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"ABSTRAKGovernmental committees are a type of collegical organizations in the executive branch whereby policy stakeholders are incorporated into the decision-making process so that they may negotiate with each other to achieve policy outcomes under the overall executive leadership. However, as institutions designed to enlarge policy participation, the democratic effects of committees are still under debate. To uncover the political effects of committee mechanism, the aim of this study is to address the stakeholders influence over decision making in the committee mechanism and how this influence is affected by access to resources.Theoritically, the author illustrates the factors determining stakeholders influence with three perspectives. First, the election mobilization approach emphasizes the political dimension of public policies, meaning that decision making should be legitimated by majoritarian support. Second, from the viewpoint of professional asymmetry, professional dominance over knowledge sources can lead or affect policy content; as a result, those with access to profesiional resources have the implicit capacity to control decision outcomes. Third, the administrative approach focuses on the normative legitimacy of the state, as well as its monopoly over executive functions."

"Pasca diimplementasikannya program Jaminan Kesehatan Nasional (JKN), peningkatan pemanfaatan pelayanan kesehatan terjadi pada setiap jenis kepesertaan. Meskipun mengalami tren peningkatan, sasaran utama program JKN yaitu peserta PBI masih dianggap belum optimal dalam pemanfaatan pelayanan kesehatan, berbeda dengan jenis kepesertaan PBPU, PPU, dan Bukan Pekerja yang memiliki tingkat pemanfaatan pelayanan kesehatan yang optimal. Penelitian ini bertujuan untuk melihat bagaimana pengaruh pendapatan terhadap pemanfaatan pelayanan kesehatan berdasarkan jenis kepesertaan JKN. Menggunakan data sekunder dari data Klaim Pelayanan Kesehatan BPJS Kesehatan tahun 2015 - 2018 dengan pendekatan metode analisa deskriptif dan estimasi persamaan regresi ordinary least square dan probit ordinal, diperoleh bahwa pendapatan yang diproyeksikan melalui jenis kepesertaan memiliki pengaruh terhadap tingkat pemanfaatan pelayanan kesehatan di antara peserta jaminan kesehatan nasional. Peserta PBI yang berasal dari kelompok pendapatan rendah memiliki periode perawatan kesehatan yang lebih lama, biaya pengeluaran kesehatan yang tinggi, dan tingkat keparahan penyakit yang lebih berat saat melakukan perawatan kesehatan dibandingkan dengan peserta yang berasal dari kelompok pendapatan menengah atas. Hasil penelitian ini menjelaskan kunjungan pemanfaatan pelayanan kesehatan peserta PBI yang rendah diakibatkan perilaku untuk mengobati sendiri dan pengetahuan yang rendah akan jaminan kesehatan nasional.

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After the implementation of the National Health Insurance (JKN) program, an increase in the utilization of health services occurred in each type of participation. Although experiencing an increasing trend, the main target of the JKN program, namely PBI participants, is still considered not optimal in the utilization of health services, in contrast to the types of PPU, PBPU, and Non-Workers participation which have an optimal level of utilization of health services. This study aims to see how income affects the utilization of health services based on the type of JKN membership. Using secondary data from BPJS Health Health Service Claims data in 2015 - 2018 with a descriptive analysis method approach and estimation of regression equations ordinary least squares and ordinal probit, it was found that the projected income through the type of participation has an influences on the level of utilization of health services among national health insurance participants. PBI participants from low-income groups had longer periods of health care, higher health expenditures, and more severe disease severity during health care than participants from upper-middle-income groups. The results of this study explain the low utilization of PBI participants of health service visits due to self-medicating behavior and low knowledge of national health insurance."

"Terealisasinya keadaan sehat merupakan keinginan semua orang, juga dari keluarga, perkumpulan dan masyarakat. Perusahaan asuransi dan lembaga asuransi adalah lembaga ekonomi, yaitu lembaga pengalihan risiko. Tingkat risiko dapat diukur dengan nilai produk dimana peristiwa itu terjadi. Penelitian ini dilakukan untuk mengetahui penyelesaian klaim asuransi kesehatan nasional. Penelitian ini menggunakan metode literature review. Pada pencarian studi menggunakan tiga online database yaitu PubMed, Google Scholar, dan Science Direct. Ada 7 studi yang terinklusi dalam penelitian ini. Hasil penelitian menunjukkan dalam menyelesaikan klaim terdapat bentuk-bentuk penyelesaian klaim asuransi kesehatan nasional, faktor pendukung dan faktor penghambat. Faktor pendukung diantaranya adalah ketepatan penyelesaian klaim, tingkat penyelesaian klaim, klaim rasio dan keluhan ganti rugi. Adapun faktor penghambat klaim diantaranya adalah staf yang kurang memenuhi kualifikasi dalam memproses klaim, tata cara pengecekan yang kurang jelas dan peserta asuransi baru menyadari saat membuat klaim bahwa tidak mencakup penyakit tertentu.

