Indonesia faces a growing informal sector in the wake of implementing a national social health insurance system—Jaminan Kesehatan Nasional (JKN)—that supersedes the vertical programmes historically tied to informal employment. Sustainably financing coverage for informal workers requires incentivising enrolment for those never insured and recovering enrolment among those who once paid but no longer do so. This study aims to assess the ability- and willingness-to-pay of informal sector workers who have stopped paying the JKN premium for at least six months, across districts of different fiscal capacity, and explore which factors shaped their willingness and ability to pay using qualitative interviews. Surveys were conducted for 1,709 respondents in 2016, and found that informal workers’ average ability and willingness to pay fell below the national health insurance scheme’s premium amount, even as many currently spend more than this on healthcare costs. There were large groups for whom the costs of the premium were prohibitive (38%) or, alternatively, they were both technically willing and able to pay (25%). As all individuals in the sample had once paid for insurance, their main reasons for lapsing were based on the uncertain income of informal workers and their changing needs. The study recommends a combination of strategies of targeting of subsidies, progressive premium setting, facilitating payment collection, incentivising insurance package upgrades and socialising the benefits of health insurance in informal worker communities.
Salah satu amanah dari Undang-Undang No. 40 Tahun 2004 tentang Sistem Jaminan Sosial Nasional (SJSN) adalah adanya pelayanan medis dan non-medis yang sama, tidak ada perbedaan, dalam rangka mencapai keadilan sosial. Dalam Program Jaminan Kesehatan Nasional (JKN), keadilan ini diterjemahkan sebagai pelayanan kelas standar rawat inap untuk menggantikan tingkatan fasilitas akomodasi rawat inap yang saat ini berlaku. Memasuki tahun keempat implementasi Program JKN, amanah ini masih belum dapat terwujud. Untuk itu, studi ini berupaya menganalisis kemungkinan penerapan kelas standar rawat inap, termasuk menghitung ketersediaan tempat tidur di Indonesia untuk mendukung penerapan tersebut. Studi ini menggunakan mixed method di mana studi kuantitatif dilakukan melalui metode survei terhadap 520 responden peserta JKN yang pernah mendapatkan pelayanan rawat inap di rumah sakit. Studi kualitatif dilakukan melalui wawancara dan diskusi terarah pada pembuat kebijakan Program JKN. Hasil studi menunjukkan bahwa seluruh responden studi dari peserta maupun pembuat kebijakan mendukung penerapan kelas standar rawat inap dengan preferensi yang beragam. Meskipun demikian, disepakati bahwa diperlukan waktu setidaknya 5 tahun untuk memastikan penerapan kelas standar rawat inap dapat dilaksanakan dengan baik. Rumah sakit khususnya membutuhkan waktu untuk mempersiapkan sarana dan prasarana agar sesuai dengan ketentuan kelas standar rawat inap. Studi ini merekomendasikan kepada seluruh pemangku kepentingan untuk mendukung kebijakan kelas standar rawat inap. Tenggat waktu penerapan kelas standar rawat inap pada dokumen Peta Jalan Jaminan Kesehatan perlu direvisi, dilengkapi dengan beberapa regulasi tambahan dan sosialisasi yang intensif.
Analisis situasi TB dan biaya program TB pada tingkat kabupaten kota belum banyak dilakukan padahal hal ini s angat penting untuk perencanaan, penganggaran, pembiayaan dan evaluasi pelayanan TB. Studi dilakukan di Kabupaten Tangerang, Kabupaten Tanggamus, Kota Metro dan Kota Dumai dengan pendekatan mixed method. Pengumpulan data kuantitatif menggunakan data sekunder untuk mengetahui situasi dan biaya program TB. Pengumpulan data primer dilakukan secara kualitatif dengan melakukan round table discussion dengan para stakeholder. Hasil studi menunjukkan insiden TB dan success rate tertinggi di Kabupaten Tanggamus. Kota Metro juga memiliki insiden TB tertinggi disertai dengan notifikasi kasus tertinggi. Kabupaten Tangerang memiliki cure rate tertinggi. Biaya program TB tertinggi di Kabupaten Tangerang, yaitu Rp. 6.737.303.630. Alokasi biaya program TB terbesar di semua wilayah digunakan untuk obat. Permasalahan yang terjadi dalam pengendalian TB di empat wilayah tersebut adalah tatalaksana kasus tidak standar, underestimated data, temuan kasus baru masih kurang, terbatasnya SDM program TB, kontribusi CSR sangat rendah, kurangnya upaya promotif dan preventif tentang TB, stigma buruk TB, kesulitan monev kasus dan survey kontak, dan permasalahan pasien dari kelompok miskin dan kelompok pekerja. Pengendalian TB di semua wilayah belum optimal maka direkomendasikan untuk segera membuat payung hukum untuk memberikan kekuatan anggaran dan kerjasama lintas sektor dalam pengendalian TB.
The Minister of Health Regulation No. 52 of 2016 states that the tariff for first-level health services in remote areas and islands is determined based on special capitation tariffs, which is greater than the usual capitation tariffs. In North Bengkulu there is a primary health care that does not include a special capitation even though the criteria are the same as the primary health care that received it. The perception of stakeholders involved is needed to see whether the determination of criteria for disadvantaged areas for recipients of special capitation funds is in accordance with existing regulations or not. The study was based on in-depth interviews with 6 respondents from 6 institutions (Local Government, Regional Secretary, Health Office, the BPJS health branch office, and two Primary health care). The local government does not help question that matter to BPJS or help in other ways so that health care that do not receive special capitation funds can still provide optimal services like other remote health care. This study found the lack of socialization about health services in remote areas to non-health officials in local governments is the causes of weak support by local governments. This research shows that the application of central policies without joint review and verification with local stakeholders can lead to unproductive situations. Local governments should also look for solutions so that health care in remote areas that do not receive special capitation funds continue to run optimally.
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