QUO VADIS UNDANG-UNDANG SISTEM JAMINAN SOSIAL NASIONAL?

Abstract

The National Social Security System Law (SJSN / Law No. 40 of 2004) was set on 2004 and consists of 9 chapters, 53 articles, and 112 clauses. The law regulates the formation for The National Social Security Council and the conduct of Tri Partit between 1)The Social Insurance Management Agency, 2) the participants and 3) Healthcare Facilities owned by the Government or Private Companies who collaborated with The Social Insurance Management Agency. For article 24 clause (1) and (3) about quality of health services and cost affectivityefficiency, few of the working procedures is still unclear, such as how the management of the patients is ranging from admission until discharge process (clinical pathway), and the exact amount of the cost or tariff and capitation to be agreed on as the cost of treatment between The Social Insurance Management Agency and the existing healthcare facilities/ hospitals, in order to achieve mutual agreement based on the principles of fairness and win-win solution. Keywords: INA DRG, clinical pathway, cost of treatment, The National Social Security Law