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"Tesis ini membahas tentang Asuransi Sosial dalam Sistem Jaminan Sosial Nasional, objek penelitiannya (1) Peraturan perundangan yang mengatur sistem asuransi sosial sebelum diundangkannya Undang-undang Nomor 40 Tahun 2004 Tentang Sistem Jaminan Sosial Nasional (2) Asuransi sosial dalam Sistem Jaminan Sosial Nasional yang diatur dalam Undang-undang Nomor 40 Tahun 2004 Tentang Sistem Jaminan Sosial Nasional dan (3) Permasalahan hukum yang timbul pada asuransi sosial sebelum diberlakukannya Undang-undang Nomor 40 Tahun 2004 Tentang Sistem Jaminan Sosial Nasional. Penelitian ini mengunakan metode penelitian yuridis normatif, kemudian menganalisa permasalahan yang timbul sebelum berlakunya sistem jaminan sosial nasional yang akan menjadi tantangan pada pelaksanaan asuransi sosial pada sistem jaminan sosial nasional.Berdasarkan hasil penelitian diperoleh hasil secara normatif Sistem Jaminan Sosial Nasional akan lebih memberikan kepastian hukum, jaminan kepesertaan dan manfaat bagi peserta jaminan sosial, namun demikian tidak adanya lembaga pengawas dan kewenangan pemberi sanksi yang secara tegas di amanatkan oleh Undang - Undang Sistem Jaminan Sosial Nasional akan sangat potensial mengulang kegagalan yang sama.

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This thesis discusses Social Insurance in the National Social Security System, the object of research (1) legislation governing social insurance system prior to the enactment of Law No. 40 Year 2004 on National Social Security System (2) Social Insurance in the National Social Security System is set the Law No. 40 Year 2004 on National Social Security System, and (3) the legal issues that arise in the social insurance before the enactment of Act No. 40 of 2004 on National Social Security System. This study uses normative research methods, and then analyze the problems that arise before the entry into force of the national social security system that will be a challenge in the implementation of social insurance on the national social security system.Based on the research results normative National Social Security System will provide more legal certainty, a guarantee of participation and social security benefits for the participants, however, the absence of the regulatory agencies and authorities giver expressly sanctions mandated by the Constitution - Constitution of National Social Security System will potential repeat the same failure."

"ABSTRAKJaminan Kesehatan Sosial Nasional Indonesia saat ini dikelola oleh Badan Pengelola Jaminan Sosial Kesehatan melalui Dana Jaminan Sosial Kesehatan. Sejak beroperasinya dari tahun 2014, Dana Jaminan Sosial Kesehatan selalu mengalami defisit dan akhirnya harus dibantu oleh pemerintah dengan subsidi dari APBN. Pola tersebut tentu tidak sehat dan berlawanan dengan prinsip jaminan sosial yang tercantum dalam peraturan perundang-undangan yakni kegotong-royongan. Penyesuaian daripada tariff iuran Dana Jaminan Sosial yang dikelola Badan Pengelola Jaminan Sosial Kesehatan sudah dicoba dilakukan namun mendapat tentangan dari masyarakat. Sistem National Health Insurance di Taiwan pernah mengalami masalah yang sama di tahun 2006. Namun pada saat itu, di samping melakukan penyesuaian iuran, pemerintah Taiwan juga memberikan insenti pajak penghasilan dimana iuran NHI yang dibayarkan sendiri oleh pekerja boleh menjadi pengurang penghasilan bruto. Dengan insentif tersebut, pemerintah Taiwan dapat melakukan penyesuaian-penyesuaian atas iuran NHI tanpa resistensi dari masyarakat. Tesis ini menganalisa perkembangan jaminan kesehatan sosial di Indonesia dan di Taiwan serta perlakuan daripada peraturan perpajakan terhadap iuran Dana Jaminan Sosial tersebut. Hasil penelitian menunjukkan pembuat kebijakan di Indonesia masih belum berpikir untuk memberikan insentif pajak karena sifat iuran yang sudah dipaksakan tidak memerlukan lagi fasilitas berupa insentif. Pemikiran ini berbeda dengan pembuat kebijakan di Taiwan yang menggunakan insentif pajak untuk meningkatkan social feasibility masyarakat terhadap penyesuaian nilai iuran jaminan kesehatan, serta sebagai instrumen supply side tax policy untuk menjaga daya konsumsi masyarakat.

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ABSTRACTIndonesia's National Social Health Insurance is currently managed by the Indonesian Social Security Administration of Health through the Social Security Fund for Health. Since its operation from 2014, the Social Security Fund for Health always suffers deficits and ultimately must be assisted by the government with subsidies from the state budget. This pattern is certainly not efficient and contrary to the principle of social security which is mutual cooperation between people. In the past time, the adjustment of the contributions rate has been attempted by the government but it got a resistance from the public. The National Health Insurance system in Taiwan had experienced similar problems in 2006. But at that time, in addition to adjusting the contributions rate, the Taiwanese government also provided income tax incentives in which NHI contributions paid by employees is treated as tax deduction for the taxable income. With these incentives, the Taiwanese government can make adjustments to NHI contributions rate without notable resistance from the public. This thesis analyzes the development of social health insurance in Indonesia and in Taiwan as well as the treatment of the tax regulations on the Social Security Fund. The results show that policy makers in Indonesia do not think of providing tax incentives because the contributios have already been forced and it no longer needs the facilities in the form of tax incentives. While in the other hand, Taiwanese policy makers use tax incentives to increase the social feasibility of the public towards the policy of the adjustment of the Social Security Fund contributions, as well as the supply side tax policy instrument to safeguard people's consumption power. "

