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The highly competitive healthcare industry in Cirebon poses a significant challenge for Klinik Utama X, especially as a non-BPJS facility. This condition requires a paradigm shift from a provider-centric marketing mix to a patient-centric approach to retain patient loyalty. This study aims to evaluate and formulate the marketing strategy of Klinik Utama X using a comparative 4P (Product, Price, Place, Promotion) and 4C (Customer Solution, Customer Cost, Convenience, Communication) approach based on SWOT analysis. This research used a qualitative descriptive design with purposive sampling, gathering primary and secondary data through in-depth interviews, observations, and document studies. The data were systematically evaluated using Internal Factor Evaluation (IFE) and External Factor Evaluation (EFE) matrices. The findings reveal that the clinic is strategically positioned in Quadrant I, with an IFAS score of 2.53 and an EFAS score of 2.60, indicating strong internal capabilities to seize external opportunities. The recommended aggressive growth strategy involves integrating psychiatric and aesthetic services, penetrating the Business-to-Business (B2B) market through corporate medical check-ups, accelerating digitalization via telemedicine and online queuing, and preparing for BPJS accreditation. The managerial implications suggest that the clinic must prioritize resolving internal human resources and strengthening financial record-keeping systems before investing heavily in medical assets, while actively expanding digital convenience and corporate partnerships to secure short-term financial stability.

BPJS Ketenagakerjaan aims to protect workers and ensure their welfare. However, in reality, many companies do not register some or all of their workers, which affects the welfare of workers and has the potential to impact the social security system as a whole. The research questions are: How does the non-payment of BPJS Ketenagakerjaan contributions affect workers' rights in relation to the theory of legal protection in Decision Number 40/Pdt.G.S/2023/PN Pbr and How the mechanism for fulfilling workers' rights when a company that has previously defaulted on its contributions has paid off its obligations. This research is normative-empirical, using three approaches, namely legislation, case studies, and legal sociology. The results show that the arrears in this case not only caused workers to lose access to JKK, JKM, JHT, and JP program benefits, but also placed them in economic and social vulnerability because they did not receive compensation when employment risks occurred. After the company has fulfilled its obligations, the membership and service team will verify the payment and reactivate the participant's status so that workers can reapply for claims, thereby ensuring that workers' rights are promptly fulfilled both administratively and substantively.

Abstract. The right to health is an integral part of human rights guaranteed by the Constitution and further reinforced by Law Number 17 of 2023 on Health, which places the state as the party responsible for ensuring the provision of safe, high-quality, and non-discriminatory health services for all citizens. However, in practice, the fulfillment of the right to health continues to face various challenges, particularly in the delivery of health services for participants of BPJS Kesehatan. This study aims to analyze the legal protection of the right to health in Indonesia and to examine the refusal of medical services to BPJS patients that resulted in death in Papua from a human rights perspective. The research employs a normative legal research method using statutory, conceptual, and case approaches. The findings indicate that although the national legal framework has clearly regulated the obligations of the state and health care facilities in providing emergency services, its implementation remains weak due to administrative barriers, unequal access to health services, and inconsistent law enforcement. The refusal of medical services to BPJS patients in Papua reflects a tension between hospitals’ administrative compliance and the professional obligation of medical personnel to save human lives. The implications of this study emphasize the need to strengthen supervision, ensure consistent law enforcement, and improve health service governance so that the right to health is truly protected as part of human dignity within the Indonesian rule of law. 

Digital transformation in healthcare services is a strategic approach to improve access, efficiency, and service quality, particularly within Indonesia’s National Health Insurance (JKN) system. BPJS Kesehatan has introduced an online queue feature through the Mobile JKN application to minimize manual queuing and reduce waiting times in outpatient services. However, despite the widespread ownership of the application, its actual utilization for online queuing remains relatively low, including in a regional public hospital (RSUD) in West Bandung. This condition reflects a gap between the availability of digital health technology and patients’ actual usage behavior, highlighting the need to examine factors influencing adoption.This study aims to analyze the effects of perceived ease of use, social influence, and facilitating conditions on the actual use of the Mobile JKN online queue, with behavioral intention as an intervening variable among outpatients. A quantitative cross-sectional design was applied, involving 255 JKN outpatient participants selected through purposive sampling. Data were collected using structured questionnaires and analyzed using Structural Equation Modeling (SEM) with AMOS version 24, based on the Technology Acceptance Model (TAM) and the Unified Theory of Acceptance and Use of Technology (UTAUT). Data analysis included descriptive statistics, validity and reliability testing, normality assessment, goodness-of-fit evaluation, Three Box Method, and hypothesis testing.

