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Patient satisfaction is a key indicator of health service quality in the National Health Insurance era. Outpatient services for BPJS members still face problems regarding waiting time, communication, and facilities. This study aimed to analyze factors affecting BPJS patient satisfaction with outpatient service quality at Malahayati Islamic Hospital Medan in 2026. A cross-sectional analytic design was applied to 150 respondents selected through consecutive sampling. Data were collected using a validated questionnaire (r>0.361; α=0.876) and analyzed by Chi-square and multiple logistic regression. Results showed that waiting time (p<0.001), staff competence (p<0.001), staff attitude (p<0.001), drug availability (p=0.032), facility comfort (p<0.001), administrative ease (p=0.003), and information clarity (p=0.008) were significantly associated with satisfaction. Multivariate analysis revealed waiting time as the most dominant factor (OR=5.42; 95% CI: 2.31–12.71), followed by staff competence (OR=4.18), facility comfort (OR=2.87), and staff attitude (OR=2.42), with Nagelkerke R²=0.512. Hospital management should optimize service flow and adopt digital queuing systems to enhance patient satisfaction.

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.

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 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.

The National Health Insurance Program (Jaminan Kesehatan Nasional or JKN) is a government initiative aimed at ensuring equitable, accessible, and affordable healthcare services for all Indonesian citizens. Since its implementation in 2014, the program has covered more than 90% of the population; however, several challenges remain, particularly concerning the quality of services at primary healthcare facilities such as community health centers (puskesmas). This study aims to analyze the quality of JKN services at the Cengkareng Public Health Center, West Jakarta, using the five dimensions of service quality proposed by Parasuraman: tangibles, reliability, responsiveness, assurance, and empathy. The research employed a descriptive qualitative method through in-depth interviews, direct observations, and document analysis involving healthcare workers and JKN patients. The findings indicate that the overall service quality at Puskesmas Cengkareng remains suboptimal. The tangibles and assurance dimensions are relatively good, while reliability, responsiveness, and empathy are still lacking. Major complaints include long waiting times, poor doctor–patient communication, and unfriendly staff attitudes. These findings highlight the need for improving human resource professionalism, strengthening service management systems, and conducting periodic evaluations to enhance the overall quality and patient satisfaction among JKN participants.  

This study analyses the challenges of digitalising registration services at Primary Healthcare Facilities (Fasilitas Kesehatan Tingkat Pertama, FKTP) in East Java, including limitations in human resources, technological infrastructure, and public digital literacy, all of which affect the satisfaction of National Health Insurance (Jaminan Kesehatan Nasional, JKN) patients. Utilising the Systematic Literature Review (SLR) methodology with the PRISMA approach, the study reviews literature from 2024–2025 sourced from databases such as Google Scholar, using keywords related to digitalisation, FKTP, and patient satisfaction. The analysis is based on the ADO (Antecedent, Decision, Outcome) framework. The findings identify three key factors: (1) Antecedents (human resource competence, infrastructure, digital literacy); (2) Decisions (human resource training, facility modernisation, public outreach); and (3) Outcomes (increased patient satisfaction through time efficiency and ease of access). The study emphasises the need to strengthen human resources, provide adequate infrastructure, and educate the public to ensure the sustainability of digital healthcare services at FKTPs in East Java.

Informal workers are a group that contributes significantly to the Indonesian economy, but still have a low level of independent participation in the national health insurance program. This low participation is caused by minimal insurance literacy, income instability, and a lack of awareness of the importance of health protection. This activity aims to empower informal workers to have the ability and willingness to become independent participants in health insurance. The method used is a community-based participatory approach through three main stages: education on the benefits of health insurance, microfinance management training for regular premium payments, and assistance with independent registration for participation. The activity results showed a significant increase in participants' knowledge and understanding of the benefits of health insurance. In addition, there was an increase in the number of informal workers registering as independent participants and demonstrating a commitment to sustainable premium payments. This program demonstrates that community empowerment can be an effective strategy to expand Universal Health Coverage (UHC) and improve the welfare of informal workers through sustainable health protection.

