Optimizing the services of the regional health insurance (Jamkesda) based on enterprise risk management ISO 31.000:2018 at RSU Permata Cibubur.
Alsabaravi Ghiffari, Yanuar Andrianto
Sekolah Tinggi Manajemen PPM, Jakarta, indonesia
alsabaravi12[at]gmail.com
Sekolah Tinggi Manajemen PPM, Jakarta, indonesia
YNR[at]ppm-manajemen.ac.id
Abstract
1. Introduction and research problem Hospitals in providing health services are governed by various regulations from the regulator. Regulations and laws that apply to activities will be overseen by the Ministry of Health, the Indonesian National Agency for Drug and Food Control (BPOM), and the Indonesian Doctors Association (IDI). This aims to minimize the risk of mishandling and death of the patient. The provision of health services in hospitals in conducting health care is carried out thoroughly in accordance with Law number 44 of 2009. The intended health maintenance such as promotive, preventive, curative, and qualitative. Professional management is needed in dealing with problems and managing risks in hospital management. Permata Cibubur Hospital (RSU) is a private hospital that provides maternal and child health services in the fields of obstetric and gynecology, and pediatrics. Permata Cibubur Hospital serves several collateral programs such as private guarantees and government guarantees. Permata Cibubur Hospital is obliged to serve Regional Health Insurance (Jamkesda) in accordance with the regulations and implementation guidelines. Health insurance is a health service program from the government or a private company that uses an insurance system with the aim of providing dependents in using health facilities to all hospitals that collaborate with the health insurance. Management of Jamkesda in Permata Cibubur Hospital is still often found problems that affect the management system in the hospital. The impact that occurred was that the claim process carried out by the hospital to Jamkesda was hampered, which resulted in disrupted hospital revenue. The researcher uses a risk management approach based on ISO 31,000: 2018 which aims to evaluate and propose the potential risks and risk control measures faced by hospitals in managing health insurance programs. 2. Methods The researcher uses a qualitative approach to explore natural object conditions, where the researcher is a key instrument. Researchers conducted a study of documents related to the results of audits, procedures for implementing health services in the regional health insurance program (Jamkesda) and conducted in-depth interviews about aspects of risk and health services at the Permata Cibubur Hospital, namely in the division of the Internal Audit Unit (SPI) Permata Cibubur Hospital. Retrieval of information from informants is done by purposive and snowball, the combination of techniques with triangulation techniques and data analysis is inductive/qualitative. This study aims to develop a concept that already exists in Permata Cibubur Hospital. This study uses several procedures to test data validation, namely triangulation and peer review conducted on interview data sources obtained from various perspectives. 3. Results and findings Internal control aims to ensure that risks and risk events do not hamper the guarantee service process. However, some related
Keywords: Risk Management, ISO 31000:2018, Hospital, Internal Control
Topic: Finance and Risk Management