ANALISIS POTENSI FRAUD DALAM PELAKSANAAN JAMINAN KESEHATAN NASIONAL PADA PUSKESMAS DI KOTA PALEMBANG

FATIMAH, RIZKI NURUL and Misnaniarti, Misnaniarti and Syakurah, Rizma Adlia (2020) ANALISIS POTENSI FRAUD DALAM PELAKSANAAN JAMINAN KESEHATAN NASIONAL PADA PUSKESMAS DI KOTA PALEMBANG. Master thesis, Sriwijaya University.

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Abstract

In the implementation of the health insurance program, fraud in the National Health Insurance is an act that is carried out deliberately by obtaining profit. The impact of fraud can affect financial aspects, the quality of clinical services, and on the image and reputation of the perpetrator. This study is aimed to analyze the potential of fraud in the implementation of the National Health Insurance at Health Center in Palembang City. This research used qualitative method with a phenomenological approach, the research informants consisted of the heads of helath center, registration officers, BPJS Helath patients and heads of sections of the health office in Palembang City. Primary data was focus group discussion (FGD) on heads of the health center and registration officers. Then in-depth interviews with BPJS Helath patients and heads of section at the Health Office, indirect observation and document review at 14 health center. The results shown by, that the potential of fraud at health center is related to charging fees to patients, mistakes in referring patients, and transfer of patient membership. Potential fraud that occurs can be indicated from the factors influence, inadequate of external and internal controls, limited number of employees, constraints on infrastructure, complaints from patients, inadequate income due to late payment of non-capitation claims, unstable patient referral ratios, and less a given of training. The conclusion of this study is the potential of fraud in public health centers can occur, so that there is a need for increased internal and external control and the development of an anti-fraud prevention system for NHI in health center.

Item Type:	Thesis (Master)
Uncontrolled Keywords:	Potensi Fraud, Pencegahan, Jaminan Kesehatan Nasional, Puskesmas
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions:	10-Faculty of Public Health > 13101-Public Health Science (S2)
Depositing User:	Users 10286 not found.
Date Deposited:	26 Jan 2021 02:42
Last Modified:	26 Jan 2021 02:42
URI:	http://repository.unsri.ac.id/id/eprint/41002

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