TINJAUAN TERHADAP SENGKETA KLAIM PEMBAYARAN PESERTA JAMINAN KESEHATAN NASIONAL ANTARA BADAN PENYELENGGARA JAMINAN SOSIAL KESEHATAN DAN RUMAH SAKIT GRAHA MEDIKA KENARI KABUPATEN BOGOR

Abstract

As a developing nation where prosperity is not yet evenly distributed, Indonesia has an obligation to ensure the health of its citizens; consequently, the state established a health insurance program to guarantee healthcare for the entire population. This initiative aims to realize public welfare through a Social Security System (SSS), designed to provide a sense of security throughout a person’s life from birth to death. In 2014, the government implemented a universal health insurance policy known as the Social Security Agency for Health (BPJS Kesehatan), regulated by Law Number 24 of 2011 concerning the Social Security Agency (BPJS). Physicians affiliated with “Dokter Indonesia Bersatu” (DIB) have discussed the detrimental aspects of the BPJS program; these issues have significantly impacted hospitals’ ability to provide optimal patient care, leading to instances where patients under the BPJS program have been refused service in West Java. Conflicts have arisen between hospital administrations and BPJS due to ineffective collaboration. This thesis examines three key issues: the nature of the partnership between hospitals and BPJS; legal protections for hospitals regarding BPJS’s failure to settle payments for patient healthcare services; and the legal avenues available to hospitals should BPJS fail to make such payments. The study employs an empirical juridical legal research method, utilizing primary, secondary, and tertiary legal materials. It adopts both statutory and socio-juridical approaches, gathering data through fieldwork and literature reviews. Data processing involves editing and coding, followed by quantitative descriptive analysis and the drawing of conclusions via the inductive method.