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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 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.

BPJS Health experienced losses due to stopped payment of contributions for participants who had utilized delivery services of more than 200 billion in a period of 2 years. It was recorded that 64.7% of mothers who were about to give birth registered as participants a month before giving birth and then stopped (43%) or behaved in adverse selection in payments after delivery. The largest percentage comes from independent participants or Non-Wage Recipient Participants (PBPU). In Jambi Province, non-compliance in paying BPJS Health contributions is highest in Jambi City. It was recorded that 77,489 participants were in arrears in 2021, resulting in losses of 60.1 billion. Non-compliance with paying contributions is adverse selection behavior. The aim of this study is to analyze the factors causing adverse selection behavior among independent participants in paying post-natal JKN contributions in Jambi City.  Quantitative study approach with a cross-sectional design carried out in Jambi City. Respondents totaling 96 people were selected based on accidental sampling technique. The study instrument is a questionnaire. Data analysis consists of univariate analysis stages and bivariate analysis using the chi-square test. The study results found that as many as 33.3% of independent participants behaved in adverse selection when paying JKN contributions after giving birth. There is a significant relationship between the factors number of family members (p=0.001), knowledge (0.000), perception of illness (p=0.001), clinical assessment (p=0.000), and willingness to pay (WTP) with adverse selection behavior in independent JKN participants postpartum. It is recommended that BPJS Health consider implementing a waiting period method for participants who will utilize maternity services. As well as increasing promotive activities for the Jambi City Government in educating and increasing public awareness about the importance of health insurance in protecting household finances.

The Maternal Mortality Rate (MMR) is closely related to the low number of pregnant women visiting the Community Health Center (Puskesmas). This situation can occur due to patient dissatisfaction with the quality of services provided by health facilities, which can lead to patients deciding not to undergo check-ups at the Puskesmas or going to non-medical personnel, which can lead to complications in pregnant women. The purpose of this study was to analyze the effect of health service quality on patient satisfaction among third-trimester pregnant women at Pucakwangi 2 Pati Community Health Center. This study adopted a quantitative, observational, analytical, cross-sectional approach. This study was conducted at Pucakwangi 2 Pati Community Health Center in October 2023. The sample size was 42 third-trimester pregnant women using BPJS services. The sampling method used was total sampling, and the results were analyzed using the Mann-Whitney statistical test. The results showed that the dimensions of tangible, reliability, responsiveness, and empathy were related to patient satisfaction with a p-value of 0.000. Meanwhile, the assurance dimension was not related to patient satisfaction because the p-value was 0.356. Four quality dimensions were found to be related to patient satisfaction, namely tangible, reliability, responsiveness, and empathy dimensions on the satisfaction of pregnant women in the third trimester at Pucakwangi 2 Community Health Center, Pati. Meanwhile, no relationship was found between the assurance dimension and the satisfaction of pregnant women in the third trimester at Pucakwangi 2 Community Health Center, Pati. This finding indicates that improving the quality of health services, especially in the aspects of tangible, reliability, responsiveness, and empathy, is very important to increase the satisfaction of pregnant women. The Community Health Center needs to conduct continuous evaluation and improvement in maternal health services to encourage regular visits by pregnant women, reduce the risk of complications, and contribute to reducing maternal mortality in the Pucakwangi 2 Community Health Center's working area.

The implementation of the Enhanced Recovery After Cesarean Surgery (ERACS) method as an innovation in the Sectio Cesarea (SC) surgical procedure aims to accelerate recovery, minimize pain, and improve patient comfort. Although it has been clinically proven, there is still limited research exploring patients' subjective experiences with this method, particularly in eastern Indonesia. This study aims to explore in depth the physical, emotional, psychological experiences, as well as perceptions of service and patient expectations after undergoing SC with the ERACS method at Banggai Laut General Hospital. The study employs a qualitative approach with a phenomenological study design. Data were collected through in-depth interviews with purposively selected informants and analyzed using Braun & Clarke's thematic analysis technique. The results showed that patients experienced rapid physical recovery, minimal pain, and were able to mobilize early. Emotionally, patients felt calm and stable, supported by good communication with medical staff and family support. However, information about the ERACS procedure before surgery was still perceived as lacking detail. Patients also hope that this method continues to be implemented with improvements in educational aspects and financial support from BPJS. Patients' experiences with the ERACS method are generally very positive and reflect the success of this approach not only clinically but also in creating a more comfortable, efficient, and humane childbirth experience. This study recommends enhancing preoperative education, postoperative monitoring, and more inclusive financial support systems.

