The ethical dilemma of medical specialists in the era of national health insurance in Semarang

Sigid Kirana Lintang Bhima; Yayi Suryo Prabandari; Edward Kurnia Setiawan Limijadi; Astika Utomo; Laila Mubarokah; Mohammad Hakimi

doi:10.15562/bmj.v12i2.4068

The ethical dilemma of medical specialists in the era of national health insurance in Semarang

Sigid Kirana Lintang Bhima ,

Yayi Suryo Prabandari ,

Edward Kurnia Setiawan Limijadi ,

Astika Utomo ,

Laila Mubarokah ,

Mohammad Hakimi ,

pdf |
DOI: https://doi.org/10.15562/bmj.v12i2.4068 |
Published: 2023-04-12

Abstract

Purpose: The National Health Insurance (JKN) implemented by the Indonesian government since 2014 has brought Indonesia to a new phase in realizing the right to health for its people. The social insurance system managed by Social Health Insurance Administration Body (BPJS) is felt to bring many benefits to the community despite many obstacles in its implementation. This study seeks to find the ethical dilemmas experienced by surgical and non-surgical specialists in implementing the JKN program in hospitals.

Methods: The study was conducted using the qualitative method with the phenomenological approach by conducting in-depth interviews with five surgical specialists (an obstetric and gynecology, an otolaryngologist specialist, a surgeon, an eye specialist, and an anaesthesiologist) and six non-surgical specialists (children, mental health, internal medicine, medical rehabilitation, nerves, and skin specialists) in Semarang, Indonesia. In each specialization, there are two respondents interviewed. The data were analyzed using a qualitative approach.

Results: Some problems still exist when specialist doctors treat BPJS patients in hospitals, which include: 1) lack of socialization, making doctors as implementers find it difficult to implement the rules; 2) different implementations in various hospitals, making doctors find it difficult to adjust when they practice at type C hospitals because the number of claims is often insufficient to provide services to patients; 3) the JKN program that has increased the number of patients, resulting in doctors' concerns about lawsuits if they make mistakes; moreover, doctors also have to adjust to existing cost claims; and 4) doctors still trying to uphold the doctor's oath and The Indonesian Medical Ethics Code (KODEKI) and always do the best for patients whatever the problem. Conclusion: The implementation of JKN must always be evaluated continuously, and the government still has to pay attention to the obstacles faced by doctors in the field. In carrying out their practice full of dilemmas, doctors must always receive adequate legal and ethical protection.

References

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Kasule, Omar Hasan K. Health insurance and the ethical issue of equity. Journal of Taibah University Medical Sciences. 2012; 7(2), p. 61–68. https://doi.org/10.1016/j.jtumed.2012.10.003
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Andi FA. Analysis of national health insurance towards a universal health insurance. Kajian Ekonomi dan Keuangan. 2015;19(1):63-78. https://doi.org/10.31685/kek.v19i1.27
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[1] Purwadianto A. Peran KODEKI di Indonesia di masa datang [KODEKI's future role in Indonesia]. Seminar Revitalisasi Kode Etik Kedokteran [Seminar on Revitalizing Medical Ethics Code]. Jakarta : FK Unika Atmajaya; 2006.

[2] Sjamsuhidajat R. Pengertian dan makna profesi kedokteran serta pengembangannya menuju pembangunan bangsa, dalam Menuju seni ilmu kedokteran; Bagaimana dokter berpikir dan bekerja [The definition and meaning of the medical profession and its development towards nation building, in the direction of the art of medical science; How doctors think and work], edited by Daldiyono, Jakarta: Gramedia Pustaka Utama; 2006, p. 423-436.

[3] Undang-Undang Dasar Negara Republik Indonesia Tahun 1945 [1945 Constitution of the Republic of Indonesia].

[4] Lagomarsino G, Garabrant A, Adyas A, Muga R, Otoo N. Moving towards universal health coverage: health insurance reforms in nine developing countries in Africa and Asia. The Lancet. 2012 Sep 8;380(9845):933-43. https://doi.org/10.1016/S0140-6736(12)61147-7

[5] Kasule, Omar Hasan K. Health insurance and the ethical issue of equity. Journal of Taibah University Medical Sciences. 2012; 7(2), p. 61–68. https://doi.org/10.1016/j.jtumed.2012.10.003

[6] Hidayat B. Financial Sustainability of the National Health Insurance in Indonesia: A First Year Review: Policy Brief; 2015.

[7] Andi FA. Analysis of national health insurance towards a universal health insurance. Kajian Ekonomi dan Keuangan. 2015;19(1):63-78. https://doi.org/10.31685/kek.v19i1.27

[8] Muslimah AT, Pinzon R, Endarti D. Perbandingan Biaya Riil Terhadap Tarif INA-CBG’s Penyakit Stroke Iskemik di RS Bethesda Yogyakarta [Comparison of Real Costs Against INA-CBG's Ischemic Stroke Rates at Bethesda Hospital Yogyakarta]. Jurnal Manajemen Rumah Sakit Universitas Gajah Mada. 2017;7(2). https://jurnal.ugm.ac.id/jmpf/article/download

[9] /30289/pdf

[10] Yuniarti E, Prabandari YS, Kristin E, Suryawati S. Rationing for medicines by health care providers in Indonesia National Health Insurance System at hospital setting: a qualitative study. Journal of pharmaceutical policy and practice. 2019 Dec;12(1):1-1. https://doi.org/10.1186/s40545-019-0170-5

[11] Thomasma DC. Theories of medical ethics: The philosophical structure. Military Medical Ethics. 2003;1:23-60.

[12] Darmadipura MS. Dari etik ke bioetik, dalam Kajian bioetik [From ethics to bioethics, in Bioethics Studies], edited by Darmadipura MS, Surabaya: Airlangga University Press; 2005, p. 25-33

[13] Jonsen AR, Siegler M, Winslade WJ. Clinical ethics a practical approach to ethical decisions in clinical medicine. The5th ed, USA: McGraw-Hill; 2002.

[14] Fadila NF, Afandi D, Indrayana MT. Penerapan Nilai Kode Etik Kedokteran Indonesia pada Era Jaminan Kesehatan Nasional di Kabupaten Siak [The implementation of the Value of the Indonesian Medical Code of Ethics in the Era of National Health Insurance in Siak Regency]. Doctoral dissertation, Riau University; 2017. https://media.neliti.com/media/publications/

[15] -ID-penerapan-nilai-kode-etik-kedokteran-ind.pdf

[16] Firdaus KK, Wondabio LS. Analisis Iuran dan Beban Kesehatan dalam Rangka Evaluasi Program Jaminan Kesehatan [Analysis of Health Contributions and Burden of Health in the Framework of Evaluation of the Health Insurance Program]. Jurnal ASET (Akuntansi Riset). 2019;11(1):147-58. https://doi.org/10.17509/jaset.v11i1.16898

[17] Kode Etik Kedokteran Indonesia Tahun 2012 [Indonesian Medical Code of Ethics, 2012).

The ethical dilemma of medical specialists in the era of national health insurance in Semarang

Abstract

References

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