Analysis on National Health Insurance Financing at Jeneponto Regency, Indonesia

The health service funding by the Social Security Organizing Board (SSOB) is generally carried out by the prepaid method for PHC and post paid method for the hospital. Meanwhile, the Health Service Providers (HSP) undergo the difficulty in the budgeting of the National Health Insurance (NHI), primarily the claim disbursement in the form of the claim disbursement felt too difficult and complicated, claim file problem, subsequent claim magnitude, tariff incongruity proposed by the hospital with the INA CBGs tariff or being paid by the Health SSOB, disease diagnosis coding peculiarity, or the delay of the claim payment by Health SSOB. Therefore, the good management claim must and is important to be conducted by the Health SSOB. The research aimed at investigating the implementation of the National Health Insurance (NHI) financing at Jeneponto Regency. The research used the qualitative approach. The research was conducted in the hospital, PHC, SSOB, private clinic, and patients at Jeneponto Regency in 2014. The research informants included the hospital head, PHC head, SSOB head, clinic doctors, and patients. The research result indicates that the NHI financing still has problems in terms of the vagueness of the health service real value and the hospital’s inability in assessing the adequacy level of the NHI fund in line with the necessity, lack of comprehension of the hospital management concerning the NHI fund utilization. The hospital still complains of the delay of the claim verification result conveyance, the claim payment is carried out repeatedly, the claim disbursement procedure difficulty, the level of SSOB budget disbursement easiness to the PHC is not evenly distributed, there are still PHC'S which get the NHI fund payment once in four months, and SSOB side does not pay the NHI fund because of the incongruity between the participant's card and family card, so that PHC undergoes the loss because of this. The research concludes that generally the NHI fund has been carried out properly, however, there are still problems in terms of fund adequacy, fund management comprehension, fund disbursement delay, the delay of the claim verification result, the PHC claim procedure difficulty of one payment in four months, and some other problems. Suggestion: it is necessary to provide the sufficient fund addition, punctual claim verification, fund management training, and claim simplification.