The incidence of chronic diseases is not comparable to the ratio of chronic disease service utilization in Jambi City. Data from BPJS Kesehatan Jambi states that Talang Banjar Health Center is a health center with the lowest achievement of the Controlled Chronic Disease Management Program Participant Ratio (RPPT) of 0.55% from ≥ 5%. It is suspected that the behavior of chronic disease sufferers influences this figure. The study aims to analyze the behavior of health service utilization by chronic disease patients in the work area of Talang Banjar Health Center, Jambi City. Quantitative research with a cross-sectional study design. The research sample was selected through the Total Sampling Technique, namely all prolanis participants who have been registered at Talang Banjar Health Center, Jambi City, totaling 75 respondents. Data analysis using the chi square test. The results of the study showed that there was a relationship between Education (p = 0.049), knowledge (p = 0.000), accessibility (p = 0.043), and perception of disease (0.020) with prolanis utilization. There is no relationship between age (p = 0.254), gender (p = 0.383), occupation (p = 1.000), and health worker attitudes (p = 0.320) with the utilization of prolanis health services. It is concluded that education, knowledge, accessibility and perception of disease factors influence patient behavior in utilizing Prolanis services.

Healthcare financing for patients covered by BPJS Kesehatan in hospitals is carried out through a claims mechanism. Delayed BPJS Kesehatan claims represent a critical issue within the healthcare service context in Indonesia. The aim of this study is to identify management strategies that can expedite the eligibility of BPJS Kesehatan claims at Restu Ibu Hospital in Balikpapan. This research is conducted using a descriptive qualitative approach, with data collection through interviews and Focus Group Discussions (FGD). The informants consisted of one doctor, three coders, and one verifier. The study begins by identifying the claim service system situation, focusing on both internal aspects (Strengths and Weaknesses) and external aspects (opportunities and Threats), also known as SWOT analysis. This study identifies several strategies, including: 1) Enhancing the competence of staff and medical personnel through regular training; 2) Developing a more advanced and integrated information system; 3) Improving communication with BPJS Kesehatan; 4) Improving documentation and data verification; and 5) Strengthening coordination with relevant units.

This study aims to calculate the unit Cost of echocardiography services at RSAL dr. Oetojo Sorong, West Papua, using the Activity-Based Costing (ABC) method and compare it with the applied INA-CBG’s tariff. The research method employed is a quantitative descriptive approach focusing on direct Cost analysis, overhead Costs, and Cost allocation based on activities. The data used includes primary data obtained from direct observation and interviews, as well as secondary data such as financial reports and hospital medical records. The results show that the unit Cost of echocardiography services calculated using the ABC method is higher than the INA-CBG’s tariff, indicating a disparity between the standard tariff and actual Costs. The application of the ABC method provides significant benefits to RSAL dr. Oetojo Sorong, such as identifying Cost-intensive activities, improving operational efficiency, and providing transparency in Cost management. This study also recommends that hospital management evaluate service tariffs and that BPJS Kesehatan review the alignment of INA-CBG’s tariffs with the actual Costs of healthcare services.

The Maternal Mortality Rate (MMR) in Indonesia is still high and is a major challenge in the health system, especially in the labor phase. This study aims to analyze the implementation of the BPJS patient labor referral system in reducing MMR at the Gunung Tinggi Health Center. The study used a qualitative method with a case study approach to health workers at the Gunung Tinggi Health Center. The results of the study showed that the availability of competent health workers, adequate facilities and infrastructure, and a referral system integrated with BPJS have made a positive contribution to labor services. However, challenges were still found in the form of late responses from referral hospitals, geographical constraints, and low public health literacy regarding the importance of referrals. This study concludes that strengthening the coordination system between facilities and educating the community is very important in increasing the effectiveness of the referral system and reducing maternal mortality.  

