Applying a policy to prepare and optimize the complaint handling system from participants

Oct 13, 2025 by talynt.org 105 views

Implementation of the Quality of BPJS Health Services According to the National Health Insurance Road Map in Deli Serdang Regency

Introduction

The National Health Insurance Program (JKN) was launched in 2014 based on the SJSN Law and BPJS Law (2011). The program aimed to provide universal health coverage to the Indonesian people. However, despite its implementation for five years, the satisfaction target of BPJS Health participants in Deli Serdang Regency has not reached 85%. This article explores the quality of BPJS Health services in Deli Serdang Regency and discusses the implementation of the National Health Insurance Road Map.

Background

The National Health Insurance Program (JKN) was launched to provide universal health coverage to the Indonesian people. The program was implemented based on the SJSN Law and BPJS Law (2011). The program aimed to provide health services to all citizens, regardless of their income or social status. However, despite its implementation for five years, the satisfaction target of BPJS Health participants in Deli Serdang Regency has not reached 85%. This is due to the method of measurement of participants' satisfaction that still relies on the questionnaire.

Efforts to Improve the Quality of BPJS Health Services

Efforts to improve the quality of BPJS Health services in Deli Serdang Regency have been carried out in various ways. Some of the efforts include:

Applying a policy to prepare and optimize the complaint handling system from participants: This policy aims to improve the handling of participant complaints and provide a more effective solution to their problems.
Applying a policy of measuring participants' satisfaction using a questionnaire: This policy aims to measure the satisfaction of participants and provide feedback to improve the quality of services.
Forming a Quality and Cost Control Policy Team: This team aims to improve the quality of services and control costs by implementing policies and procedures that are effective and efficient.
Implement a capitation payment policy based on service commitment: This policy aims to provide a payment system that is based on the quality of services provided by health facilities.
Implement the Health Capitation Policy System (Anti Fraud) to prevent fraud: This policy aims to prevent fraud and ensure that health facilities provide quality services to participants.

Obstacles Encountered in Improving the Quality of BPJS Health Services

Despite the efforts to improve the quality of BPJS Health services, there are still some obstacles encountered in Deli Serdang Regency. Some of the obstacles include:

Bandar Khalifah Health Center, one of the Puskesmas that has implemented KBPKP (Service Commitment and Cost Control) in accordance with three indicators, still has a low contact rate (51.79%): This is due to the achievement of an assessment that has not yet reached target 150/mile.
Deli Serdang Health Office uses capitation funds for the number of Puskesmas officers and the population in accordance with regulations: This may not be sufficient to meet the needs of participants.
KMKB Team (Medical Committee and Ethics Committee) Lubuk Pakam has not fully carried out its functions due to the lack of KMKB implementation activities and ethical guidance and discipline among health workers: This may lead to a lack of quality services provided by health facilities.
Participant complaints handling and participants' satisfaction measurements are still being carried out with their own policy by the BPJS Health Branch of Lubuk Pakam: This may not be effective in improving the quality of services.

Qualitative Research

Qualitative research with the source triangulation method was conducted to understand in depth about the implementation of the quality of BPJS Health services in Deli Serdang Regency based on the National Health Insurance Road Map. The results showed that the quality of BPJS Health services in Deli Serdang Regency had been running in accordance with the JKN road map, but had not yet reached the set targets.

Strategic Steps to Improve the Quality of BPJS Health Services

To improve the quality of BPJS Health services in Deli Serdang Regency, strategic steps are needed, including:

Increasing the effectiveness of handling the complaints of participants: This can be achieved by improving the complaint handling system and providing a more effective solution to participant problems.
Evaluating the satisfaction of participants and compliance with health facilities for the payment policy based on service commitment: This can be achieved by measuring the satisfaction of participants and providing feedback to improve the quality of services.
Evaluating the implementation of anti -fraud policies: This can be achieved by monitoring the implementation of anti-fraud policies and taking action to prevent fraud.
Improving communication and collaboration between the Health Office, Bandar Khalifah Health Center, and BPJS Health to improve the quality of services for BPJS Health participants: This can be achieved by improving communication and collaboration between health facilities and BPJS Health.

Conclusion

The quality of BPJS Health services in Deli Serdang Regency has been running in accordance with the JKN road map, but has not yet reached the set targets. To improve the quality of BPJS Health services, strategic steps are needed, including increasing the effectiveness of handling participant complaints, evaluating the satisfaction of participants and compliance with health facilities, evaluating the implementation of anti-fraud policies, and improving communication and collaboration between health facilities and BPJS Health. Through joint efforts and strong synergy, it is expected that the quality of BPJS Health services in Deli Serdang Regency can continue to increase and meet the health needs of the public optimally.

Recommendations

Based on the findings of this study, the following recommendations are made:

BPJS Health should improve the complaint handling system and provide a more effective solution to participant problems: This can be achieved by improving the complaint handling system and providing a more effective solution to participant problems.
Health facilities should improve the quality of services and provide feedback to participants: This can be achieved by improving the quality of services and providing feedback to participants.
The Health Office and BPJS Health should improve communication and collaboration to improve the quality of services: This can be achieved by improving communication and collaboration between health facilities and BPJS Health.
The government should provide support and resources to improve the quality of BPJS Health services: This can be achieved by providing support and resources to improve the quality of services.

