Preventing Fraud and Deficit Through The Optimization of Health Insurance In Indonesia

Abstract

Sri Sunarti, MT Ghozali, Fahni Haris, Ferry Fadzlul Rahman, Rofi Aulia Rahman, Ghozali.

BPJS Kesehatan (Indonesian Health Insurance System) has been experiencing a severe problem for many years that BPJS Kesehatan has been suffering a huge deficit. That situation is getting worse and taking a negative impact on hospitals, medical practitioners, and patients itself. The more severe problem felt by a patient who needs special treatment and medication. Due to the deficit of the BPJS Kesehatan budget, some hospitals owe some money to the pharmaceutical company to buy some medicines. However, they cannot buy the medication because they have no budget. This study is to explain and compare with the National Health Insurance System in Taiwan to resolve the problems within BPJS Kesehatan in Indonesia, notably on the supervisory system between 2 (two) countries. The method used in this study is the Systematic Literature Review (SLR) method with qualitative approval from secondary data in approving, reviewing, evaluating, and research supporting all available research in 2015-2020. Then obtained the appropriate literature received seven literature. the factors that make BPJS Kesehatan deficit is because of the small premium, bad management, and fraud. A lot of fraud obtained within BPJS Kesehatan. The fundamental reason why fraud still exists is the weak of the supervisory system. The author will explain that problem of BPJS Kesehatan actually can be tackled by transplanting the healthcare system in Taiwan to the Indonesian healthcare system on the supervisory system.