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Jurnal Jaminan Kesehatan Nasional
ISSN 2798-7183 · BPJS Kesehatan · 108 articles in the index
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Journal Article
Implementation of Stereotactic Surgery and Radiotherapy Top-Up Policy in National Health Insurance
BPJS Kesehatan administers Indonesia’s social security program in health and ensures access to quality and affordable healthcare services. Radiotherapy is one of the cancer services covered under the Jaminan Kesehatan Nasional program, with total expenditure reaching IDR 6.8 trillion from 2014 to…
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Journal Article
Coordination Of Benefits in National Health Insurance: Policy Implementations and Governance in Eastern Indonesia
To mitigate the duplication of healthcare coverage costs, the Social Security Administrative Body for Health employs a mechanism known as Coordination of Benefits (CoB). Beyond cost control, CoB contributes to improving efficiency and supporting the achievement of Universal Health Coverage (UHC)…
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Journal Article
Change Agents and Resource Support Play Crucial Role in Executing Change Management Strategy
This study uses the ADKAR Change Management model to examine how change agents influence organizational culture at the Social Security Administration Agency (BPJS Kesehatan). The research included 218 participants, and the data were analyzed using Structural Equation Modeling with Partial Least…
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Journal Article
Urban-Rural Disparities in Maternal Healthcare Utilization in Indonesia: A Decade of National Health Insurance
Despite Indonesia’s achievement of near-universal health coverage through National Health Insurance (JKN), persistent geographic and socioeconomic disparities in maternal healthcare access continue to hinder progress toward Sustainable Development Goal (SDG) 3.1. This cross-sectional study analyzes…
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Journal Article
Fraud of Wage Recipient Participants in National Health Insurance: A Prevention Study
Fraud in implementing the National Health Insurance program occurs not only in health facilities but also among participants, especially in using an inappropriate membership status to obtain services to which they are not entitled. This study aims to analyze the role of socialization in preventing…
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Journal Article
Coverage Cost Transparency on National Health Insurance Mobile App: A Strategy to Prevent Fraud
The National Health Insurance (JKN) is a government program that covers more than 98% of Indonesia’s population and reached claims IDR 47 trillion by March 2025. However, massive financial flows have enabled various fraudulent practices, resulting in state financial losses and a decline in public…
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Journal Article
Integrating Knowledge Management to Prevent National Health Insurance Fraud and Improve Hospital Service Quality
This review examines the role of knowledge management (KM) in preventing fraud in Indonesia’s National Health Insurance Program (JKN) claims and improving hospital service quality. A literature-based conceptual review was conducted using selected publications from Scopus, PubMed/Medline, DOAJ…
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Journal Article
Anti-Fraud Teams’ Role in Preventing and Detecting Hospital Fraud in Indonesia’s National Health Insurance Program
Indonesia’s National Health Insurance (JKN-KIS) program has been implemented nationwide, reaching 281,598,621 participants as of August 2025. Despite this achievement, fraudulent practices such as upcoding, fictitious claims, and manipulation of service data continue to pose financial risks to BPJS…
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Journal Article
Analysis of Business Entities Non-Compliance with the National Health Insurance Program: Administrative Fraud Study
The National Health Insurance (JKN) Program, organized by the Social Security Administrative Body for Health (BPJS Kesehatan), is the government’s effort to ensure that all residents have the right to health protection. One of the obligations in implementing JKN is that employers, including…
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Journal Article
Examining Regulatory Framework: Challenges in Addressing National Health Insurance Claim Fraud at Primary Care Facilities
The National Health Insurance (JKN) program is a government initiative designed to ensure that every Indonesian citizen receives comprehensive health protection, enabling them to live healthy, productive, and prosperous lives. Primary Health Care Facilities (FKTP) serve as the backbone of the JKN…
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Journal Article
Healthcare Fraud Detection Research (2015–2025). A Bibliometric and Meta-Scientific Review
This bibliometric and meta-scientific review examines the evolution of healthcare fraud detection research from 2015 to 2025, covering 290 Scopus-indexed documents authored by 1,010 researchers across 217 journals. To delineate the scholarly landscape, the study employs bibliometric software…
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Journal Article
Landscape of Machine Learning for Health Insurance Fraud Detection: Global Evidence and Lessons for Indonesia
Fraud in health insurance claims threatens the sustainability of health financing systems and the quality of healthcare services. Conventional detection methods often fail to capture complex, evolving fraud patterns, whereas machine learning (ML) offers adaptive, data-driven solutions capable of…
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Journal Article
Mental Health Index for Preventive Career Policy in the Social Security Administrative Body for Health
Mental health at work is increasingly recognised as a key determinant of productivity, retention, service quality, and career sustainability. This study introduced a career-centered workplace mental health framework that integrates psychosocial safety, career sustainability, and productivity into a…
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Journal Article
Implementation of the JKN-Mobile Application at the Mangkubumi Health Center Tasikmalaya City in 2024
The implementation of technology and information is currently starting to be applied in the health sector. The JKN Mobile Application is an effort to improve services for BPJS Health participants. The largest number of JKN Mobile users in Tasikmalaya City is at the Mangkubumi Health Center, which…
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Journal Article
Information Security Management System (ISMS) at BPJS Kesehatan Tondano: Implementation of ISO 27001:2022 Standard
Information security is crucial for organizations managing sensitive data in the digital era. This is especially true for institutions like the Social Security Administrative Body for Health (BPJS Kesehatan), which organizes social health security for the Indonesian people and handles various…
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Journal Article
Enhancing The Quality and Cost Control Team's Role in Improving Primary Care Referrals in Bantaeng.
This study evaluates how well the Quality and Cost Control Team (TKMKB) can improve referral quality by reviewing and medically auditing Non-Specialist Referral Rasio (RRNS) indicators with the First Level Health Facility (FKTP). The quantitative descriptive approach compares RRNS data with Time…
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Journal Article
Analysis of Factors Affecting Medical Cost and Insurance Reimbursement Gaps in Hypertension Heart Failure Patients
Hypertension with congestive heart failure (CHF) results in high disease-related costs, placing a burden on patients, families, and healthcare facilities. Direct medical costs are known to be the highest proportion. This study aims to identify factors associated with direct medical costs in…
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Journal Article
Employee Engagement, Satisfaction, and Commitment among BPJS Kesehatan Employees in 2024: A Quantitative Study
This study analyzes employee engagement, satisfaction, and commitment among BPJS Kesehatan employees through an employee opinion survey in 2024. The survey conducted at BPJS Kesehatan showed positive results in several aspects but also identified areas that require attention. The Employee…
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Journal Article
Analysis of Factors Affecting Referral Rates in Community Health Centers: A Scoping Review
The implementation of the National Health Insurance (JKN) in Indonesia has gone well, with the strengthening of primary care functions. One health facility that provides primary health care services owned by the government is the Community Health Center (Puskesmas). The target referral rate for…