesehatan, sistem pelayanan kesehatan, dan sistem informasi kesehatan yang terintegrasi.

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This study focuses on the implementation of National Health Insurance NHI in Thailand as a learning for the implementation of Jaminan Kesehatan Nasional JKN in Indonesia. NHI in Thailand has similar applications with JKN in Indonesia in terms of expansion of assurance membership, payment method for health service provider, health service system, and integrated health information system. JKN in Indonesia is still considered new despite its years of execution. Therefore, JKN needs some development to improve the quality of JKN it self by learning from other country who has similar health system and characteristics as Indonesia. This study is using systematic literature review as the research method and the data were collected from various published secondary sources. After collecting data, the data were analyzed using bibliography annotations analyzation."

"Memasuki kuartal pertama tahun 2014 sejak diimplementasikannya JKN, nilai (value) penjualan farmasi mengalami penurunan. Bahkan setelah implementasi JKN tahun 2014, pertumbuhan yang dicapai pada tri wulan pertama tahun 2014 hanya sebesar satu digit. Temuan fenomena tersebut mengindikasikan bahwa implementasi JKN berimplikasi pada terjadinya permasalahan pada corporate performance sustainability . Penelitian ini berusaha untuk menjawab permasalahan ?Bagaimana perusahaan farmasi meraih corporate performance sustainability di era JKN?. Penelitian ini bertujuan untuk menguji pengaruh variabel-variabel perubahan lingkungan bisnis, strategi politik, relasional, harga, corporate strategy sustainability dan corporate performance sustainability dengan pendekatan mixed method. Sampel yang digunakan penelitian adalah perusahaan farmasi baik PMDN maupun PMA. Expected outcome yang diharapkan dari penelitian ini adalah untuk menghasilkan sebuah model penelitian yang dapat diterima secara general. Hasil pengujian pengaruh pada variabel-variabel penelitian menunjukkan bahwa perubahan lingkungan bisnis terbukti berpengaruh positif signifikan terhadap strategi politik, relasional, dan harga; strategi politik, relasional, dan harga secara statistik juga terbukti berpengaruh secara positif signifikan terhadap corporate strategy sustainability dan corporate performance sustainability. Sinergi strategi politik, relasional, dan harga memiliki kontribusi yang lebih besar dalam membangun corporate strategy sustainability dan corporate performance sustainability dibanding apabila dilakukan secara terpisah.

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Entering the first quarter of 2014 since the implementation of NHI , the value pharmaceutical sales decreased. Even after the implementation of NHI 2014, the growth achieved in the first quarterly of 2014 only by one digit. The findings of these phenomena indicate that implementation of NHI implicated in the occurrence of problems incorporate performance sustainability. This study seeks to answer the problem"How pharmaceutical companies achieve corporate performance sustainability in NHI era?".

This study aimed to examine the effect of variables changing business environment, political strategies, relational, price, corporate strategy and performance sustainability with the mixed method approach. The sample used is a research pharmaceutical both domestic and FDI companies. Expected outcomes from this research is to produce a research model that can be accepted in general.

The test results on the influence of the variables of research shows that the business environment changing proved to give significant positive effect on political strategy, relational, and price; political strategy, relational, and prices statistically also proved to be significantly give positive effect on the corporate strategy and performance sustainability. The synergies of political strategy, relational, and prices have a greater contribution in building corporate strategy and performance sustainability than if it is done separately."

"