Limitations of the Study

This study has several limitations, including:

The study was conducted in a single regency: The study was conducted in Deli Serdang Regency, which may not be representative of other regencies in Indonesia.
The study used a qualitative research method: The study used a qualitative research method, which may not provide a comprehensive understanding of the implementation of the quality of BPJS Health services.
The study did not collect data on the cost of implementing the quality of BPJS Health services: The study did not collect data on the cost of implementing the quality of BPJS Health services, which may be an important consideration for policymakers.

Future Research Directions

Future research should focus on:

Conducting a study on the cost of implementing the quality of BPJS Health services: This can provide valuable information for policymakers on the cost of implementing the quality of BPJS Health services.
Conducting a study on the implementation of the quality of BPJS Health services in other regencies: This can provide a more comprehensive understanding of the implementation of the quality of BPJS Health services in Indonesia.
Conducting a study on the impact of the quality of BPJS Health services on health outcomes: This can provide valuable information on the impact of the quality of BPJS Health services on health outcomes.
Frequently Asked Questions (FAQs) About the Implementation of the Quality of BPJS Health Services in Deli Serdang Regency

Q: What is the National Health Insurance Program (JKN)?

A: The National Health Insurance Program (JKN) is a government-run health insurance program that provides universal health coverage to the Indonesian people. It was launched in 2014 based on the SJSN Law and BPJS Law (2011).

Q: What is the goal of the National Health Insurance Program (JKN)?

A: The goal of the National Health Insurance Program (JKN) is to provide universal health coverage to the Indonesian people, regardless of their income or social status.

Q: What are the challenges faced by BPJS Health in Deli Serdang Regency?

A: The challenges faced by BPJS Health in Deli Serdang Regency include:

Low satisfaction rate of participants: The satisfaction rate of participants in Deli Serdang Regency has not reached 85%.
Low contact rate of health facilities: Some health facilities in Deli Serdang Regency have a low contact rate, which may indicate a lack of quality services.
Lack of effective complaint handling system: The complaint handling system in Deli Serdang Regency may not be effective in resolving participant complaints.

Q: What are the strategic steps to improve the quality of BPJS Health services in Deli Serdang Regency?

A: The strategic steps to improve the quality of BPJS Health services in Deli Serdang Regency include:

Increasing the effectiveness of handling participant complaints: This can be achieved by improving the complaint handling system and providing a more effective solution to participant problems.
Evaluating the satisfaction of participants and compliance with health facilities: This can be achieved by measuring the satisfaction of participants and providing feedback to improve the quality of services.
Evaluating the implementation of anti-fraud policies: This can be achieved by monitoring the implementation of anti-fraud policies and taking action to prevent fraud.
Improving communication and collaboration between health facilities and BPJS Health: This can be achieved by improving communication and collaboration between health facilities and BPJS Health.

Q: What is the role of the government in improving the quality of BPJS Health services?

A: The government plays a crucial role in improving the quality of BPJS Health services by:

Providing support and resources: The government should provide support and resources to improve the quality of services.
Monitoring and evaluating the implementation of the quality of BPJS Health services: The government should monitor and evaluate the implementation of the quality of BPJS Health services to ensure that it meets the set targets.
Providing training and capacity building: The government should provide training and capacity building to health facilities and BPJS Health staff to improve their skills and knowledge.

Q: What are the benefits of improving the quality of BPJS Health services?

A: The benefits of improving the quality of BPJS Health services include:

Improved health outcomes: Improving the quality of BPJS Health services can lead to improved health outcomes for participants.
Increased satisfaction rate of participants: Improving the quality of BPJS Health services can lead to an increased satisfaction rate of participants.
Reduced costs: Improving the quality of BPJS Health services can lead to reduced costs for the government and participants.

Q: What are the challenges faced by health facilities in improving the quality of BPJS Health services?

A: The challenges faced by health facilities in improving the quality of BPJS Health services include:

Lack of resources: Health facilities may lack the resources needed to improve the quality of services.
Lack of skilled staff: Health facilities may lack skilled staff to provide quality services.
Lack of effective communication and collaboration: Health facilities may lack effective communication and collaboration with BPJS Health and other stakeholders.

Q: What are the recommendations for improving the quality of BPJS Health services?

A: The recommendations for improving the quality of BPJS Health services include:

Improving the complaint handling system: The complaint handling system should be improved to provide a more effective solution to participant problems.
Evaluating the satisfaction of participants and compliance with health facilities: The satisfaction of participants and compliance with health facilities should be evaluated to provide feedback to improve the quality of services.
Evaluating the implementation of anti-fraud policies: The implementation of anti-fraud policies should be evaluated to prevent fraud.
Improving communication and collaboration between health facilities and BPJS Health: Communication and collaboration between health facilities and BPJS Health should be improved to provide quality services.

Q: What are the future research directions for improving the quality of BPJS Health services?

A: The future research directions for improving the quality of BPJS Health services include:

Conducting a study on the cost of implementing the quality of BPJS Health services: A study on the cost of implementing the quality of BPJS Health services can provide valuable information for policymakers.
Conducting a study on the implementation of the quality of BPJS Health services in other regencies: A study on the implementation of the quality of BPJS Health services in other regencies can provide a more comprehensive understanding of the implementation of the quality of BPJS Health services in Indonesia.
Conducting a study on the impact of the quality of BPJS Health services on health outcomes: A study on the impact of the quality of BPJS Health services on health outcomes can provide valuable information on the impact of the quality of BPJS Health services on health outcomes.