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The realization of a healthy condition is the desire of everyone, also from families, associations and communities. Insurance companies and insurance institutions are economic institutions, namely risk transfer institutions. The level of risk can be measured by the value of the product where the event occurs. This study was conducted to determine the settlement of national health insurance claims.method literature review. The study search used three online databases , namely PubMed, Google Scholar, and Science Direct. There are 7 studies included in this study. The results showed that in resolving claims there are forms of settlement of national health insurance claims, supporting factors and inhibiting factors. Supporting factors include the accuracy of claim settlement, level of claim settlement, claim ratio and compensation complaints. The factors inhibiting claims include staff who do not meet the qualifications in processing claims, procedures for checking that are not clear and insurance participants only realize when making a claim that it does not cover certain diseases. "

"ABSTRAKOn January 1, 2014, the government began to implement the National Health Insurance (NHI) program to realize social welfare for the whole community. Midwifery and neonatal care in the NHI program involves Puskesmas/family doctors and Private Practice Midwife (PPM) as its network. PPM participation in the NHI program in Bungo District was still lacking, only 12 (54.5%) PPM have cooperated with family doctors from 22 existing PPM. This study aimed to get an overview of PPM participation in the NHI program in Bungo District, Jambi Province. The study used qualitative research approach with Rapid Assessment Prosedur design, purposive sampling, and conducted in-depth interview to 10 PPM, Head of Health Office, MPKP BPJS Health Manager, and Chairman of Bungo Regency Section of Indonesian Midwife Organization (IMO). The study was conducted from January to July 2017. The study found that the knowledge, perceptions and attitude towards NHI program were good, but the perceived toward the claim and predetermined tariff procedures were not so good. PPM motivated to join the NHI program as many patients had become NHI participants. Support from the Government, NHI, and IMO were low, either in the form of socialization, or policies. Therefore, the study suggest an improvement in claims procedures, tariffs, and an increase of socialization from government, NHI and IMO on NHI program related to obstetric and neonatal care."

"Implementasi Program Jaminan Kesehatan Nasional (JKN) memberikan kemudahan masyarakat dalam menikmati layanan kesehatan yang disediakan oleh Pemerintah dan bertujuan mewujudkan Universal Health Coverage bagi seluruh rakyat Indonesia. JKN membawa perubahan sistem pembiayaan kesehatan dari Fee For Service Payment (FFS) menjadi Prospective Payment System (PPS) dengan sistem paket INA CBG?s. Ketakutan bahwa JKN merugikan Rumah Sakit tidak berlaku untuk 31 Rumah Sakit Vertikal Kementerian Kesehatan. setelah implementasi JKN terjadi kenaikan pada pendapatan khususnya pendapatan layanan secara rata-rata pada 31 Rumah Sakit Vertikal Kementerian Kesehatan. Terjadi penurunan yang drastis juga pada masa penagihan piutang. Likuiditas Rumah Sakit Vertikal Kementerian Kesehatan sangat tinggi terlebih setelah JKN diimplementasikan. Likuiditas tinggi belum tentu baik karena dapat diartikan lemahnya manajemen kas.

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National Health Insurance (NHI) programe implementation gives easiness to people for enjoying the health service from Govermance and aimed to complish the Universal Health Coverage for all Indonesian citizen. NHI brings great 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't happen on 31 State Hospitals Under The Ministry of Health. After the implementation of NHI, there's an increasing on average revenue especially comes from service activity of 31 State Hospitals Under The Ministry of Health. Theres also a decresing of collectible receivable periode. Liquidity of state hospital is very high especially after JKN implemented. High liquidity is not necessarily good for hospital because it can be interpreted as weakness in hospital cash management."

