BPJS Health Patient Guarantee on Claim for Birth Operation with The Indonesian Case Base Groups System Maqaship Syariah Perspective
Keywords:
Guarantee, Health BPJS, Maqashid SyariahAbstract
The background of this research is that the claims payment system using INA-CBGs often results in problems in type C hospitals where the INA-CBG's tariff system is considered to be burdensome for hospitals because the comparison between INA-CBG's rates and real costs is very much different, one of which is the cost of caesarean delivery. for BPJS Health participants. Claims for INA-CBGs for caesarean section are based on the type of hospital and cost sharing is not allowed by the patient if the patient uses BPJS Health services according to class and drug administration must comply with the national formulary which is the provision of BPJS Health.
The formulation of the problems in this study are: (1) How is the guarantee for BPJS Kesehatan patients in claims for childbirth operations with the Indonesian Case Base Groups Perspective Maqashid Syariah system? (2) What is the practice of paying BPJS Kesehatan patients for claims for childbirth operations with the Indonesian Case Base Groups system at Bhayangkara Tulungagung Hospital? (3) What is the impact caused by BPJS Health patients on claims for childbirth operations with the Indonesian Case Base Groups system at Bhayangkara Tulungagung Hospital in terms of Maqashid Syariah Perspective?
To analyze the assurance of BPJS Kesehatan patients on claims for childbirth operations with the Indonesian Case Base Groups Perspective Maqashid Syariah system.
The results of this study indicate that (1) Guarantee of BPJS Kesehatan patients in claims for childbirth operations with the Indonesian Case Base Groups system in accordance with maqashid sharia protection for life/life (ḥifẓ al-nafs) where this protection is realized by making decisions at the right time to add medicines or replace them with drugs that are more needed by patients even with the consequence that the INS CBGs claim value is less than the operational costs incurred by Bhayangkara Tulungagung Hospital. (2) The practice of paying BPJS Kesehatan patients for claims for childbirth operations with the Indonesian Case Base Groups system at Bhayangkara Hospital is lower than the fee for service rate, causing the hospital to take efficiency measures by cutting actions that are not cost effective. (3) The impact caused by BPJS Kesehatan patients on claims for childbirth operations with the Indonesian Case Base Groups system at Bhayangkara Tulungagung Hospital can be handled properly so that the benefits of religion and the world can be realized in accordance with Maqashid Syariah Hifdz An-Nafs.
References
Undang-Undang Republik Indonesia Nomor 40 Tahun 2004 tentang Sistem Jaminan Sosial Nasional Nasional(Book)
Undang-Undang Nomor 24 Tahun 2011 tentang Badan Penyelenggara Jaminan Sosial(Book)
Undang-Undang Nomor 7 Tahun 2014 tentang Hukum Dagang(Book)
Peraturan Meteri Kesehatan Nomor 28 Tahun 2014 tentang Pedoman Pelaksanaan Program Jaminas Kesehatan Nasional(Book)
Peraturan Menteri Kesehatan Republik Indonesia Nomor 76 Tahun 2016 tentang Pedoman Indonesian Case Base Groups (INA-CBG) dalam Pelaksanaan Jaminan Kesehatan Nasional(Book)