The National Health Insurance Program (JKN) is a government policy aimed at providing health protection for all Indonesians through fair, equitable, and sustainable healthcare services. However, its implementation still faces various challenges and issues. This study aims to analyze the implementation of the JKN program in Indonesia using a systematic literature review and the CIPP (Context, Input, Process, Product) evaluation model. Ten scientific articles published between 2021 and 2025 were selected and analyzed based on established inclusion and exclusion criteria. The results indicate that in the context aspect, there are still problems, such as a large number of participants with inactive membership status and a low level of public understanding of their rights and obligations as JKN participants. In the input aspect, obstacles faced include limited health workers, uneven distribution, and inadequate facilities and infrastructure. Furthermore, in the process aspect, various obstacles were found, such as long service queues, complex administrative procedures, disruptions in the medical record system, and the suboptimal use of digital-based services. Meanwhile, in terms of products, the National Health Insurance (JKN) program has proven effective in improving public access to healthcare services, although service quality remains uneven, drug availability remains unstable, and the BPJS Kesehatan financing system still faces several challenges. Overall, the JKN program has had a positive impact on the community, but comprehensive improvements are still needed, particularly in strengthening governance, equitable access to services, and improving the quality of healthcare services.

In response to the evolving landscape of public healthcare services, hospitals are expected not only to maintain operational efficiency but also to adapt to the shifting needs and expectations of patients as healthcare consumers. The presence of non-BPJS patients in regional public hospitals plays a strategic role not only contributing to revenue diversification but also reflecting service quality, institutional competitiveness, and shaping public perception. The declining trend in outpatient visits by general patients at RSUD Balaraja over the past three years highlights the need to understand the factors influencing consumer behavior in determining revisit intentions. This study examines the effect of co-creation and hospital image on the revisit intention of outpatient general patients at RSUD Balaraja, with patient experience as a mediating variable. The research employed a quantitative explanatory design involving 278 outpatient general patients selected through purposive sampling. Data were collected via structured questionnaires and analyzed using Structural Equation Modeling–Partial Least Squares (SEM-PLS). The results indicate that patient experience plays a significant mediating role in shaping revisit intention among general outpatients at RSUD Balaraja. These findings confirm that patient experience serves as a central factor in post-service evaluation processes, which ultimately drive patients’ intention to return. Therefore, hospitals need to enhance patient involvement in service processes (co-creation), improve public perception of institutional image (hospital image), and develop patient-centered service systems as a key strategy to increase revisit intention among general outpatients.

The PESIAR Program (Petakan, Sisir, Advokasi, dan Registrasi Map, Screen, Advocate, and Register) is an operational instrument of BPJS Kesehatan designed to accelerate the achievement of Universal Health Coverage (UHC) by increasing National Health Insurance (JKN) membership at the local level. However, the effectiveness of this program’s implementation is strongly determined by the institutional capacity and configuration that support it. This article aims to reposition institutional determination not only as a factor influencing program effectiveness, but as a model of administrative governance in achieving UHC. The study uses a mixed methods approach with a sequential explanatory design. Quantitative data were obtained through a survey of PESIAR Agents in Semarang City, while qualitative data were collected through open-ended questionnaires and interviews. The results show a strong, positive relationship between institutional determination and the effectiveness of the PESIAR Program. Qualitative findings further clarify that issues of program effectiveness largely originate from institutional capacity, the quality of cross-sector coordination, and the role of PESIAR Agents as field implementers. This study concludes that institutional determination deserves to be positioned as an administrative governance model for the PESIAR Program in promoting the achievement of UHC at the local level.

The digital transformation of health services through the Mobile JKN application was introduced by BPJS Kesehatan to provide easier access for the public in obtaining information, managing membership administration, and receiving health services more quickly and efficiently. This study aims to measure the readiness level of patients at Abdul Manap Regional Hospital, Jambi City, in adopting the Mobile JKN application using the HOT-Fit method, which covers three main components: Human, Organization, and Technology. Data were collected from 360 respondents through questionnaires and analyzed using Partial Least Square Structural Equation Modeling (PLS-SEM). The results indicate that technology factors—including system quality, information quality, and service quality— along with organizational support have a significant effect on system use and user satisfaction, which in turn positively influence the net benefits. The outer loading values of all indicators exceeded 0.7, with Composite Reliability above 0.8 and AVE above 0.6, confirming that the research instruments are valid and reliable. Overall, patients at Abdul Manap Hospital are categorized as ready to adopt Mobile JKN, although improvements in digital literacy and stronger organizational support are still required to optimize its utilization.

