Published date: Mar 03 2023

Journal Title: KnE Social Sciences

Issue title: 2nd Paris Van Java International Seminar on Health, Economics, Social Science and Humanities (PVJ-ISHESSH 2021)

Pages: 709–717

DOI: 10.18502/kss.v8i4.12965

Nugroho Mardi Wibowonugrohomardi@uwp.ac.idDepartment of Management, Universitas Wijaya Putra, Indonesia

Woro UtariDepartment of Management, Universitas Wijaya Putra, Indonesia

Yuyun WidiastutiDepartment of Management, Universitas Wijaya Putra, Indonesia

Abdul Muhith .Nursing Department, Universitas Nahdlatul Surabaya, Indonesia

The National Health Insurance ( JKN) system is designed to provide the availability of quality health services, but until now JKN participant have not felt the quality health care. The purpose of this study is to identify threats and weaknesses in health care quality control and formulate the implications of its strategy. The study was conducted at four Regional General Hospital (RSUD) in East Java - Indonesia, namely RSUD IbnuSina Gresik, RSUD NgudiWaluyoWlingiBlitar, RSUD dr. H. SlametMartodirdjoPamekasan, and RSUD dr. H. KoesnadiBondowoso. The sampling of research samples was conducted by purposive sampling and data retrieval with questionnaires and interviews. Analysis techniques used are external factor analysis, internal factor analysis, and SWOT analysis. The results of the study found that the barriers to quality control of JKN health services are the delay in payment of hospital claims by the Social Security Regulatory Agencyof Health (BPJS Health), INA-CBGs rate, BPJS Health Regulations and low people awareness for a healthy lifestyle. In terms of internal hospitals, fraud prevention systems have not been affective. The implication of the strategy is that hospitals must develop and implement fraud prevention information systems properly.

Keywords: JKN; BPJS; quality control; health services

[1] Fatima T, Malik SA, Shabbir A. Hospital healthcare service quality, patient satisfaction and loyalty: An investigation in context of private healthcare systems. Int. J. Qual. Reliab. Manag. 2018;35(6):1195–1214. doi: 10.1108/IJQRM-02-2017-0031.

[2] Jandavath RKN, Byram A. Healthcare service quality effect on patient satisfaction and behavioural intentions in corporate hospitals in India. Int. J. Pharm. Healthc. Mark. 2016;10(1):48–74. doi: 10.1108/IJPHM-07-2014-0043.

[3] Nguyen TLH, Nagase K. The influence of total quality management on customer satisfaction. Int. J. Healthc. Manag. 2019;12(4):277–285. doi: 10.1080/20479700.2019.1647378.

[4] Al-Shdaifat EA. Implementation of total quality management in hospitals. J. Taibah Univ. Med. Sci. 2015;10(4):461–466. doi: 10.1016/j.jtumed.2015.05.004.

[5] Hasri ET, Wulan S, Djasri H. Evaluasi kebijakan kendali mutu dan kendali biaya, pencegahan kecurangan dan kapitasi berbasis komitmen dalam era JKN di provinsi bengkulu menggunakan pendekatan realis evaluasi. Yogyakarta; 2020.

[6] Gupta KS, Rokade V. Importance of quality in health care sector: A review. J. Health Manag. 2016;18(1):84–94. doi: 10.1177/0972063415625527.

[7] Vidya N. A regulatory affair and contribution of total quality management towards quality assurance in healthcare management. Int. J. Manag. Soc. Sci. 2017;5(12):132–145. Available from: https://www.academia.edu/38551097/ A_Regulatory_Affair_AndContribution_Of_Total_Quality_Management_Towards_Quality_Assurance_

[8] Wibowo NM. Strategi pengembangan pelayanan rawat inap puskesmas berbasis service delivery system. EKUITAS ( Jurnal Ekon. dan Keuangan). 2020;17(3):337–356.

[9] Wibowo NM, Utari W, Muhith A, Widiastuti Y. Pengembangan model dan strategi pengendalian mutu pelayanan kesehatan pada era jaminan kesehatan nasional sebagai upaya menuju pelayanan kesehatan berkeadilan pada faskes tingkat pertama dan rujukan di jawa timur. Surabaya; 2018.

[10] Hojabri R, Manafi M, Eftekhar F, Ghassemzadeh H, Sharifi M, Kaliannan M. Effective methods for health care organizations: An evaluation of excellence models. African J. Bus. Manag. 2013;7(27):2665–2675. doi: 10.5897/AJBM11.2747.

[11] Ulumiyah NH. Meningkatkan mutu pelayanan kesehatan dengan penerapan upaya keselamatan pasien di puskesmas. J. Adm. Kesehat. Indones. 2018;6(2):149–155. doi: 10.20473/jaki.v6i2.2018.149-155.

[12] McCalman J et al. Continuous quality improvement and comprehensive primary health care: A systems framework to improve service quality and health outcomes. Front. Public Heal. 2018;6. doi: 10.3389/fpubh.2018.00076.

[13] El-Tohamy AE, Al Raoush AT. The impact of applying total quality management principles on the overall hospital effectiveness: An empirical study on the HCAC accredited governmental hospitals in Jordan. Eur. Sci. J. 2015;11(10).

[14] Matloob I, Khan S. A Framework for fraud detection in government supported national healthcare programs. Paper presented at: Proceedings of the 11th International Conference on Electronics, Computers and Artificial Intelligence, ECAI 2019; 2019. doi: 10.1109/ECAI46879.2019.9042126.

[15] Wibowo NM, Utari W, Muhith A, Widiastuti Y. Detection of healthcare fraud in the national health insurance program based on cost control. Paper presented at: International Conference on Tourism, Economics, Accounting, Management, and Social Science (TEAMS 19); 2019 December. doi: 10.2991/teams-19.2019.46.