Analisis Pemanfaatan Clinical Pathway Sectio Caesaria Di Rumah Sakit Dalam Program Jaminan Kesehatan Nasional Penelitian ini bertujuan menganalisis hubungan antara faktor sosial ekonomi dan klinis ibu melahirkan Sectio Caesaria (SC) di Rumah Sakit (RS) dengan pemanfaatan Clinical Pathway (CP), outcome klinis serta pembayaran klaim. Studi desain Cross Sectional pada unit analisis 1155 data rekam medis ibu melahirkan SC periode 1 Januar-31 Desember 2018 di 3 RS. Hasil penelitian menunjukan pemanfaatan CP peserta Jaminan Kesehatan Nasional (JKN) yaitu sebanyak 939 Ibu melahirkan SC proporsinya sebesar 43.1% masih menunjukkan pemanfaatan yang kurang baik. Pemanfaatan CP terkait penyimpanan dokumen Clinical Pathway ibu melahirkan SC peserta JKN sebanyak 71.8% tidak tersimpan di Rekam Medis, 72.6% tidak lengkap pengisiannya dan 64.6% kondisi klinis Ibu melahirkan SC tidak sesuai dengan PPK RS. RS Pemda memiliki Proporsi tertinggi skor pemanfaatan CP yang kurang baik sebesar 76.8%, kemudian diikuti RSP (36.8%). RSNP menunjukkan proporsi skor pemanfaatan CP baik. Jenis RS (p=0.000), Kelas rawat (p=0.014) dan Rujukan (p=0.008), jenis SC (p=0.005), Usia Ibu (p=0.053), Paritas (p=0.016), Riwayat ANC (p=0.000), Kondisi Panggul p=0.000), kondisi plasenta (p=0.001), penyakit penyerta (p=0.000) dan riwayat SC (p=0.000) menunjukkan berhubungan secara signifikan dengan pemanfaatan CP (p<0.05). Pemanfaatan CP ibu melahirkan SC peserta JKN menunjukan adanya hubungan yang signifikan dengan Outcome klinis (p=0.002). Outcome Klinis ibu melahirkan SC menunjukkan sebesar 67.5% bermasalah antara lain terkait LOS yang tidak sesuai Panduan Praktek Klinis (PPK) RS, Ibu memiliki komplikasi klinis paska SC atau kondisi bayi saat dilahirkan tidak normal. Pemanfaatan CP berhubungan secara signifikan dengan pembayaran klaim (p=0.000). Pembayaran klaim ibu melahirkan SC peserta JKN bermasalah sebesar 39.3% terkait jangka waktu pembayaran klaim dari BPJSK ke pihak RS. Pembayaran klaim yang tidak bermasalah pada pemanfaatan CP yang kurang baik lebih banyak. Monitoring dan evaluasi yang komprehensif pada pemanfaatan CP, outcome klinis dan proses pembayaran klaim sebagai kendali mutu pelayanan ibu melahirkan SC dalam JKN oleh RS, Organisasi Profesi dan Pemerintah. Pemerintah harus membuat payung hukum yang bersifat operasional pada pemanfaatan CP Ibu melahirkan SC di RS dalam program JKN, sehingga kendali mutu dan kendali biaya pelayanan ibu melahirkan SC menjadi efektif dan efisien. Pedoman Nasional Pelayanan Kedokteran perlu segera diterbitkan dan disosialisikan ke Rumah Sakit. Kata kunci: SC, Sosial-ekonomi dan Klinis, Pemanfaatan Clinical Pathway, Outcome Klinis, Klaim Pembayaran

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Analysis of Sectio Caesarea Clinical Pathway Utilization in Hospital Under National Health Insurance This study aims to analyze the relationship between socioeconomic and clinical factors of women giving birth to Sectio Caesaria (SC) in Hospitals (RS) with the utilization of Clinical Pathway (CP), clinical outcomes and claim payment. Cross Sectional design study in the 1155 unit of analysis of medical records of women giving birth to SC for the period January 1 to December 31, 2018 in 3 hospitals. The results showed that the utilization of CP for mothers giving birth to SC (939) participants of the National Health Insurance (JKN) from the 3 research study hospitals, the proportion of 43.1%, still showed poor utilization. Utilization of CP related to document keeping of mother who gave birth SC to JKN participants as much as 71.8% were not kept in the Medical Record, 72.6% were incomplete filling and 64.6% of clinical conditions of mother who gave birth to SC were not in accordance with PPK RS. Regional Government Hospital has the highest proportion of poor CP utilization scores of 76.8%, followed by RSP (36.8%). RSNP shows the proportion of good CP utilization scores. Type of hospital (p = 0.000), nursing class (p = 0.014) and type of referral (p = 0.008), type of SC (p = 0.005), maternal age (p = 0.053), parity (p = 0.016), ANC history (p = 0.000), Pelvic Conditions (p = 0.000), placental conditions (p = 0.001), comorbidities (p = 0,000) and history of SC (p = 0,000) showed significant correlation with CP utilization (p <0.05). Utilization of CP for mothers giving birth to SC JKN participants showed a significant relationship with clinical outcome (p = 0.002). Clinical Outcomes of mothers giving birth to SC showed that 67.5% had problems, among others related to LOS that was not in accordance with the Clinical Practice Guidelines (PPK) of the Hospital. CP utilization was significantly related to claim payment (p = 0,000). Claim Payment of mothers with SC under JKN participants was 39.3% related to the period of payment of claims from BPJSK to the hospital. The utilization of CP which were under score mean seems not having administration problem and paid by JKN earlier and without any problem. Comprehensive monitoring and evaluation of the utilization of CP , clinical outcomes and the process of claim as a quality control service for SC mothers in JKN by hospitals, professional organizations and the government. The government must make an operational legal policy on the utilization of CP for women giving birth to SC in hospitals under the JKN program, so that quality control and cost control of maternal care services for SC become effective and efficient. National Guidelines for Medical Services need to be immediately published and disseminated to hospitals. Keywords: SC, Socio-economic and Clinical, Clinical Pathway Utilization, Clinical Outcome, Payment Claims