This study is motivated by the increasing complexity of financing coordination between the National Health Insurance (BPJS Kesehatan) and supplementary health insurance providers under the Coordination of Benefits (KAPJ) scheme, which creates potential claim disputes and administrative risks for hospitals. Although Minister of Health Decree No. HK.01.07/MENKES/1117/2025 regulates payment allocation and membership verification mechanisms, it does not explicitly recognize pre-admission confirmation as a preventive legal protection instrument. This research aims to analyze the normative position of pre-admission confirmation within the KAPJ framework, conceptualize it as a preventive legal protection mechanism, and formulate a proportional implementation model. The study employs a normative juridical method using statutory and conceptual approaches through literature review of relevant regulations and scholarly works. The findings indicate that pre-admission confirmation possesses implicit normative legitimacy through membership verification obligations and system integration requirements, and functions as a risk allocation mechanism that clarifies payment responsibilities prior to service delivery. Its implementation enhances legal certainty, reduces fraud potential, and minimizes claim disputes, provided that access to emergency medical services remains guaranteed.

Although JKN aims to provide equitable and quality health services, fraudulent practices, such as phantom billing and diagnosis manipulation, continue to grow, harming BPJS Kesehatan and participants. This study aims to examine the effectiveness of legal sanctions against JKN claim fraud in FKRTL and identify gaps in their implementation. Although regulations are in place, law enforcement remains weak, with administrative sanctions failing to provide sufficient deterrence. The gap in this research lies in the lack of application of criminal sanctions in fraud cases, especially in existing regulations. The novelty of this research is its comparative approach between current administrative sanctions and the potential application of criminal sanctions in the context of healthcare fraud. The research method uses a normative-descriptive approach, analyzing regulations and fraud audit results, and identifying gaps in the implementation of legal sanctions. The results of the study indicate that strengthening criminal sanctions and integrating technology in claim monitoring can increase the effectiveness of fraud prevention. These findings are expected to strengthen regulations and improve the integrity of the JKN system, as well as provide policy recommendations for more effective law enforcement.

The Outpatient Unit is an important service unit that contributes to the hospital's revenue. However, at Adam Talib Cikunir Hospital, the number of patient visits has not yet reached the target, thus it is necessary to formulate a strategy to enhance competitiveness. This research aims to develop a strategic plan for the Outpatient Unit to improve service quality and increase its contribution to the hospital's revenue. The research uses a qualitative descriptive approach. Analysis is conducted through Internal Factor Evaluation (IFE), External Factor Evaluation (EFE), SWOT analysis, and Quantitative Strategic Planning Matrix (QSPM). The IFE score of 2.44 and the EFE score of 2.41 place RS DAT Cikunir in Quadrant V of the IE Matrix, which means RS DAT Cikunir is in a Hold and Maintain position. The SWOT analysis generates several alternative strategies, and the QSPM prioritizes three strategies: enhancing specialized services (score 5,84), expanding services and digital promotion (score 5,66), and optimizing cooperation with BPJS and private insurance (score 5,38). The research concludes that improving specialized services, expanding services and digital promotions, as well as optimizing cooperation between BPJS and private insurance are the right strategies to enhance service quality, attract more patients, and strengthen the competitiveness of RS Dokter Adam Talib Cikunir amid competition in the healthcare sector.  

The high cost of colloid fluids and the large number of patients are concerns in determining which treatment standard should be chosen from several treatment alternative, where the total cost for 43 cases with a combination of crystalloid colloid fluids is IDR 209.370.993 while the total cost for 45 cases of crystalloid fluids is only UDR 146.492.268 which causes hospital losses. This study aims to determine the difference in the cost-effectiveness between crystalloid fluids and crystalloid-colloid combinations in hospitalized dengue fever patients without shock at Tangerang City Hospital. The research design used was cross-sectional with a comparative quantitative analysis method, where cost effectiveness was analyzed using the Average Cost Effectiveness Ratios (ACER) method. There were two groups of study samples: the first group, 25 patients who received crystalloid fluids, and the second group, 23 patients who received crystalloid-colloid combination fluids. This study showed a difference in the average hospitalization costs for dengue patients between crystalloid fluid therapy and crystalloid-colloid combination therapy. Hospitalization costs for dengue patients were lower in the crystalloid fluid group, with a significant difference (p=0.000). It was also found that crystalloid fluids were more cost-effective than the crystalloid-colloid combination. The implications of the study results consist of theoretical implications and practical implications. Based on the results of the analysis carried out, the crystalloid solutions are more cost-effective than crystalloid-colloid combinations. This finding can be used as a consideration in making decisions and policies that are in accordance with quality control and cost control for patients covered by the National Health Insurance (BPJS Health insurance).

