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CHAPTER I

PRELIMINARY

A. Background

Health problems in Indonesia is still very numerous and difficult to get

right, the main thing is the payment issue. Health payments is strong, stable and

continuous vital role for the provision of health services in order to achieve

important goals of health development in a country of which it is the equalization

of health services and access and quality services.

In Indonesia, the problem is still a topic of health payments in the actual

problems in the field of health. The cost of care is still a major priotitas in

hospitals and do not heed the condition of patients who come for treatment. The

payment issue is very complicated and hard to find completion.

In this case the victim is the poor who need health care but do not have a

cost. More and more patients who are not able to drop out can receive treatment

just because it does not have a down payment for the treatment.

The government has already issued a number of policies related to solving

this problem, such as by issuing multiple regulations. One of them has been

mentioned in Law No. 36 Year 2009 on Health has required health care facilities

in order to prioritize efforts to save the patient.

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Although it has a lot of rules and suggestions that help put the health

facilities to patients, but the denial of services to patients by reason of the

economy is still going on. It has been explained well in the legislation that the

hospital has a social function that can not be removed with the function of other

hospitals.

B. Purpose

1. Knowing the health care payment

2. Knowing the mechanism of payment

3. Knowing the healthcare payment system

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CHAPTER II

DISCUSSION

A. Payment of Health Services

Health is an important element and is a constitutive element in the process

of a person's life. Without health, could not take place as usual activities. In the

life of the nation, health development actually worth very investatif. The

investment value lies in the availability of resources senatiasa ready to use and

still avoid the attack of various diseases. However, there are still many people

take it.

The lack of state budget earmarked for the health sector, can be seen as a

lack of appreciation of the importance of health as a buffer element, which if

neglected will pose a new set of problems that would absorb larger state finances.

A kind of new waste arising from our own mistakes.

Healthy Indonesia Vision 2010 concept, in principle, implying a

centralized approach in the implementation of health development, a paradigm

that is in fact quite contrary to fad decentralization where autonomous regional

authority to determine the direction and development model in the region without

having to be bound is far from the center.

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B. Payment Mechanism

The mechanism of payments made over the years is through the provider

payment system is budget, except for service delivery by a midwife in the claims

to a health center or the nearest Post Office. Another alternative is empowerment

through a voucher system. The strengths and weaknesses of these alternatives

need to be explored with the involvement of actors at the service level.

Information about the strengths and weaknesses of each of these ways is

also an important input to complete the planning policy and payment of health

care of the poor. Alternative Payment Source: Health Insurance Prospects In

disbursements JPS-BK 2001, try develop managed care (Community Health

Insurance) as to facilitate the channeling of funds JPS-BK. Such efforts are

generally not successful, because in practice has to do is granting financial

administration services known as TPA (Third Party Administration). Based on

these experiences it is known that one of the fundamental principles of insurance

can not be applied, namely the "pooling of risk". In this principle of risk borne by

the participants of various levels, not just the poor. In addition, 4 Award

"premium" for Rp 10,000 / Gakin (and cut 8% by the Executive Agency JPKM)

is not based on the calculation of financial risks following the principles of

actuarial professionals.

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C. Payment System Health

1. Claims

This is the payment model health insurance system. For example JKN, Askes,

JAMKESNAS, Social Security, public payments, Jampersal, etc. Nurses

should know the type of guarantee for its claim different patients. Explain to

patients and any rules that will be covered. Also make sure that the hospital

works with companies where patients taking jamsostek. Clarity of information

is very important that there are no losers.

To claim, nurses provide services in accordance askep made. After that, give

evidence in the form of a report signed by a doctor, examination sheet, patient

insurance cards, etc. Claims made from the hospital to the government

2. Service Pack.

This system is similar to the claim, but for the payment using the package

system. The system is often used for jamkesmas package. Hospitals will be

paid according to the type of illness and the SOP.

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3. Capitation

Capitation system is a payment system that is often applied in the clinic.

Capitation is derived from the word (Head), depending on per-head payment

(people) who come to the clinic multiplied by the price to be paid by the

government (already set). Suppose the government sets for a community

health center per-person payment price is 15,000 rupiah. Today there are 13

people who get health center services. So, 13x15.000 price to be paid to

government health centers.

4. Fee for service

The system is paid first, then the patient get service. The system is suitably

applied in developed countries, but in Indonesia is a developing country, this

system is applied.

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CHAPTER III

CONCLUSIONS AND RECOMMENDATIONS

A. Conclusion

Hospital as a health care provider should accept all patients who come, giving the

required services, and then take care of the costs involved and not ask for

payment upfront without any medical procedures done first, especially if the

patient who comes to the critical state. Hospitals should put patient safety first,

not prioritizing cost.

B. Recommendations

Standardization should be done about the cost of the hospital. Although there are

laws that govern, but the reality on the ground is not as in written by the existing

laws. This can be detrimental to people who are unable to access health services

because of lack of fees.

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