文章基本信息

标题：Fraud in Healthcare Service
本地全文：下载
作者：Dara Pustika Sukma ; Adi Sulistiyono ; Widodo Tresno Novianto 等
期刊名称：SHS Web of Conferences
印刷版ISSN：2416-5182
电子版ISSN：2261-2424
出版年度：2018
卷号：54
页码：1-6
DOI：10.1051/shsconf/20185403015
语种：English
出版社：EDP Sciences
摘要：In Indonesia, the fraud of healthcare service implementation occurs widely in hospitals, thereby harming the participants of social insurance. The objectives of research were to find out, to analyze, and to give solution to the fraud in the healthcare service. This research was taken place in several hospitals in Central Java Indonesia using non-doctrinal or empirical method on stakeholders related to national health insurance. The result of research showed that the substance of the ratification of Health Minister’s Regulation Number 36 of 2015 about Fraud Prevention in National Health Insurance in National Social Insurance System becomes the government’s attempt in suppressing fraud in healthcare service. In its structure, healthcare service occurs due to the pressure of enacted costing system, limited supervision, and justification in committing fraud and the imbalance between health service system and burden among clinicians, service provider not giving adequate incentive, inadequate medical equipment supply, system inefficiency, less transparency in health facilities, and cultural factor. Those who are responsible for the attempt of eradicating fraud such as Health Ministry, Regency/City Health Service, Hospital’s Board of Directors, Hospital Supervision Agency and Council, Social Insurance Administration Organization, professional organization, and Social Insurance participants should walk in the cycle starting from building awareness, reporting, detecting, investigating, sanction imposing, to building awareness.