ANALISIS PELAKSANAAN PROGRAM PENCEGAHAN KECURANGAN (FRAUD) JAMINAN KESEHATAN NASIONAL DI PUSKESMAS KOTA SEMARANG

Zafirah Rizka; Septo Patria Jati; Syamsulhuda BM

doi:10.14710/jkm.v6i4.21361

DOI: https://doi.org/10.14710/jkm.v6i4.21361

ANALISIS PELAKSANAAN PROGRAM PENCEGAHAN KECURANGAN (FRAUD) JAMINAN KESEHATAN NASIONAL DI PUSKESMAS KOTA SEMARANG

*Zafirah Rizka - , Indonesia

Septo Patria Jati - , Indonesia

Syamsulhuda BM - , Indonesia

Received: 26 Jul 2018; Published: 26 Jul 2018.

BibTex Citation Data :

@article{JKM21361,
    author = {Zafirah Rizka and Septo Jati and Syamsulhuda BM},
    title = {ANALISIS PELAKSANAAN PROGRAM PENCEGAHAN KECURANGAN (FRAUD) JAMINAN KESEHATAN NASIONAL DI PUSKESMAS KOTA SEMARANG},
    journal = {Jurnal Kesehatan Masyarakat},
  volume = {6},
    number = {4},
    year = {2018},
    keywords = {National Health Insurance, Fraud Prevention Program, Puskesmas, Policy Implementation},
    abstract = {  National Health Insurance (NHI)   fraud is actions taken by the participants, BPJS Kesehatan officers, medicines and medical devices providers intentionally by obtaining financial benefits from the NHI program through fraudulent conduct that isn’t in accordance with the provisions. In 2017, 26 puskesmas in 14 provinces have fraud potential of their capita funds. The government is implementing NHI fraud prevention program at puskesmas, as stated in the PMK RI no. 36 Year 2015. This study aims to analyze the implementation of PMK RI no.36 year 2015 in the Implementation of NHI fraud prevention program in Puskesmas Semarang City.     This research used descriptive qualitative method with purposive sampling criteria toward 5 main informants and 2 informant triangulation. Processing and data analysis based on validity and reliability with triangulation.     The result of this research shows that the establishment of NHI fraud prevention team is late because of SK DKK legality weakness about NHI fraud prevention team, and commitment of team members. Funding sources have not been allocated specifically for this program and team members' ignorance on its. The absence of monev activities, the planning of target, performance, budget, and technical guidelines from Ministry of Health or Semarang’s specific regulation. And, SKB3 hasn’t give a clear direction.     The main cause of this team late establishment is SK DKK legality weakness about NHI fraud prevention team that affect to commitment of team members. Ministry of Health is suggested to make technical guidance related to PMK no. 36 of 2015. Semarang government is suggested to improve the coordination across sectors, and strengthen SKK DKK with the Mayor Regulation, so the legality is stronger. DKK Semarang is suggested to increase commitment and performance of program implementation. Head of Puskesmas is suggested to socialize prevention of NHI fraud to subordinates. And BPJS Kesehatan is suggested to increase cooperation  },
   issn = {2356-3346},   pages = {95--104}  doi = {10.14710/jkm.v6i4.21361},
    url = {https://ejournal3.undip.ac.id/index.php/jkm/article/view/21361}
}

Citation Format:

Abstract

National Health Insurance (NHI) fraud is actions taken by the participants, BPJS Kesehatan officers, medicines and medical devices providers intentionally by obtaining financial benefits from the NHI program through fraudulent conduct that isn’t in accordance with the provisions. In 2017, 26 puskesmas in 14 provinces have fraud potential of their capita funds. The government is implementing NHI fraud prevention program at puskesmas, as stated in the PMK RI no. 36 Year 2015. This study aims to analyze the implementation of PMK RI no.36 year 2015 in the Implementation of NHI fraud prevention program in Puskesmas Semarang City. This research used descriptive qualitative method with purposive sampling criteria toward 5 main informants and 2 informant triangulation. Processing and data analysis based on validity and reliability with triangulation. The result of this research shows that the establishment of NHI fraud prevention team is late because of SK DKK legality weakness about NHI fraud prevention team, and commitment of team members. Funding sources have not been allocated specifically for this program and team members' ignorance on its. The absence of monev activities, the planning of target, performance, budget, and technical guidelines from Ministry of Health or Semarang’s specific regulation. And, SKB3 hasn’t give a clear direction. The main cause of this team late establishment is SK DKK legality weakness about NHI fraud prevention team that affect to commitment of team members. Ministry of Health is suggested to make technical guidance related to PMK no. 36 of 2015. Semarang government is suggested to improve the coordination across sectors, and strengthen SKK DKK with the Mayor Regulation, so the legality is stronger. DKK Semarang is suggested to increase commitment and performance of program implementation. Head of Puskesmas is suggested to socialize prevention of NHI fraud to subordinates. And BPJS Kesehatan is suggested to increase cooperation

