Jaminan Kesehatan dan Managed Care

Abstract

The National Health Insurance (NHI) developed in Indonesia is part of the National Social Security System. Some of the principles adopted at JKN are the principle of mutual cooperation, nonprofit, transparency, prudence, accountability, efficiency, effectiveness, portability, participation is mandatory, a trust fund and management outcomes of the Social Security Fund. National Health Insurance Benefits include promotive, preventive, curative, and rehabilitative care including drugs and medical materials consumables according to medical need. Managed care is a health care financing system that is based on the number of members registered with the control from the planning services and includes contracts with health care providers for comprehensive service. Overall managed care cause a positive reaction in controlling the growth of health care costs. This approach can reduce moral hazard to health services that are not needed by the patient. Managed care is different from the traditional indemnity health insurance. In managed care payments to providers not based on fee for service and reimbursement, but the cost has been determined and paid to provide comprehensive services including preventive services.(JKS 2015; 2: 104-113)