This qualitative study tries to answer the implication of the cost and quality pressures originating from the introduction of National Social Security System (SJKN), particularly in the health care area or what is known as BPJS. This study obtained the data through observation and a series of interviews to key persons in the financial division of five hospitals in Malang, Blitar and Tulung Agung. Following interpretive tradition, institutional theory is employed. It is found that more transformational organizational change may happen when BPJS representing market power in health care start to implement more stringent measures either through cost or quality
