Online ISSN: 2515-8260

Keywords : national health insurance


Evaluation of the implementationof the outpatient referral system in a communityhealth center in the national health insurance era.

MiftahulHaerati Sulaiman; Djazuly Chalidyanto

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 5, Pages 535-539

It has been reported that there are some obstacles in the implementation of the National Health Insurance, one of which is its referral system.The high number of referral in public health centers indicates that the implementation of the referral system has not gone well.This study aims to evaluate theimplementation of the outpatient referral system in a public health center in the national health insurance era. This study was qualitative research with a case study approach on eightinformants selected by purposive sampling method that was conducted in Singgani Community Health Center, Central Sulawesi, as one of the communityhealth centers in Indonesia. The data was obtainedthroughobservation, in-depth interviews, and document studies. The validity test was done with source triangulation and methodological triangulation and was analyzed by using Miles and Huberman analysis model.The results showed that the input in the form of human-related to doctors, machines-related to medical devices, and materials-related to the availability of drugs wasnot in line with the rules. The doctor's process of deciding to refer patients did not follow the rules of 155 diagnoses of diseases and the process of implementing referrals from the communityhealth center to the hospital was not listed in the waiting room. Besides, the output of the referral system was not optimal, seen from the suitability of the referral implementation at Singgani Community Health Center, which exceeded the ratio. Thus, it can be concluded thatthe application of the outpatient referral system on nationalhealth insurance participants is still not appropriate.

Evaluation of the implementationof the outpatient referral system in a communityhealth center in the national health insurance era

MiftahulHaerati Sulaiman; Djazuly Chalidyanto

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 5, Pages 441-445

It has been reported that there are some obstacles in the implementation of the National Health Insurance, one of which is its referral system.The high number of referral in public health centers indicates that the implementation of the referral system has not gone well.This study aims to evaluate theimplementation of the outpatient referral system in a public health center in the national health insurance era. This study was qualitative research with a case study approach on eightinformants selected by purposive sampling method that was conducted in Singgani Community Health Center, Central Sulawesi, as one of the communityhealth centers in Indonesia. The data was obtainedthroughobservation, in-depth interviews, and document studies. The validity test was done with source triangulation and methodological triangulation and was analyzed by using Miles and Huberman analysis model.The results showed that the input in the form of human-related to doctors, machines-related to medical devices, and materials-related to the availability of drugs wasnot in line with the rules. The doctor's process of deciding to refer patients did not follow the rules of 155 diagnoses of diseases and the process of implementing referrals from the communityhealth center to the hospital was not listed in the waiting room. Besides, the output of the referral system was not optimal, seen from the suitability of the referral implementation at Singgani Community Health Center, which exceeded the ratio. Thus, it can be concluded thatthe application of the outpatient referral system on nationalhealth insurance participants is still not appropriate.

ANALYSIS OF ECONOMIC LOSSES DUE TO DIABETES MELLITUS IN NATIONAL HEALTH INSURANCE PARTICIPANTS

Ani Pujiningrum; Thinni Nurul Rochmah

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 5, Pages 821-830

The result of Indonesia Basic Health Research in 2018 showed an increase in the percentage of people with diabetes mellitus. This study aimed to analyze economic losses due to diabetes mellitus in National Health Insurance (NHI) participants with insurance fee waiver (IFW) and non-insurance fee waiver (IFW). This research was a quantitative study with a cross-sectional design. The sample of this study was 17 patients with IFW and 15 patients with non-IFW. The instrument used in this study was a questionnaire consisting of questions about the variable characteristics of the respondents and the direct and indirect costs that should be paid for treatment. Economic losses due to diabetes mellitus were analyzed through direct and indirect total costs.The economic loss for patients with IFW was IDR 5,572,366. Meanwhile, the economic loss for patients with non-IFW was IDR 2,989,984. So, the biggest economic loss due to diabetes mellitus was found in patients with IFW. This was very high when compared to their average income of around IDR 634,375. This can happen because the NHI participants have not taken full advantage of the use of NHI.