"Dalam rangka membangun sistem pencegahan korupsi pada Program Jaminan Kesehatan Nasional (JKN), Kementerian Kesehatan telah mengeluarkan Peraturan Menteri Kesehatan (Permenkes) No. 36 Tahun 2015 tentang Pencegahan Kecurangan dalam Pelaksanaan Program Jaminan Kesehatan Pada Sistem Jaminan Sosial Nasional. Hasil kajian KPK pada tahun 2017 mengungkapkan bahwa dari nilai total dana asuransi kesehatan yang dikelola BPJS Kesehatan sebesar sekitar Rp 40 triliun pada 2014, dana yang berpotensi hilang akibat kecurangan bisa mencapai Rp 2 triliun.Penelitian ini bertujuan untuk mengetahui dan menganalisa proses implementasi Permenkes No.36 tahun 2015 di Faskes Rujukan Tingkat Lanjutan wilayah Kota Tangerang dilihat dari 4 (empat) variabel implementasi sesuai teori Edward III yaitu komunikasi, sumberdaya, disposisi dan struktur birokrasi. Penelitian ini menggunakan metode kualitatif dengan teknik wawancara mendalam dan telaah dokumen. Hasil penelitian menunjukkan bahwa impelmentasi pencegahan kecurangan dalam pelaksanaan Program JKN wilayah Kota Tangerang masih belum optimal. Pada variabel komunikasi, proses transmisi pemangku kepentingan diluar sektor kesehatan belum mendapatkan sosialiasi. Implementator belum memahami kejelasan informasi mengenai pengawasan terhadap penyelenggaraan sistem pencegahan kecurangan. Pada variabel sumber daya didapatkan kurangnya kuantitas dan kualitas SDM sebagai implementator kebijakan. Belum ada peraturan daerah ataupun peraturan setingkat institusi tingkat daerah yang mengatur fraud JKN di FKRTL baik di level Kota maupun di level Propinsi . Dari variabel disposisi didapatkan bahwa terdapat perbedaan sikap dan kecenderungan pada masing-masing pemangku kepentingan. Belum ada insentif khusus yang mendorong pelaksanaan regulasi oleh para implementator. Sebaliknya, harga keekonomian dari tarif JKN yang dipandang belum sesuai seakan-akan menjadi disinsentif yang akan diterima FKRTL apabila melaksanakan Permenkes No 36 tahun 2015. Pada variabel struktur birokrasi didapatkan SOP di internal FKRTL belum efektif dan belum terdapat koordinasi yang optimal antar tim pencegahan Fraud JKN dari FKRTL dan pemangku kepentingan lainnya. Kata kunci: Implementasi, kebijakan, fraud, jaminan kesehatan

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Title : The Implementation of Regulation of Minister of Health of Republic of Indonesia Number 36 Year 2015 on Fraud Prevention in the Implementation of Health Insurance At National Social Security System in The Referral Health Facilities of Tangerang City in 2018 Academic Advisor : Prof. Dr. drg Jaslis Ilyas MPH In order to establish a corruption prevention system in the National Health Insurance Program (JKN), the Ministry of Health has issued a Regulation of the Minister of Health (Permenkes) No. 36 of 2015 concerning Fraud Prevention in the Implementation of the Health Insurance Program in the National Social Security System. The Corruption Eradication Commission of the Republic of Indonesia (KPK)revealed that from the total value of health insurance funds managed by BPJS Kesehatan amounting to around Rp 40 trillion in 2014, funds that could potentially be lost due to fraud could reach Rp 2 trillion.This study aims to find out and analyze the implementation process of Minister of Health Regulation No. 36 of 2015 in the Referral Health Facilities in the Tangerang City area seen from 4 (four)implementation variables from Edward III: communication, resources, disposition and bureaucratic structure. This study used qualitative methods with in-depth interview techniques and documents review. The results showed that the implementation of Minister of Health Regulation No. 36 of 2016 in Referral Health Facilities, the fraud prevention system in the implementation of the Tangerang City JKN Program, was still not optimal. Analysis of communication variable showed that in the process of transmitting, stakeholders from non health sector has not been socialized. The implementor has not yet understood the clarity of information regarding supervision of the implementation of fraud prevention systems. In the resource variable there is a lack of quantity and quality of Human Resources as policy implementors. There are no regional regulations at the level of regional institutions that regulate JKN fraud in Referral Health Facilities at both the City and Provincial levels. From the disposition variable, it was found that there were differences in attitudes and tendencies in each stakeholder. There are no special incentives that encourage the implementation of regulations by implementors. On the other hand, the economic price of JKN tariffs that are deemed not appropriate seems to be a disincentive to be received by FKRTL when implementing Minister of Health Regulation No. 36 of 2015. The bureaucratic structure variables found that the internal SOP of Referral Health Facilities has not been effective and there has been no optimal coordination between Fraud prevention teams of Referral Health Facilitie and other stakeholders."