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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.

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 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.

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.

Based on Law No. 11 of 2006 and Qanun Aceh No. 4 of 2010, the Government of Aceh has special authority in implementing prioritized health services for poor communities as part of its special autonomy. In practice, the Aceh Health Insurance (JKA) program provides health coverage for all Acehnese residents, including underprivileged groups, by covering insurance contributions and several referral and companion costs not fully guaranteed by the national health insurance system. This study aims to analyze the implementation system of JKA, examine the responsibility of the Aceh Government in providing health insurance for its citizens, and evaluate the government’s obligation to pay contributions for poor participants. This research uses an empirical juridical method with a sociological approach and utilizes both primary and secondary data. The results show that several provisions in the Qanun as the legal basis for JKA implementation are not fully aligned with field conditions and the Social Security Administrator Law. In practice, the Aceh Government bears insurance contributions and various referral costs for residents, including poor communities. Although the obligation to pay contributions for the poor has been implemented, funding for referral transportation, companions, and their consumption has not been fully covered, especially for inter-regional advanced healthcare services. Therefore, the Aceh Government needs to revise Article 43 of Qanun Aceh No. 4 of 2010 and evaluate the JKA program to ensure more targeted healthcare financing.        

This research evaluates the effectiveness of human capital development policies in Indonesia within the education and health sectors during the periods of 2015–2019 and 2020–2024. The analysis focuses on strategic programs implemented by the Ministry of Education and Culture and the Ministry of Health by comparing planned targets with the realization of performance indicators as stated in the Strategic Plan (Renstra) documents. The study employs a qualitative evaluative approach supported by descriptive quantitative data derived from official planning and performance reports. The findings indicate that during the 2015–2019 period, programs emphasizing the expansion of basic education and health services were relatively effective in increasing participation rates and improving equitable access. In contrast, programs aimed at enhancing the quality of human resources, particularly teacher development and institutional capacity building, showed lower levels of effectiveness due to weak performance measurement systems and inconsistent data reporting. During the 2020–2024 period, the effectiveness of most education and health programs declined significantly as a result of external shocks caused by the COVID-19 pandemic. However, health programs with strong financial protection mechanisms, such as the National Health Insurance (JKN), demonstrated greater resilience compared to other programs. The study concludes that the effectiveness of human capital development policies is strongly influenced by the clarity of performance indicators, consistency in program implementation, institutional capacity, and the ability of policies to adapt to external disruptions.

Regional economic development requires understanding the structure and performance of economic sectors to create effective policies. PadangiCity, the capital of West SumatraiProvince, plays a strategic role in the regional economy. However, differences in sector contributions and growth indicate structural imbalances that need attention. This studyiaims to identify leading and potential economic sectors in Padang City to support sustainable development planning. The study uses Location Quotient (LQ), iDynamic Location Quotient (DLQ), and the Growth Ratio Model (GRM) to analyze secondary data on GrossiRegional Domestic Product (GRDP) at constant 2010 prices from 2020 to 2024, sourced from the CentraliBureau of Statistics of Padang City and West Sumatra Province. LQ results show that most sectors in Padang City are base sectors, especially business services, transportation and warehousing, ifinancial and insurance services, real estate, and wholesale and retail trade. DLQ analysis indicates that mining and quarrying, trade, transportation and warehousing, iinformation and communication, and health and social services have higher growth prospects than the reference region. GRM results show that trade, information andicommunication, real estate, health services, andiother services are leading sectors with good performance and growth potential. In contrast, agriculture, manufacturing, and construction are still lagging sectors. These findings highlight a structural shift in Padang City’s economy toward service-sector dominance and underline the need for sustainable, inclusive, and adaptive development policies to support long-term economic growth.

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).

This study investigates the optimization of claims under the Indonesian Case-Based Groups (INA-CBGs) payment mechanism within the National Health Insurance Program (Jaminan Kesehatan Nasional) at Hospital X in Serang. The research aims to analyze the influence of managerial competence, digital adoption, and organizational behavior on claim effectiveness, with policy implementation serving as a moderating variable. Employing a quantitative explanatory approach, data were collected from 144 respondents comprising management staff, casemix teams, and medical record officers through questionnaires and structured interviews. Structural Equation Modeling–Partial Least Square (SEM-PLS) was applied to examine the relationships among variables. Findings reveal that managerial competence, digital adoption, and organizational behavior significantly and positively affect the optimization of INA-CBGs claims. Furthermore, the implementation of the National Health Insurance Program policy strengthens these relationships, enhancing claim efficiency and equity. The results align with the Resource-Based View theory, highlighting the strategic role of internal resources in achieving organizational performance. Managerial implications include capacity building for managers, integration of hospital information systems (SIMRS) with e-Claim platforms, and fostering collaborative organizational culture. Overall, the study underscores the importance of managerial, technological, and behavioral factors, moderated by policy implementation, in improving hospital claim optimization under the INA-CBGs system.

The biggest challenge faced by the community, especially vulnerable and poor groups, is the cost of managing chronic diseases. Even though there is national health insurance, non-medical costs, costs arising from self-medication, and limitations on certain benefits are still often obstacles that cause high out-of-pocket expenses for the community. The high costs of curative and rehabilitative care indicate that preventive and promotive efforts must be significantly improved, and one way to support the sustainability of these efforts is through a pre-emptive health financing scheme. Community service activities are carried out using a participatory approach so that community members are actively involved in the activities. The activities are carried out in three stages, that is preparation or needs identification, implementation and evaluation. The results of the activity show that the community's knowledge increased significantly because of the community service activity. Participants who took part in the activity also successfully designed a community-based financing scheme involving health savings, whereby each member makes agreed monthly contributions. This community service project demonstrates that community empowerment through the establishment of a pre-emptive financing scheme for chronic diseases can provide an effective, sustainable solution for improving public health.

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.

Equal access to health services is a fundamental right of citizens. However, vulnerable groups such as beggars are often neglected because they do not have valid residence documents. The Medan City Government launched the Medan Berkah Health Insurance Program (JKMB) to support universal Health Coverage, allowing free health services only with a Medan ID card. This study aims to assess the implementation of JKMB on beggars in Medan City by using the implementation suitability model from David C. Korten, which emphasizes the relationship between programs, organizations, and beneficiaries. The method used is a descriptive qualitative approach, with data collection through in-depth interviews, observations, and documentation studies. Informants consisted of beggars without identity who had been disciplined by Social Services, program Implementation officers, and academics in the field of social welfare. The results showed that JKMB can only be accessed by beggars while under the supervision of Social Services, through temporary identities such as "Mr. X". After being repatriated (reunification), access to health services cannot be continued due to the absence of An ID. The Program has not been able to reach marginalized groups on an ongoing basis, and there has been no integration of cross-sector data systems. The findings expose the discrepancy between program design and Target conditions, highlighting the importance of more inclusive policy reformulation, facilitation of identity ownership, and inter-agency coordination to create equitable and sustainable health access for all citizens