Compliance in paying contributions is an important factor in ensuring the sustainability of the National Health Insurance (JKN) program, especially in the Non-Wage Workers (PBPU) segment who make payments independently. However, the level of compliance of PBPU participants in Jakarta City is still low, as indicated by the high rate of contribution arrears and the large number of deactivated memberships. This study aims to analyze the factors that influence compliance in paying National Health Insurance (JKN) contributions in the Non-Wage Workers (PBPU) segment in Jakarta City in 2025. The research design used was quantitative with a cross-sectional approach, involving 180 respondents. Bivariate analysis using the Chi-Square test showed that there was a significant relationship between perception and compliance (p = 0.002), income with compliance (p = 0.046), and motivation with compliance (p = 0.000). However, there was no significant relationship between knowledge (p = 0.291) and sanctions (p = 0.103) on compliance in paying contributions. These findings indicate that psychological and economic aspects have a strong influence on driving compliance with JKN premiums. Therefore, efforts to improve compliance need to focus on enhancing positive perceptions, internal motivation, and sustainable income for participants. Perception is the most dominant factor influencing compliance among PBPU participants. Strategies to increase education and improve services are needed to boost compliance and ensure the sustainability of the JKN program.

BPJS Health has incurred losses exceeding 200 billion rupiah over a two-year period due to the payment of contributions that were discontinued by participants who had utilized maternity services. Data show that 64.7% of mothers registered as BPJS Health participants only one month prior to childbirth, after which 43% either withdrew their membership or failed to continue paying contributions following delivery. The highest proportion of this behavior was observed among independent participants or non-wage recipients (PBPU). In Jambi Province, the highest level of contribution non-compliance occurs in Jambi City. In 2023, there were 77,489 participants with contribution arrears, resulting in financial losses amounting to 60.1 billion rupiah. Contribution non-compliance is influenced by various factors. This study aims to analyze the factors contributing to non-compliance among independent participants in paying BPJS Health contributions after utilizing childbirth services in Jambi City. The findings revealed that 33.3% of independent participants were non-compliant in paying BPJS Health contributions after using maternity services. Significant associations were found between contribution non-compliance and the number of family members (p = 0.001), level of knowledge (p = 0.000), illness perception (p = 0.001), clinical assessment (p = 0.000), and willingness to pay (WTP). Based on these findings, it is recommended that BPJS Health consider implementing a waiting period policy for participants intending to utilize maternity services. In addition, the Jambi City Government should strengthen promotive efforts to educate the public and raise awareness of the importance of health insurance in safeguarding household financial security.  

The JKN Mobile application is an electronic-based service innovation introduced by BPJS Health to facilitate JKN participants in accessing healthcare services and managing their membership information. This study aims to explore the experiences and perspectives of outpatient patients regarding the effectiveness of the JKN Mobile online registration system at Baubau City Regional General Hospital. A qualitative phenomenological approach was employed, with informants selected through purposive sampling. Data were collected to capture the meanings of patients’ experiences in using the application. The findings show that most patients are satisfied with the practicality, speed, and flexibility of the online registration system. However, technical problems, particularly unstable internet connectivity, remain a major challenge. Furthermore, the online registration system has contributed to improved service efficiency and patient satisfaction. These findings indicate the importance of continuous evaluation and improvement of the JKN Mobile online registration system to enhance service quality and health information system development at Baubau City Regional General Hospital.

Electronic Medical Record (EMR) is an essential component of hospital digital transformation aimed at improving administrative efficiency and service quality. This study aims to analyze the factors influencing the implementation of EMR in outpatient registration at a private hospital in North Jakarta. A mixed-methods design was employed, combining quantitative data collected from questionnaires completed by 30 registration staff with qualitative data obtained through structured interviews and direct observation. The logistic regression analysis revealed that Training and Staff Competence (X2) had a significant positive effect on outpatient registration (OR 30.663; p=0.040), while System Integration and Data Security (X4) also showed a significant effect (OR 15.121; p=0.047). In contrast, Technological Infrastructure Readiness (X1) was positive but not significant (p=0.112), and Organizational Culture and Managerial Support (X3) was negative and not significant (p=0.954). Simultaneously, the model explained 72.1% of the variation in registration effectiveness (Nagelkerke R²=0.721) with a classification accuracy of 93.3%. Qualitative findings supported the quantitative results, highlighting insufficient staff training, persistent technical issues in BPJS system bridging, and difficulties faced by elderly patients in adapting to digital registration. Elderly patients still required staff assistance and simple educational media such as tutorial videos displayed in hospital waiting areas. This study concludes that staff competence and system integration are the key determinants of successful EMR implementation in outpatient registration. It is recommended that hospitals strengthen continuous training programs, improve network and server stability, and expand patient education initiatives to ensure effective, efficient, and patient-friendly digital services.

