Professional Documents
Culture Documents
A. Introduction
Until now, health problems remains a major topic in selurruh world. The
World Health Organization (WHO) and the World Bank Group on 12 June 2015
showed that 400 million people do not have access to essential health services and
6% of people in countries of low and middle income were tipped into or pushed
further into extreme poverty because of health spending. According to the WHO
to address health issues should be in charge of health policy. According to WHO
health policy refers to decisions, plans, and actions taken to achieve certain health
care in the community. Explicit health policy can accomplish several things:
define a vision for the future which in turn helps to set targets and a reference
point for the short and medium term. It outlines priorities and the expected role of
the different groups; and builds consensus and informs people.
So also is the case in Indonesia, the cost of treatment is still considered very
expensive. Therefore, the existence of public health insurance is needed in terms
of health care. To achieve national health insurance establishes health. Therefore,
the Indonesian government issued a policy that clearly regulate health care for
Servants and Pension Recipients (civil and military) and their family members
under Presidential Decree No. 230 Year 1968, the Minister of Health established a
specialized agency within the Ministry of Health is an Operating Body
Maintenance Fund Health (BPDPK), where the Minister of Health at that time
(Prof. Dr. GA Siwabessy) expressed as a forerunner of the National Health
Insurance.
In the period of implementation continues to progress until today. At 1984 the
Government issued Government Regulation No. 22 of 1984 on Health Care for
Civil Servants, Pension Recipients (civil, military and state officials) and their
family members. By Government Regulation No. 23 of 1984, the status of the
organizing body is converted into a Public Company Bhakti Husada. And in 1991
the health insurance on the responsibility of government plus the Veterans and
Independence Pioneers and their family members. In addition, the company is
allowed to expand the reach of membership to business entities and other entities
principle
refers
to:
resulting
Referring
to
the
principle
cross-subsidy.
of
social
health
insurance.
The
program
e.
Protabilitas
and
was
organized
ensure
equity
by
in
the
non-profit
service
to
principle.
participants.
with
legislation.
2. Non Beneficiaries Health Insurance Contribution (Non PBI),
comprising
from :
1) Wages of workers and members of their families Recipients:
Government employees,TNI members, Members of the
Police,State
officials,
Government
Employees
non
family
members
who
desired
(unlimited).
4. Participants can include additional family members, which include
the 4th child and so on, father, mother and in-laws
5. Participants can include additional family members, which include
other relatives such as siblings / in-law, household assistants, etc.
H. Contribution
1. For participants Beneficiary Contribution (PBI) Health Insurance
dues paid by the Government.
2. Contribution to the participants of Labor Wage Recipients who
works at the Institute of Government consists of the Civil Service,
members of the military, members of the police, state officials, and
employees of non-government civil servants by 5% (five percent)
of the salary or wages per month with the following provisions: 3
% (three percent) is paid by the employer and 2% (two percent) is
paid by the participants.
3. Contribution to the participants of Labor Wage Recipients who
work in state-owned enterprises, and private enterprises of 4.5%
(four point five percent) of the salary or wages per month provided
that: 4% (four percent) paid by the Employer and 0.5 % (zero point
five percent) is paid by the participants.
4. Fees for additional family workers Wage Recipients consisting of 4
onwards to the child, father, mother and in-laws, the amount of
dues amounting to 1% (one percent) of the salary or wages per
person per month, paid by workers wage earners.
5. Fees for other relatives of the workers wage earners (such as
sibling / in-law, household assistants, etc.); participants not worker
wage earners as well as the contributions of participants not worker
is:
a. Amounting to Rp.25.500, - (twenty five thousand five
hundred rupiah) per person per month with service benefits
in the treatment room Class III.
b. Amounting to Rp.42.500 (forty-two thousand five hundred
rupiah) per person per month with the benefits of services
in Class II treatment rooms.
c. Amounting to Rp.59.500, - (fifty-nine thousand five
hundred rupees per person per month with service benefits
in the treatment room Class I.
6. Contribution Health Insurance for
Veterans,
Independence
Hospital
(INP),
General
General
TNI,
Hospital
General
Private,
Hospital
Special
Recipients
and
Non-
members; and
Participants Workers Not Receiver Wages and participants
not worker with a contribution for benefits in the treatment
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The first is that participants have to go to a health facility first, when in need
of intensive action and can not be done in this health facility it will be ascribed to
the second fasilits, unless in emergencies.
Procedures to Get Health Care
1. First Level Health Care
a. Each participant must be registered on the first level health
facility that has been working with Health BPJS.
b. Participants receive medical care at first-level health facilities
where participants registered.
c. Participants can obtain inpatient care at first-level health
facilities in accordance with the medical indications.
2. Advanced Health Care
a. Participants come to BPJS Center Hospital by showing
participant card and submit a referral letter from the First Level
Health Facilities / warrant control post-hospitalization.
b. Participants receive a Letter of Eligibility Participants (SEP)
for advanced services.
c. Participants can obtain inpatient care at health facilities in
accordance with the advanced level of medical indications.
3. Care & E (Emergency):
a. Emergency Services are health services that should be provided
as soon as possible to prevent death, severity or disability,
according to the ability of health facilities.
b. Participants who require emergency services can directly obtain
service in every health facility.
c. Criteria for emergencies in accordance with applicable
regulations.
d. Participants who receive health care in health facilities who do
not cooperate with BPJS Health, will be immediately referred
to health facilities in collaboration with Health BPJS an
emergency after emergency.
e. resolved and the patient's condition can be moved.
f. Costs due to emergency services billed directly by the Health
Fasiltas BPJS Health.
4. Health Services That Do Not Guaranteed
a. Health services were performed without going through the
procedures as stipulated in applicable regulations.
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insurance program
Health services are performed abroad
Health care for aesthetic purposes
Services to overcome infertility
Leveling service dentistry (orthodontics)
Health disorders / diseases caused by drugs and or alcohol
dependence
j. Health problems from accidentally hurting yourself, or as a
result of a hobby which endanger yourself
k. Complementary medicine, alternative and traditional, including
acupuncture, shin she, chiropractic, which has not been
declared effective by health technology assessment (health
technology assessment)
l. Treatment and medical actions that are categorized as an
experiment (experimental)
m. Contraceptives, cosmetics, baby food and milk
n. Household health supplies
o. Catastrophic health care in emergency relief, extraordinary
events / outbreaks.
p. Cost of other services that are not related to health insurance
benefits are provided.
5. Accountability BPJS Health
Health BPJS obliged to pay health facilities for services provided
to participants no later than 15 (fifteen) days from the claim documents
received in full. The amount of payments to health facilities is
determined by agreement between the association BPJS Health and
Health Facilities in the region with reference to the standard rate set by
the Minister of Health. In case there is no agreement on the amount of
the payment, the Minister of Health to decide the amount of payment
for a given program JKN.
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Referance:
BPJS ( 2010 ), Vision and Mission of the Agency of Social Security, http://www.bpjskesehatan.go.id/bpjs/index.php/pages/detail/2010/2
Health BPJS, (2015) . Participant guide BPJS Health Services. Retrived Desember
20,2015 From www.bpjs-Kesehatan.go.id
BPJS, Participants BPJS Service Guide For Health.
Lestari, Andayani Budi ( 2013 ). Role of the National Health Insurance & Health
BPJS.
13
WHO, http://www.who.int/topics/health_policy/en/
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