Quality of Services and Health Financing Efficiency of Community Health Insurance (Jamkesmas) at 21 General and Specialty Hospitals in Indonesia


Background: Community Health Insurance (Jamkesmas) has been implementing maintained since 2008 with 76.4million individual quota increased to 86.4 million in 2012. The major problem of involved is unfairness (inequity) in the quality and financing of health services for participants. This study aims to analyse the quality and financing of health perspective of Jamkesmas participants in the hospital. Method: This study was conducted in 21 general and specialty hospitals in Indonesia, The sample were selected purposively They were 9 Central Government hospitals (RSUP), Regional hospital and 3 specialty hospital ie cancer hospital, cardiologie hospital and stroke hospital. Those hospital involved covers 8 RSU Class A General Hospital. 8 RSU Class B, 2 RSU Class Cand 3 Specialty Hospital. Primary data wascollected by interviewing 1700 outpatient and inpatients, and 280 hospital staffs. Secondary data were human resources, finance and coverage. Results: Quality of services review on the adequacy of the physician\u27s quality was very varied.There were 570–2372 outpatient visits per physician, and 37-674 inpatients per doctor visit. Adequacy of nursing staff(nurses and midwives) was better, 123–671 outpatient visits per nursing staff and 3–127 inpatient visits per nursing staff.Quality of services according to health officers perceptions on equipment and facilities was good and complete. Quality ofservices according to patients\u27 expectations and reality was appropriate, never the less the direct heath services, were low. Hospital financing was very large, 33–460 billion, and one third for Jamkesmas and Regency Community Health Insurance (Jamkesda) services. Proportion Jamkesda funding in RSUD was larger than Jamkesmas while in RSUP, Jamkesda was smaller than Jamkesmas. Jamkesmas financing perspective according to the staff, was most of them stated that funding for Jamkesmas was matched and appropriate the number of served patients served, Recommendation: Improving the quality of health services particularly in the completeness of equipment and facilities (technical domain) and the availability of doctors, as well as retaining to BPJS 2014 is very needed and important

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This paper was published in Neliti.

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