"

"Penelitian ini bertujuan untuk mengetahui pengaruh pelaksanaan program Jaminan Kesehatan Nasional JKN terhadap sales growth dan net profit margin perusahaan farmasi terdaftar di Bursa Efek Indonesia periode 2012 ndash; 2016 dengan variabel kontrol adalah nilai tukar dan apakah terdapat perbedaan pada kinerja keuangan antara sebelum dan sesudah pelaksanaan Jaminan Kesehatan Nasional JKN tersebut. Metode sampel yang digunakan dalam penelitian ini adalah purposive sampling yaitu teknik pengambilan sampel yang memenuhi kriteria-kriteria khusus. Data yang digunakan dalam penelitian ini merupakan data laporan keuanga perusahaan farmasi yang terdaftar di Bursa Efek Indonesia selama periode dari tahun 2012 hingga tahun 2016 yaitu sebanyak 9 perusahaan dengan total observasi 90 data. Metode analisis yang digunakan adalah analisis data panel dan analisis paired sample t-test.Berdasarkan hasil penelitian dengan menggunakan analisis data panel menunjukkan bahwa pelaksanaan Jaminan Kesehatan Nasional JKN diduga tidak berpengaruh terhadap sales growth dan net profit margin perusahaan farmasi dengan nilai tukar sebagai variabel pengontrol. Sementara itu, hasil pengujian dengan paired sample t test menunjukkan bahwa NPM, ROA, ROE, DAR, DER, CR, dan QR diduga tidak memiliki perbedaan antara sebelum dan sesudah pelaksanaan Jaminan Kesehatan Nasional JKN , sedangkan cash asset ratio perusahaan farmasi yang terdaftar di Bursa Efek Indonesia untuk periode tahun 2012 hingga 2016 diduga memiliki perbedaan antara sebelum dan sesudah pelaksanaan Jaminan Kesehatan Nasional JKN.

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This study aims to determine the effect of the implementation of the National Health Assurance JKN program on sales growth and net profit margin of pharmaceutical companies listed on the Indonesia Stock Exchange period 2012 2016 with the control variable is the exchange rate and whether there is a difference in financial performance between before and after the implementation The National Health Assurance JKN . Sample method used in this research is purposive sampling that is sampling technique that fulfill the special criteria. The data used in this research is data of financial report of pharmaceutical company listed in Bursa Efek Indonesia during period from 2012 until year 2016 that is 9 companies with total observation 90 data. The analysis method used is panel data analysis and paired sample t test analysis.Based on the result of research by using panel data analysis shows that the implementation of National Health Assurance JKN is suspected to have no affect on sales growth and net profit margin of pharmaceutical company with exchange rate as controlling variable. Meanwhile, the test result with paired sample t test shows that NPM, ROA, ROE, DAR, DER, CR, and QR are suspected to have no difference between before and after the implementation of National Health Assurance JKN , while cash asset ratio of listed pharmaceutical companies in the Indonesia Stock Exchange for the period 2012 to 2016 is suspected to have differences between before and after the implementation of the National Health Assurance JKN."

"[ABSTRAKDalam UUD 1945 menyebutkan bahwa setiap orang berhak memperolehpelayanan kesehatan dan Negara bertanggung jawab atas penyediaan fasiltaskesehatan dan fasilitas umum yang layak. Untuk memenuhi dan mewujudkan hakbagi setiap warga negara dalam mendapatkan pelayanan kesehatan yang layak dankewajiban pemerintah penyediaan fasilitas kesehatan sebagai amanat UUD 1945maka pemerintah pusat menyelenggarakan program jaminan kesehatan nasional(JKN) dan untuk pemerintahan daerah khusus Ibukota (DKI Jakarta)menyelenggarakan jaminan kesehatan daerah yang dikenal dengan nama KartuJakarta Sehat (KJS). RSCM adalah rumah sakit milik pemerintah pusat yang salahsatu visinya adalah menjadi rumah sakit pusat rujukan nasonal terkemuka di AsiaPasifik tahun 2014. RSCM diharapkan dapat melayani masyarakat dari seluruhpenjuru Indonesia dengan sistem rujukan berjenjang dengan optimal sesuaidengan standar pelayanan kesehatan dan peraturan yang berlaku. Penelitian inimembahas mengenai indeks kepuasan masyarakat miskin terhadap pelayanan diRSCM dalam program JKN dan KJS. Program kesehatan JKN dan KJS ini tidaklepas dari permasalahan dalam pelaksanaannya, salah satunya adalah mengenaipelayanan di rumah sakit dalam pelaksanaan program tersebut. Tujuan dalampenelitian ini adalah untuk mengukur nilai indeks kepuasan masyarakat miskin diRSCM dalam pelaksanaan program JKN dan KJS serta untuk mengetahui unsurunsuryang sudah baik dan yang masih membutuhkan peningkatan kualitaspelayanannya. Hasil dari penelitian kuantiatif menilai bahwa indeks kepuasanmasyarakat miskin di RSCM adalah sangat baik, tetapi ada beberapa pelayananyang perlu menjadi perhatian dan atau perbaikan yang didapat dari hasil penelitiankualitatif.