Panduan Praktis Administrasi Klaim Fasilitas Kesehatan BPJS Kesehatan(Book)
Rumah Sakit Bhayangkara Tulungagung. Profil Rumah Sakit Bhayangkara Tulungagung, 2023. (Book)
Andika Wijaya, Hukum Jaminan Sosial Indonesia, Jakarta: Sinar Grafika, 2017(Book)
Syakir Sula, Asuransi Syariah: Konsep dan Sistem Operasional, Jakarta, 2004.(Book)
Abdulah Amrin, Asuransi Syariah, Jakarta: PT. Elex Media Kompitindo,2006.(Book)
Amir Syarifudin. Ushul Fiqh. Bandung : Kencana Prenada Media Group, 2011.(Book)
Mulyadi Nitisusastro, Asuransi dan Usaha Peransuransian di Indonesia, (Bandung: Alfabeth, 2013) (Book)
Frisca Anindhita, M.Kesos, Nila Kusumawati Elison, MPH Bunga Pelangi, SKM, Lina Rintis Susanti, Sip (Women Research Institute Lembaga penelitian yang memfokuskan kerjanya dengan menggunakan analisis femini) (Book)
Mulyadi Nitisusastro, Asuransi dan Usaha Peransuransian di Indonesia, (Bandung:Alfabeth, 2013) (Book)
Muchtar R, Sinopsis Obstetri (Edisi 2, Jilid 1, . Jakarta :EGC,1998) (Book)
Edi Susilo Devi Fadiya Ramadhani Muhammad Iqbal Fasa, Maqashid Syariah Perbankan Indonesian dan Malaysia, (Jepara :2022) (Book)
Panduan Praktis Administrasi Klaim Fasilitas Kesehatan BPJS Kesehatan(Book)
Duski Ibrahim, Al Qawa’id Al Maqashidiyah (Kaidah-Kaidah Maqashid) (Sleman, 2019) (Book)
Muhammad Syukri Albani Nasution, Rahmad Hidayat Nasution, Filsafat Hukum Islam dan Maqashid Syariah (Jakarta, Kencana:2020), 47-48(Book)
Yudian Wahyudi, Hukum Islam antara filsafat dan politik, (Yogyakarta; Pesantren Nawesea Press,2015(Book)
Muhammad Faisol, Pendekatan Sistem Jasser Auda terhadap Hukum Islam : ke arah fiqh Post-Postmodernisme (Lampung: jurnal Kalam, volume 6, 2012), 52(Book)
Zainuddin Ali, Hukum Asuransi Syariah (Sinar Grafika, Jakarta:2008), (Book)
Zulhamdi M Saad, Prinsip-Prinsip Dasar Asuransi Syariah (Arkatama, Jakarta:2020), (Book)
Moleong, Metodologi Penelitian Kualitatif (Bandung, 2018) (Book)
Jaih Mubarok, Khotibul Umam, Destri Budi Nugraheni, Veri Antoni, Kusumawati Syafei, Shandy Primadasetyo, Ekonomi Syariah, Jakarta, 2021
Pertiwi M, Nurcahyanto H. Efektivitas Program Bpjs Kesehatan Di Kota Semarang (Studi Kasus pada Pasien Pengguna Jasa BPJS Kesehatan di Puskesmas Srondol). J Public Policy Manag Rev [Internet]. 2017;6(2):416–30.Availablefrom:https://ejournal3.undip.ac.id/index.php/jppmr/article/view/16050(Article in online journal)
BPJS Kesehatan. Perubahan Tarif INA-Cbgs Membuat Biaya Kesehatan Lebih Efektif. Jakarta: Badan Penyelenggara Jaminan Sosial Pusat, 2014. (Article in online journal)
Aulia D, Ayu SF, Nasution NH. Analisis Upaya Rumah Sakit dalam Menutupi Kekurangan Biaya Klaim Indonesia Case Base Group (INA-CBGs) Yang Dihitung dengan Metode Activities Base Costing pada Rumah Sakit Swasta Kelas C di Kota Medan Tahun 2017, 2017. (Article in online journal)
Mahayanti DGN. Gambaran Penerapan Sistem In donesian Case Based Groups Pada Rumah Sakit Provider Bpjs Kesehatan Di Kabupaten Badung Tahun 2015. Universitas Udayana; 2015. (Article in online journal)
Wa Ode DW, Karimuna SR, Munandar S. Studi Penerapan Sistem Pembayaran Layanan Kesehatan dengan Sistem Diagnosis Penyakit (Indonesia Case Based Groups / Ina-cbgs) (Article in online journal)