Fulltext View|Download

Keywords: National Health Insurance, Fraud Prevention Program, Puskesmas, Policy Implementation

Article Metrics:

Article Info

Section: Administrasi dan Kebijakan Kesehatan

In Vol 6, No 4 (2018): JULI

Recent articles

ANALISIS PERBEDAAN PROSES PEMBENTUKAN POS UPAYA KESEHATAN KERJA (UKK) DI KOTA SEMARANG ANALISIS PELAKSANAAN PROGRAM KESELAMATAN PASIEN PUSKESMAS MANGKANG, KOTA SEMARANG HUBUNGAN PENGETAHUAN, SIKAP DAN USIA DOKTER TERHADAP KELENGKAPAN PENGISIAN BERKAS REKAM MEDIS PADA PASIEN BPJS DI RUMAH SAKIT AISYIYAH BOJONEGORO HUBUNGAN BEBERAPA FAKTOR DENGAN KEJADIAN UNMET NEED KELUARGA BERENCANA DI KELURAHAN BULU LOR DESCRIPTION OF FACTORS RELATED TO SEVERITY OF DIABETIC MELLITUS PATIENT TYPE 2 (Study in RSUD Kota Semarang) HUBUNGAN SANITASI TPM TERHADAP KEPADATAN KECOA DI PELABUHAN PEMENANG KKP KELAS II MATARAM HUBUNGAN ASUPAN PROTEIN, ZAT BESI, VITAMIN C, FITAT, DAN TANIN TERHADAP KADAR HEMOGLOBIN CALON PENDONOR DARAH LAKI-LAKI (Studi di Unit Donor Darah PMI Kota Semarang) PENGARUH PEMBERIAN EDUKASI KEAMANAN PANGAN TERHADAP PERUBAHAN PENGETAHUAN DAN SIKAP PEDAGANG PENYETAN DI WILAYAH TEMBALANG PENEREPAN METODE “LEARNING FROM INCIDENTS” PADA SEBUAH TERMINAL PETI KEMAS HUBUNGAN SUPERVISI, REKAN KERJA, GAJI, KEAMANAN KERJA, KONDISI KERJA, PROMOSI JABATAN DAN JENIS PEKERJAAN DENGAN KEPUASAN KERJA (Studi Kasus Pada Karyawan Koperasi Simpan Pinjam X di Kabupaten Pemalang, Jawa Tengah) GAMBARAN KONDISI SANITASI LINGKUNGAN RUMAH DENGAN KEJADIAN DIARE PADA BALITA DI WILAYAH KERJA PUSKESMAS BUAYAN KABUPATEN KEBUMEN HUBUNGAN KONDISI KESEHATAN LINGKUNGAN RUMAH BULAT SUKU DAWAN DAN TRADISI SE’I DENGAN KEJADIAN ISPA PADA BAYI DI PUSKESMAS KUANFATU KECAMATAN KUANFATU BEBERAPA FAKTOR YANG MEMPENGARUHI PENCAPAIAN TARGET CDR OLEH KADER TB ‘AISYIYAH DALAM PENEMUAN KASUS TB DI KOTA SEMARANG PERSEPSI KERENTANAN DAN HAMBATAN IBU TERHADAP PENDIDIKAN SEKSUAL PADA ANAK USIA DINI (4-6 TAHUN) More recent articles

Last update:

No citation recorded.

Last update:

No citation recorded.

The Authors submitting a manuscript do so on the understanding that if accepted for publication, copyright of the article shall be assigned to Jurnal Kesehatan Masyarakat (JKM, p-ISSN: 2715-5617, e-ISSN:2356-3346) and Faculty of Public Health, Diponegoro University as the publisher of the journal. Copyright encompasses the 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.

JKM journal and Faculty of Public Health, Diponegoro University, the Editors and the Advisory Editorial Board make every effort to ensure that no wrong or misleading data, opinions or statements be published in the journal. In any way, the contents of the articles and advertisements published in the JKM journal are the sole and exclusive responsibility of their respective authors and advertisers.

The Copyright Transfer Form can be downloaded here: [Copyright Transfer Form JKM journal]
The copyright form should be signed originally and send to the Editorial Office in the form of original mail or scanned document to jkm@live.undip.ac.id.