Pengalaman Indonesia dalam Penanganan Dispute Klaim Covid-19

Wahyu Pudji Nugraheni, Risky Kusuma Hartono, Chazali Situmorang, Hasbullah Thabrany

Abstract

Dispute claims for Covid-19 patient financing become a problem amidst the pandemic that could impact the sustainability of health service cash flow in several provinces in Indonesia. This research aims to explore the handling and dispute claims of Covid-19 patients in nine provinces in Indonesia. Also, this is qualitative research using a case study approach. Informants came from primary and secondary health services. Data analysis was carried out by means of triangulation of sources between the informants. The results from this research indicate that several provinces still have difficulties using the online application for claim handling based on the experience that has occurred. Other obstacles include claim documents that failed to upload, unreadable documents, and residents without a national identity number or NIK. These are what made most of the dispute claims occur due to the incomplete claim files and the criteria for guaranteed patients who were not eligible. One of the efforts the hospital took was improving the hospital management information system to minimize dispute claims. This research concludes that dispute claims are still vulnerable, so increasing the capacity and information system of health services, commitment, coordination, and regular socialization from the payer side is needed to prevent the dispute claims of Covid-19 patients.


Abstrak:
Dispute klaim pembiayaan pasien Covid-19 menjadi permasalahan di tengah pandemi yang dapat berdampak pada keberlangsungan arus kas pelayanan kesehatan di beberapa provinsi di Indonesia. Penelitian ini bertujuan untuk mengeksplorasi penanganan dan dispute klaim pasien Covid-19 di sembilan provinsi di Indonesia. Penelitian ini juga merupakan penelitian kualitatif dengan pendekatan studi kasus. Informan berasal dari pelayanan kesehatan primer dan sekunder. Analisis data dilakukan dengan cara triangulasi sumber antarinforman. Hasil dari penelitian ini menunjukkan bahwa beberapa provinsi masih kesulitan menggunakan aplikasi daring untuk penanganan klaim berdasarkan pengalaman yang telah terjadi. Kendala lainnya antara lain dokumen klaim yang gagal diunggah, dokumen yang tidak terbaca, dan penduduk yang tidak memiliki nomor identitas nasional atau Nomor Induk Kependudukan. Hal inilah yang membuat sebagian besar dispute klaim terjadi karena berkas klaim yang tidak lengkap dan kriteria jaminan pasien yang tidak memenuhi syarat. Salah satu upaya yang dilakukan pihak rumah sakit adalah dengan meningkatkan sistem informasi manajemen rumah sakit untuk meminimalisasi dispute klaim. Penelitian ini menyimpulkan bahwa dispute klaim masih terjadi sehingga peningkatan kapasitas dan sistem informasi pelayanan kesehatan, komitmen, koordinasi, dan sosialisasi secara berkala dari pihak pembayar diperlukan untuk mencegah terjadinya dispute klaim pasien Covid-19.

Keywords

Klaim Dispute; Klaim Ulang; Covid-19; Sistem Informasi

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References

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DOI: https://doi.org/10.46807/aspirasi.v13i1.2747

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