Pemetaan Stakeholder Program Pencegahan Fraud Jaminan Kesehatan Nasional di Puskesmas Kota Semarang

Abstract

ABSTRAK

Latar belakang: Dalam periode 2014 sampai 2017 terdapat 12 isu penyelewengan dana kapitasi di 12 daerah. Terdapat 8 dari 13 potensi Fraud yang terjadi di Puskesmas terkait dengan kapitasi dan sedikitnya terdapat 8 kasus korupsi terungkap. Fraud dapat berdampak pada pemberian pelayanan yang tidak bermutu. Penelitian ini bertujuan untuk memahami peran dan keterlibatan stakeholder dalam Program Pencegahan Fraud Jaminan Kesehatan Nasional di Puskesmas Kota Semarang supaya program dapat berjalan lebih optimal.

Metode: Penelitian kualitatif dengan pendekatan deskriptif melalui indepth interview dengan sampel purposive dan analisis menggunakan teori stakeholder mapping. Variabel yang diteliti adalah sikap, keterlibatan, dan pengaruh. 

Hasil: Berdasarkan penelitian, didapatkan hasil bahwa pada variabel sikap, seluruh kelompok stakeholder mendukung terselenggaranya kegiatan Program Pencegahan Fraud JKN di Puskesmas Kota Semarang. Pada variabel keterlibatan, yaitu stakeholder provider yang paling kurang terlibat dari stakeholder lain. Dari ketiga upaya dalam program, upaya pendeteksian menempati urutan terendah keterlibatan stakeholdernya dibandingkan upaya pencegahan dan upaya penindakan. Pada variabel pengaruh, dari ketiga kelompok stakeholder, kelompok provider menjadi kelompok yang paling kurang memiliki pengaruh dalam Program Pencegahan Fraud JKN di Puskesmas Kota Semarang. Upaya pendeteksian menjadi upaya yang paling sedikit menjadi intervensi dalam program. Dalam upaya pendeteksian, hanya 3 dari 12 stakeholder yang secara signifikan berpengaruh.

Simpulan: Antar stakeholder harus meningkatkan komunikasi dan koordinasi dengan lebih rutin untuk menggiatkan program. Dinas Kesehatan sebagai sleeping giant harus meningkatkan keterlibatannya sebagai decision maker dan segera menyelesaikan pembentukan pedoman Program Pencegahan Kecurangan Jaminan Kesehatan Nasional di Fasilitas Kesehatan Tingkat Pertama Kota Semarang sebagai acuan pelaksanaan.

Kata kunci: Fraud, puskesmas, pemetaan stakeholder

ABSTRACT

Title: Mapping of the National Health Insurance Fraud Prevention Program Stakeholders in Semarang City Community Health Centers

Background: In the period 2014 to 2017, there were 12 issues of misappropriation of capitation funds in 12 regions. There were 8 out of 13 potential Frauds that occurred at the Community Health Centers related to capitation and at least 8 cases of corruption were revealed. Fraud can have an impact on providing quality services. This study aims to understand the role and involvement of stakeholders in the National Health Insurance Fraud Prevention Program in Semarang City Community Health Centers.

Method: This research is qualitative research with a descriptive approach through in-depth interviews with purposive sampling and employed the stakeholder mapping theory. The variables studied were attitude, involvement, and influence.

Result: Based on the research, the results show that the attitude variable, all stakeholder groups support the implementation of the JKN Fraud Prevention Program at the Semarang City Health Center. In the involvement variable, namely the stakeholder provider who is least involved from other stakeholders. Of the three efforts in the program, detection efforts ranked the lowest of stakeholder involvement compared to prevention and enforcement measures. On the influencing variable, of the three stakeholder groups, the provider group is the group that has the least influence in the JKN Fraud Prevention Program in the Semarang City Health Center. Detection efforts are the least intervened in the program. In the detection effort, only 3 out of 12 stakeholders have significant influence.

Conclusion:. Stakeholders must improve communication and coordination periodically to improve the program. The District Health Office as a sleeping giant must intensify its involvement as a decision-maker and immediately accomplish the making of the National Health Insurance Fraud Prevention Program guideline in the as guidance for implementation.

Keywords: Fraud, community health center, stakeholder mapping