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Kata kunci : implementasi kebijakan; Kader JKN-KIS; sektor informal
The JKN-KIS Cadre Program was established to increase membership growth and increase the collation of BPJS Health contribution to informal segment participants. The purpose of this research is to analyze the implementation of JKN-KIS Cadre program in Bekasi City. This research uses a qualitative method, conducted during May 2018 with in-depth interview technique, observation and document review using Van Meter and Van Horn policy implementation theory. Test validity through a source and method triangulation. The result of the research shows that the implementation of JKN-KIS Cadre program in Bekasi City has not run optimally yet. There are already standards and targets are determined to see the performance, but its achievement is not maximized and the target of the function of the cadre is not yet complete. Recording systems, application technology systems, and information dissemination are still constrained. Consistency, clarity in communications and implementation of guidelines has not been maximized. Relationship with the village has not been established well, Kader JKN-KIS Human Resources and Branch Offices are still limited. The attitude of the implementers is not supportive and the economic, social and political environment has not fully supported the implementation of the KKD-KIS Cadre program. Conclusion: The implementation of JKN-KIS Cadre Program in Bekasi City still has obstacles. The need for improvement of standards and targets, information systems, communication, human resources, socialization, cooperation relationship for successful implementation of JKNKIS cadre program.
Keywords: policy implementation; JKN-KIS Cadre; the informal sector
Jumlah kasus kekerasan di Indonesia meningkat signifikan dari 20.499 kasus pada tahun 2020 menjadi 29.883 kasus pada tahun 2023, hal ini diikuti dengan peningkatan jumlah kebutuhan pelayanan kesehatan bagi korban setiap tahunnya. Penelitian ini bertujuan untuk mengetahui gambaran penundaan dan penolakan klaim pelayanan korban kekerasan di RSUD Tarakan Jakarta. Metode penelitian ini menggunakan pendekatan kualitatif dengan studi kasus dan deskriptif kuantitatif. Teknik pengumpulan data dilakukan dengan wawancara mendalam, telaah dokumen, dan literatur kemudian dianalisis dalam bentuk tabel, grafik, dan narasi. Hasil penelitian menunjukkan pada input, terdapat ketidaksesuaian pengetahuan sumber daya manusia dengan regulasi Jaminan Kesehatan Jakarta. Sebagian besar informan menganggap jaminan ini hanya mencakup korban perempuan dan anak-anak. Standar Prosedur Operasional yang ada masih bersifat umum. Pada proses, seluruh berkas klaim dapat diakses melalui satu pintu di klinik Bunga Tanjung. Pada output, dari 1.062 klaim korban kekerasan di tahun 2023, terdapat 202 klaim tertunda dan 17 klaim ditolak. Penyebab klaim tertunda meliputi berkas tidak valid, berkas tidak lengkap, koding tidak sesuai, dan tarif tidak sesuai, sedangkan klaim tolak disebabkan oleh otomatisasi sistem SIJAKA. Penelitian ini merekomendasikan peningkatan sosialisasi internal rumah sakit terkait Jaminan Kesehatan Jakarta, dan penyusunan SPO yang detail dan komprehensif untuk mendukung pengelolaan klaim yang lebih efektif.
The number of violence cases in Indonesia has increased significantly, rising from 20,499 cases in 2020 to 29,883 cases in 2023. This increase has been accompanied by a growing demand for health services for victims each year. This study aims to examine the delays and rejections of service claims for victims of violence at Tarakan Regional Hospital in Jakarta. The research employs both qualitative and quantitative descriptive methods, using case studies. Data collection was carried out through in-depth interviews, document reviews, and literature analysis, with the findings presented in the form of tables, graphs, and narratives. The study results indicate a mismatch between the knowledge of human resources and Jakarta Health Insurance regulations. Most informants believe that the insurance coverage applies only to female and child victims. Additionally, the existing Standard Operating Procedures (SOPs) remain too general. In terms of the claim process, all claim files can be accessed through a single point at the Bunga Tanjung clinic. Regarding claim outcomes, out of 1,062 claims for violence victims in 2023, 202 claims were pending, and 17 claims were rejected. Delays in claims were attributed to issues such as invalid files, incomplete documents, incorrect coding, and inaccurate rates, while rejected claims were largely due to issues with the automation of the SIJAKA system. This study recommends improving internal hospital communication about Jakarta Health Insurance and preparing detailed, comprehensive SOPs to support more effective claims management.