Non-formulary drug utilization in Harapan Kita Children’s and Mother’s Hospital presents a substantial challenge in healthcare cost management, especially for patients enrolled in the BPJS health insurance program. Given its status as a national referral hospital, Harapan Kita Children’s and Mother’s Hospital encounters a high prevalence of complex maternal and child health cases requiring the use of medications beyond the scope of the national formulary. This research endeavor seeks to examine the patterns and consequences of non-formulary drug use within this context. This study adopted a quasi-experimental design, incorporating both quantitative and qualitative methods, to evaluate the impact of an sosialisation intervention and audit clinic on physician compliance with formulary drug use. A pre-test and post-test design was employed to measure changes in non-formulary drug utilization. Findings indicated a statistically significant decrease in non-formulary drug use from 18% to 13% post-intervention. The integration of a clinical pathway and tailored physician training was instrumental in achieving improved formulary adherence. Given these results, it is recommended to broaden training and surveillance programs, strengthen technological support through the implementation of formulary information systems, and undertake longitudinal research to assess the long-term sustainability of the intervention's effects..

The National Health Insurance (JKN) program, administered by BPJS Kesehatan, has significantly expanded public access to healthcare services, particularly inpatient care. This study aims to analyze inpatient JKN reimbursement patterns at Surakarta General Government Hospital during the period of 2020 to 2024. The analysis focuses on five main variables: INA-CBGs grouping codes, class of care, severity level, INA-CBGs tariff, and actual hospital costs. A descriptive-analytic method with a quantitative approach was employed, utilizing secondary data extracted from the INA-CBGs system. The results indicate that inpatient reimbursements were predominantly concentrated in Class 3 services (64%–70%) and severity level 1 (45%–59%). From 2020 to 2022, respiratory-related cases dominated, likely due to the COVID-19 pandemic, while in 2023–2024 a shift occurred toward non-communicable diseases such as cardiovascular and metabolic conditions. A consistent negative tariff gap was identified, particularly in Class 3 and severity level 1, where INA-CBGs reimbursements were insufficient to cover actual service costs. These findings underscore the importance of periodic review of INA-CBGs tariff structures, reinforcement of Quality and Cost Control (KMKB), and optimization of reimbursement management information systems to enhance service efficiency and ensure the financial sustainability of JKN, especially in Type C hospitals that serve as the primary level of healthcare delivery.

The JKN mobile application in Semarang City in 2021 has been used by 228,965 people, while it is not comparable to BPJS Health participants, which amounted to 2,664,532 people and if it is percented, only 11% of JKN mobile users. The purpose of this study was to determine the effect of JKN mobile service quality on user satisfaction. This research was conducted using a quantitative cross-sectional design. The sample size was calculated using the Lameshow formula and the results obtained were 385 respondents with the inclusion criteria of JKN mobile users at the Semarang State University Service Center. This research was conducted from September to December 2024. The results showed that the core scale of service quality that has an influence on user satisfaction is efficiency (p value 0.000) and reliability (p value 0.005). The core scale of service quality that has no influence on satisfaction is fulfillment (p value 0.068) and confidentiality (p value 0.404).

Admission services in the emergency department (IGD) are an important part of hospital operations that require effective management to support health services. Optimal medical record management requires human resource planning according to actual workload. This research was conducted to analyze the need for admission registration at the Duren Sawit Regional Special Hospital (RSKD) with a quantitative approach using descriptive methods. The research results show that RSKD Duren Sawit has Standard Operational Procedures (SPO) which refer to Minister of Health Regulation No. 33 of 2015 in planning health human resource needs (HRK). Health workload analysis indicates that the ideal requirement is seven admissions officers, while currently only five officers are available, so there is a shortage of two officers. Factors that influence the workload of admission registration include: Man, namely the limited number of officers in the medical records unit, Machine, namely the BPJS server down and power outages, Material, namely the mixed admissions work room with the cashier so the medical record files are still in one room, Method, namely the HR application process at RSKD Duren Sawit found no obstacles, Money, namely there is no budget planning for additional officers in the medical records unit.

The National Health Insurance Program (JKN) organized by BPJS Health aims to improve access and quality of health services for all levels of Indonesian society. This research examines the effectiveness of the JKN program, with a focus on the use of the JKN mobile application, program implementation in health facilities, and factors that influence service quality. Based on case studies in several regions, the research results show that the JKN mobile application makes it easy for participants to access health-related services and information, although there are still obstacles such as a lack of public understanding of the application and technical problems. Apart from that, health services in hospitals and community health centers still face challenges such as a shortage of medical personnel, delays in services, and timeliness in administrative processes. Although the JKN program has expanded access to services, challenges in equal distribution of service quality and health resources still need to be overcome. Overall, the JKN program plays an important role in improving people's health and welfare, but improvements are needed in terms of community understanding, infrastructure and service efficiency to achieve more optimal and equitable health goals throughout Indonesia.