"Tesis ini membahas ketepatan praktek dokter pelayanan primer didalam skema Jaminan Kesehatan Nasional yang akan mulai berlaku pada tanggal 01 Januari 2014 di Indonesia, untuk mencapai Universal Health Coverage khususnya di Provinsi DKI Jakarta. Penelitian ini adalah penelitian kualitatif dengan desain deskriptif. Pengambilan data primer dengan cara wawancara mendalam dan data sekunder dengan telaah dokumen/literatur. Hasil penelitian menyarankan bahwa Provinsi DKI Jakarta harus melakukan pemetaan untuk seluruh dokter umum, dokter gigi, dan dokter spesialis yang berpraktek dan berdomisili di Provinsi DKI Jakarta beserta dengan pemetaan fasilitas pelayanan kesehatan primer yang ada; merekomendasikan dokter umum, dokter gigi dan dokter spesialis (swasta dan Pegawai Negeri Sipil) yang memenuhi syarat tersebut untuk bekerjasama dengan BPJS Kesehatan; memberikan subsidi (penuh/sebagian) untuk pembiayaan pendidikan berkelanjutan dalam keilmuan post graduate family medicine; dan membuat Peraturan Daerah yang mendukung penetapan dokter pelayanan primer, pemisahan bentuk Puskesmas menjadi Puskesmas Upaya Kesehatan Perseorangan (UKP) dan Puskesmas Upaya Kesehatan Masyarakat (UKM), serta penetapan alokasi dan metode pembayaran dengan metode kombinasi kepada penyedia pelayanan primer di Provinsi DKI Jakarta.

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This thesis discusses the precision of primary care physician practices in the National Health Insurance (INA-Medicare) scheme which will come into force on January 1, 2014 in Indonesia, in order to achieve Universal Health Coverage especially in Jakarta. This research is a descriptive qualitative research design. Primary data collection with in-depth interviews and secondary data with document review / literature. The results suggest that Jakarta should do the mapping for all general practitioners, dentists, and medical specialists practicing and residing in Jakarta along with mapping of primary health care facilities that exist; recommend general practitioners, dentists and specialists (private and civil servants) who are qualified to work with Health BPJS; provide subsidy (full / partial) for the financing of continuing education in family medicine post graduate scholarship, and made a local regulation that supports the establishment of a primary care physician, a health center (Puskesmas) separation form to a health center of Individual Health Care efforts (UKP) and a health Center of Public Health efforts (UKM), and the determination of the allocation and payment method with a combination of methods to primary care providers in Jakarta."

"ABSTRAKSistem Jaminan Sosial Nasional memberikan pertimbangan utama untuk memberikanjaminan sosial yang menyeluruh bagi seluruh rakyat Indonesia, sehingga semua rakyatIndonesia dapat memperoleh derajat kesehatan yang optimal agar dapat bekerja dan hidupdengan layak. Pada era SJSN tonggak utama pelayanan kesehatan adalah pelayanankesehatan primer sebagai gatekeeper. Saat ini jumlah puskesmas di kota Malang sebanyak 15puskesmas, jumlah tersebut belum berubah sejak tahun 2010 hingga tahun 2013, begitu jugadengan jumlah dokter di puskesmas. Penelitian ini bertujuan untuk menganalisis kesiapanpuskesmas kota malang dalam menyongsong SJSN tahun 2014. Penelitian ini merupakanpenelitian deskriptif analitik dengan pendekatan Cross Sectional serta wawancara mendalampada informan dan studi literature. Hasil penelitian menunjukkan bahwa keterbatasan jumlahpuskesmas serta kurangnya ketersediaan tenaga kesehatan menyebabkan ketidaksiapanpuskesmas dalam menyongsong SJSN tahun 2014.

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ABSTRACTUniversal coverage gives primary consideration to provide a comprehensive social securityfor all Indonesian people, so that all the people of Indonesia can obtain optimal health statusin order to work and live decently. Universal coverage a major milestone in the era of healthcare is primary health care as a gatekeeper. Currently the number of health centers in the cityof Malang as much as 15 health centers, that number has not changed since the year 2010until the year 2013, as well as the number of doctors in the health centers. This study aims toanalyze the city primary health center readiness in facing National Social Insurance in2014. This research is a descriptive analytical cross-sectional approach and in-depthinterviews with informants and the literature study. The results showed that the limitednumber of health centers and the lack of availability of health centers lead to unpreparednessin facing National Social Insurance in 2014."