The community assistance program in understanding BPJS administrative procedures at healthcare facilities aims to improve health literacy and service accessibility for participants of the National Health Insurance (JKN). Many citizens, particularly in rural areas, still face challenges in understanding BPJS registration, referral, and service claim procedures. This activity was carried out through a community-based participatory approach using socialization, service flow simulations, and direct mentoring at healthcare facilities. The results show a significant increase in public understanding of BPJS administrative stages, improved ability to access services independently, and higher satisfaction with healthcare services. The program also strengthened collaboration between communities, health cadres, and BPJS officers in facilitating administrative processes. Therefore, this initiative contributes to improving service efficiency and promoting equitable access to healthcare for all community groups.

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.

Increasing rural communities’ understanding of national health policy and system is a strategic step toward improving access and equality in Indonesia’s health services. Health policy education plays a crucial role in ensuring that citizens understand their rights and responsibilities as National Health Insurance (JKN) participants, as well as the mechanisms of available healthcare services. This study aims to analyze the effectiveness of health policy education in rural areas, focusing on the improvement of health literacy, community participation in decision-making, and the role of health workers as facilitators. A descriptive quantitative method was applied through surveys and field observations in three villages of Sleman Regency, Yogyakarta. The findings reveal that 82% of respondents understood their JKN rights after the education program, compared to only 45% before. Major challenges included limited information media and low digital literacy among villagers. The study concludes that community education on national health policy effectively enhances public awareness of universal health coverage but requires continuous support through collaboration between local government, healthcare providers, and educational institutions.

This study aims to analyze the adaptation strategies of Ananda Sehat Karangsono Clinic in facing the competition in healthcare services in the era of the National Health Insurance (JKN). The background of this research is based on the increasingly fierce competition between healthcare facilities, both clinics and hospitals, in providing fast, efficient, and quality services according to JKN standards. The presence of the JKN program, which demands integrated, transparent, and technology-based services, encourages clinics to innovate to remain competitive and maintain operational sustainability. The research method used is descriptive qualitative with data collection techniques through in-depth interviews, participatory observation, and documentation studies. Research informants included clinic leaders, healthcare workers, and administrative staff, thus providing a comprehensive perspective on the implemented adaptation strategies. The results show that Ananda Sehat Karangsono Clinic has integrated digital technologies, such as the Mobile JKN application and WhatsApp, to speed up the registration process, verify patient data, and facilitate communication. This innovation can improve the efficiency of service flows, reduce queues, and create a better service experience for patients. In addition, the clinic emphasizes the importance of patient satisfaction by improving service quality, speed, and friendliness of healthcare workers and support staff. The adaptation strategy implemented was not limited to technological aspects, but also encompassed operational efficiency and humanistic interpersonal services. Overall, the clinic's adaptation strategy was flexible and holistic, encompassing digitalization, strengthening internal management, and developing positive patient relationships. These findings confirm that the clinic was able to maintain competitiveness and service sustainability amidst the dynamics of the National Health Insurance (JKN) and the digitalization of the healthcare system.  

This study aims to examine the legal aspects of the Aceh People's Health Insurance Program (JKRA) by analyzing it as a hybrid between an insurance agreement and a social insurance agreement. The method used is a normative juridical approach, with qualitative analysis based on relevant laws and legal concepts. Data sources consist of primary, secondary, and tertiary legal materials. The results show that JKRA has two main characteristics. On the one hand, JKRA fulfills the elements of an insurance agreement, such as the existence of an insurer and an insured, premium payments, protection against risks, and the uncertainty of insured events. On the other hand, JKRA also reflects the characteristics of social insurance, namely being mandatory, non-profit-oriented, managed by the government, and applying the principle of mutual cooperation through a cross-subsidy mechanism. This dual character indicates that JKRA is a unique form of regional health insurance scheme that integrates private and social approaches. However, in its implementation, there are a number of legal issues that require serious attention. Some of the main problems found include the need for regulatory harmonization between JKRA and the National Health Insurance (JKN), ensuring the sustainability of funding through the Aceh Revenue and Expenditure Budget (APBA), and alignment with national health policies, especially after the enactment of Law Number 17 of 2023 concerning Health and Government Regulation Number 28 of 2024. Therefore, comprehensive legal regulations are needed so that the implementation of JKRA can run optimally and in line with the integrated national health insurance system, ensuring the sustainability of health services for the people of Aceh in a fair and sustainable manner.