The prevalence of chronic diseases in Jambi City has tended to increase in the last three years, especially hypertension and diabetes mellitus. Chronic diseases that are high risk, high volume and high cost have an impact on the household economy of sufferers who tend to incur health costs that exceed the family's financial capacity (catastrophic). The existence of the Chronic Disease Management Program (Prolanis) from BPJS Health should contribute to reducing the number of chronic diseases, reducing the burden of disease and improving the social relations of chronic disease sufferers, however the coverage of Prolanis activity is still low and several responses from community experience indicate there are problems with the acceptability of the program. This research aims to measure the level of community acceptability of health interventions and social relations in the Prolanis practice as assessed by analyzing affective attitudes, burden, ethics, intervention coherence, costs, perceived effectiveness and self-confidence of chronic disease sufferers in Jambi City in 2023. The research was conducted with Quantitative research methods use a cross-sectional design. Respondents were selected based on a purposive sampling technique totaling 180 respondents spread across five Puskesmas work areas in Jambi City. The research instrument is a questionnaire. The research results show that the indicators of burden, ethics and effectiveness are the most dominant factors in influencing the acceptability of Prolanis participants. As a recommendation, it is suggested to the government and BPJS Health to increase public understanding of the importance of using Prolanis in an effort to reduce the number of chronic diseases in Jambi City.

The increasing participation in JKN in Denpasar has prompted BPJS Kesehatan to optimize the use of e-Dabu; however, the service continues to face persistent technical and usability challenges. Ongoing system issues, limited user proficiency, and unsatisfactory user experiences have reduced engagement with e-Dabu, highlighting the importance of understanding how the customer journey shapes positive emotions and customer passion through customer experience. This quantitative study employs validated measurement scales covering e-Dabu, customer journey, positive emotions, customer passion, and customer experience, with a sample of 190 business entity PICs at the BPJS Kesehatan Denpasar Branch. Data were analyzed using the SEM-PLS method, and the findings reveal that customer journey and positive emotions significantly influence customer experience. Additionally, positive emotions and customer experience significantly affect customer passion, while customer journey does not directly impact customer passion. The study concludes that enhancing customer journey, positive emotions, and customer experience is essential for increasing customer passion within BPJS Kesehatan Denpasar. These findings offer valuable theoretical and practical contributions to improving digital public service management.

The National Health Insurance program (JKN) has been in effect in Indonesia since early 2014, administered by the Social Security Administration (BPJS). The purpose of this community service program is to enhance the role of youth in optimizing the use of Mobile JKN and to assist the community in utilizing it. Mobile JKN is an innovation for the community, eliminating the need to wait in long queues at healthcare services. The participants were adolescents, specifically 13 students from MTs. Muhammadiyah Palleko in Takalar Regency. The method used was to provide outreach through presentations on the procedures for using Mobile JKN, followed by discussions to clarify any issues that the students still lacked. The results of this community service program are expected to increase the youth's knowledge of the use and utilization of Mobile JKN as a form of digital health care that can improve the effectiveness of healthcare services, enabling them to become agents of change in the success of the JKN program in Takalar City.

Background: Accurate coding of external cause in injury diagnoses is crucial to ensure the validity of medical records, support health policy decisions, and maintain the quality of morbidity reporting.  Objective: To determine the factors that influence the inaccuracy of external cause codes in injury diagnosis at Thalia Irham General Hospital, Panciro, Gowa Regency. Method: This study employed a descriptive qualitative approach using observation and in-depth interviews with outpatient coders handling injury cases. Result: The study found that only 36% of the medical record documents were coded accurately, 26% were inaccurately coded, and 36% lacked any external cause code. The main causes of inaccuracy included incomplete anamnesis, limited time, absence of specific standard operating procedures (SOPs), and the belief that external cause codes do not impact BPJS claims. Conclusion: The low level accuracy of external cause coding is caused by the lack of understanding of officers regarding the ICD-10 Chapter XX classification, the absence of a specific SOP for coding injuries, and the perception that external cause codes do not affect the claims system.