Developing countries

Developing countries

Region type
Not official

Using electronic exchange of data to facilitate the warrants of attachment of movables and immovable

The Social Security Corporation (SSC) in its efforts to reduce indebtedness and minimize evasion of payments of social security contribution has started to link electronically with stakeholders' databases to facilitate the warrants of attachment of movables and immovable of enterprises and individuals. Actually, the electronic exchange of data between SSC and the stakeholders stems from its strategic plan 2017-2019, that stated in its objectives "reduction of insurance evasion" and "strengthening the sustainability of the insurance system”.

Social Security Smart Mobile Application

In its efforts to enhance and facilitate the services and operations, the Social Security Corporation (SSC) has introduced a new electronic communication tool. This tool available in Arabic and English and provides various services to individuals and entreprises such as detailed information, personal profile, primary data for voluntary contributors, pensioners details, payments, transactions, and SSC numbers

Mobile JKN: One-stop Solution for Social Security Health Services at People's Fingertips

The National Health Insurance (JKN) Program is one of national strategic programs mandated by Indonesian Law managed by BPJS Kesehatan aimed to provide health insurance for all Indonesian citizens. The number of JKN participants as of May 1, 2018, has reached 196.62 million. The primary issue faced by this program is the high number of visiting participants to branch offices for administrative matters. Dissatisfaction towards long waiting times caused participation satisfaction index to decline since 2014 to 2016.

Commitment-Based Capitation as Indonesia’s Model For Performance-Based Payment System for Primary Care Providers

After a year of Indonesia’s national health security program (Jaminan Kesehatan Nasional or abbreviated as JKN), in 2015 BPJS Kesehatan instituted Pay for Performance (P4P) scheme in the capitation system for primary care providers. P4P in Indonesia is named Kapitasi Berbasis Komitmen Pelayanan (KBK) or Commitment-Based capitation, as means to designate commitment of primary care providers to deliver primary care services comprehensively. Unfortunately, resistance from primary care providers hindered its full execution.

Development of Fraud Detection Tool Using Defrada (Deteksi Potensi Fraud Dengan Analisa Data Klaim) In Hospital Services

Fraud incidence in healthcare is not easy to find. As a country that only started Social Health insurance (JKN program) since 2014, there are not many parties that provide fraud detection tools for INA CBG case-mix system. In addition, the law that establishes an investigation for potentially fraudulent incidents is still being drafted. On the other hand, there is a significant increase in the JKN’s participants & in the number of claims. By the end of 2017, the number of claims submissions were 80,641,271 cases.

Health Facilities Information System (HFIS) for Better Contracting Accountability and More Effective Refferal System

Health Facilities Information System (HFIS) is a platform developed by BPJS Health of Indonesia to improve contracting accountability and referral system efficiency. Before HFIS, contracting mechanism was done and monitored manually which did not only time consuming but also sparked dissatisfaction from providers. Referral from a health facility to another was also not based on sufficient information about the availability of medical specialist or facilities of the referral hospitals.

Implementing Digital Claim Hospital Verification in National Health Social Security in Indonesia

Increasing number of Indonesia Health Insurance Program participants has greatly impacted on the increasing utilization of service and the number of claim reimbursement of BPJS Health. This change required a large number of additional resources and staff for claim administration processing. BPJS Health then launched an initiative to simplify claim processing and management so that less resources are needed. The initiative was named VEDIKA which is short for Digital Claim Verification, a digital application for the claim verification process for secondary health facility reimbursement.