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ABSTRACTIndonesia Constitution (UUD 1945) states that every citizen has the right to obtainmedical care and the Government is responsible for the provision of health andadequate public facilities. In order to satisfy and fulfil the right of every citizen ingetting proper health care as mandated by the Constitution, The centralgovernment has issued the National Health Insurance Program (JKN) whereas theJakarta Provincial Government has issued a Regional-based Health InsuranceProgram known as the Jakarta Health Card (KJS). National General Hospital Dr.Cipto Mangunkusumo (RSCM) is one of the hospitals owned by the centralgovernment and one of its visions is to become regional referral hospitals in AsiaPacific in 2014. RSCM is expected to serve people from all over Indonesiaaccordance with the standard of health services and regulations. This studydiscusses the satisfaction index of the poor with regard to services in RSCMespecially on the implementation of the JKN and KJS. The problem of theimplementation of JKN and KJS are still occurred, one of the problems is thehospital services in the implementation of the programs. The purpose of thisresearch is to measure the value of the satisfaction index of the poor in RSCM onthe implementation of JKN and KJS as well as to determine the factors that aregood and which are still in need of improvement of service quality. The results ofthe quantitative study is conclude that the satisfaction index of the poor in RSCMis ?very good?, yet there are some services that need to be improved derived fromthe results of qualitative research.;Indonesia Constitution (UUD 1945) states that every citizen has the right to obtainmedical care and the Government is responsible for the provision of health andadequate public facilities. In order to satisfy and fulfil the right of every citizen ingetting proper health care as mandated by the Constitution, The centralgovernment has issued the National Health Insurance Program (JKN) whereas theJakarta Provincial Government has issued a Regional-based Health InsuranceProgram known as the Jakarta Health Card (KJS). National General Hospital Dr.Cipto Mangunkusumo (RSCM) is one of the hospitals owned by the centralgovernment and one of its visions is to become regional referral hospitals in AsiaPacific in 2014. RSCM is expected to serve people from all over Indonesiaaccordance with the standard of health services and regulations. This studydiscusses the satisfaction index of the poor with regard to services in RSCMespecially on the implementation of the JKN and KJS. The problem of theimplementation of JKN and KJS are still occurred, one of the problems is thehospital services in the implementation of the programs. The purpose of thisresearch is to measure the value of the satisfaction index of the poor in RSCM onthe implementation of JKN and KJS as well as to determine the factors that aregood and which are still in need of improvement of service quality. The results ofthe quantitative study is conclude that the satisfaction index of the poor in RSCMis ?very good?, yet there are some services that need to be improved derived fromthe results of qualitative research., Indonesia Constitution (UUD 1945) states that every citizen has the right to obtainmedical care and the Government is responsible for the provision of health andadequate public facilities. In order to satisfy and fulfil the right of every citizen ingetting proper health care as mandated by the Constitution, The centralgovernment has issued the National Health Insurance Program (JKN) whereas theJakarta Provincial Government has issued a Regional-based Health InsuranceProgram known as the Jakarta Health Card (KJS). National General Hospital Dr.Cipto Mangunkusumo (RSCM) is one of the hospitals owned by the centralgovernment and one of its visions is to become regional referral hospitals in AsiaPacific in 2014. RSCM is expected to serve people from all over Indonesiaaccordance with the standard of health services and regulations. This studydiscusses the satisfaction index of the poor with regard to services in RSCMespecially on the implementation of the JKN and KJS. The problem of theimplementation of JKN and KJS are still occurred, one of the problems is thehospital services in the implementation of the programs. The purpose of thisresearch is to measure the value of the satisfaction index of the poor in RSCM onthe implementation of JKN and KJS as well as to determine the factors that aregood and which are still in need of improvement of service quality. The results ofthe quantitative study is conclude that the satisfaction index of the poor in RSCMis “very good”, yet there are some services that need to be improved derived fromthe results of qualitative research.]"

