The regional health insurance coverage incentive: a shift from opportunity to rationalization

DOI

10.2991/aebmr.k.200606.073How to use a DOI?

Keywords

health coverage, fraud, good governance, internal control, risk management

Abstract

This research aims to develop a conceptual framework about a shift in the meaning of subsidy as a form of incentive for universal health service in government of Bekasi City in Health Card Regional Health Insurance Program - Identity Number (Jamkesda KS-NIK) which is interpreted as a opportunity to form rationalization in action with fraud risk. Qualitative data analysis methodology was in form of literature review, identification of gap among policies, evaluation of user demographic data, and the financing of Jamkesda KS-NIK in Bekasi City, compared with effective, efficient, and fair indicators. Weaknesses are in planning, implementation, coordination between system and subsystem, and the control of governance in increasing the opportunity of fraud risk. Membership target, which covers all citizens without obstacles, and the absence of limit in coverage value cause the increase of moral hazard from members, hospital, and the management which result in the regional fiscal loss. Evaluation states that policy and transformation in the organization should be capable of meeting an ideal condition. The improvement in governance accountability should be performed by referring to the pillar of good clinical governance using the indicators of consumer value performance, performance and evaluation, risk management, and professional development and management. Furthermore, by adding obstacle to criteria of membership, limitation to coverage and its value, and effort for improving control internal function, fraud risk in terms of membership and financing can be reduced.

Copyright

© 2020, the Authors. Published by Atlantis Press.

Open Access

This is an open access article distributed under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/).

Download article (PDF)

TY  - CONF
AU  - Indra Hadi Waluyo
PY  - 2020
DA  - 2020/06/09
TI  - The regional health insurance coverage incentive: a shift from opportunity to rationalization
BT  - Proceedings of the 23rd Asian Forum of Business Education(AFBE 2019)
PB  - Atlantis Press
SP  - 430
EP  - 435
SN  - 2352-5428
UR  - https://doi.org/10.2991/aebmr.k.200606.073
DO  - 10.2991/aebmr.k.200606.073
ID  - Waluyo2020
ER  -