"Skripsi ini membahas mengenai pembelajaran dari pelaksanaan National health Insurance Program NHIP di Filipina terhadap pelaksanaan Jaminan Kesehatan Nasional JKN di Indonesia. JKN di Indonesia masih memerlukan evaluasi serta inovasi dalam pelaksanaan dan perkembangan agar menjadi program yang berkelanjutan sehingga dengan mengkaji negara tetangga yang memiliki asuransi kesehatan nasional dapat menjadi pembelajaran bagi pelaksanaan JKN. Penelitian ini menggunakan metode studi kepustakaan tersistematis bersumber dari berbagai informasi dan data sekunder yang kemudian dianalisis menggunakan teknik anotasi bibliografi bersifat deskriptif analitik. NHIP di Filipina memiliki beberapa sistem dan metode yang dapat diadaptasi dan diterapkan pada pelaksanaan JKN di Indonesia seperti metode pencakupan peserta, metode pembayaran premi dengan pilihan periode pembayaran serta metode pemberian jaminan dengan batas tertentu sehingga menekan jumlah pembayaran jaminan.

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This study discusses about lessons learned from the implementation of National health Insurance Program NHIP in Philippines for Indonesia rsquo s Jaminan Kesehatan Nasional JKN. JKN still requires evaluation and innovation in order to keep the sustainability by reviewing neighboring countries that have the scheme as well. This study uses systematic literature review method from various secondary sources of information and data which is then analyzed by using an analytic descriptive bibliographic annotation technique. NHIP in the Philippines has several systems and method that can be adapted and applied to the implementation of JKN in Indonesia such as members coverage method, payment of premium method which gives members the choices of payment period as well as the benefits limit method by giving certain limits for members to avail thereby reducing the excessive benefits payment. "

"Kenaikan jumlah penderita penyakit Diabetes Mellitus (DM) termasuk beban biaya pelayanannya mendorong penerapan kebijakan untuk melakukan pecegahan sekunder di pelayanan Tingkat pertama termasuk melalui penerapan kebijakan Kapitasi Berbasis Kinerja (KBK). Studi ini melakukan evaluasi terhadap kebijakan KBK terhadap pola pelayanan Kesehatan pasien DM baik di Fasilitas Kesehatan Tingkat Pertama (FKTP) dan Fasilitas Kesehatan Rujukan Tingkat Lanjutan, menggunakan metode Regression Discontinuity in Time (RDIT) terhadap Data Sampel BPJS Kesehatan 2015-2020. Ditemukan adanya kenaikan pada pemanfaatan pelayanan Kesehatan di FKTP dengan tingkat kepercayaan 99% dan 95%, namun tidak diikuti dengan tren penurunan rujukan pelayanan Kesehatan dari FKTP ke FKRTL serta penurunan tingkat pelayanan Kesehatan di FKRTL yang diharapkan terjadi paska penerapan KBK. Temuan ini mendukung literatur terkait penerapan konsep pay for performance dalam pelayanan Kesehatan Tingkat pertama dan dampaknya pada perbaikan pelayanan Kesehatan Tingkat pertama terkait pelayanan DM. Perbaikan kebijakan KBK perlu dilakukan dalam penetapan indikator, target serta kebijakan pendukung lainnya dalam pencapaian kinerja FKTP yang didasarkan pada temuan pada pengumpulan data secara kualitatif melalui wawancara mendalam.

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The increase in number of people suffering from Diabetes Mellitus, including the burden of service costs, has encouraged the implementation of policies to carry out secondary prevention in primary healthcare level, including to implement Performance Based Capitation (KBK) policy. This study aim to evaluate the KBK policy implemented by BPJS Health on health services for Diabetes Mellitus patients both in Primary Health Care Facilities and Referral Health Facilities, using the Regression Discontinuity in Time (RDIT) method on BPJS Health Sample Data 2015-2020. It was found that there was a slight increase in the level of utilization of Health services at FKTP with confidence levels of 99% and 95%, but this was not followed by a trend of decreasing referrals for Health services. This increase is not accompanied by a decrease in the level of health services at FKRTL which was expected to occur after the implementation of the KBK. These findings support the literature related to the application of the pay for performance concept in first level health services and its impact on improving first level health services related to Diabetes Mellitus services. Apart from that, the findings also encourage the need to improve the KBK policy both in determining indicators, targets and other supporting policies in achieving FKTP performance, based on qualitative data findings through in depth interview."