Felix Kasim(1*)

(*) Corresponding Author


Background: In the developed countries, the role of health insurance becomes more important because there is a great demand for health service. Health insurance is a kind of insurance product which is especially medical care for the member of health insurance if they are sick or get an accident. For that reasons, a research about The Analysis of the Management of the Health Service through the Health Insurance System in the Prof. Dr. WZ. Johannes Hospital Kupang 2009. Objective: The purpose of this research is to describe about the analysis of the management of the health service through the health insurance system also the enthusiasm of the participant of ASKES to health insurance services in the Prof.Dr. WZ. Johannes Hospital Kupang 2009.Method: The method used in this research was mixed of qualitative and quantitative methods, with grounded theory for the qualitative method and cross sectional for the quantitative method, descriptive observational design and survey instrument in a questionnaire form with 18 questions and depth interview to some informed. The subject of the research was the participants of ASKES outpatient and inpatient in the Prof. Dr. WZ. Johannes Hospital Kupang. The sampling method used was an accidental sampling made of 60 respondents. Result: The results of the research show that health insurance services system in Prof. Dr. WZ. Johannes Hospital Kupang ASKES administration section, infrastructure means, medic or non medics are good. Conclusion: There should be more research on service system in Prof. Dr. WZ. Johannes Hospital to ASKES members with analytical methods so that more things can be explained and described. Refers to the results of this study, it is necessary to have a Minimum Service Standards (MSS) that patterned tripartite relationship between the members, ASKES administrator and party health service providers who have contracted with health insurance provider with the managed care health insurance with service system by PPK network. On hospital’s principal of autonomy as organizers of activity, so that health status, income and education, consumer factor and PPK ability and acceptance of health service and sickness risk and environment will be develop to comprehensive responsible with overutilization decreasing and high inflation on health service, through the better financial management, more efficient and transparent. The other side of restructuring costs in hospital that global nature need cost unit which is one way for hospital to make efficiency because by that way will be known which service in hospital need to subsidized and which is profitable. By doing restructuring costs in hospital, we can use Strategic Cost Management. This strategy will help hospital to face competition. The implementation with Cost Leadership Strategy(CLS) or Low-Cost Strategy will do all it can to beat competitors by giving cheaper services from another hospital, but with same quality or better. General Hospital is the examples of hospital that may choose this strategy. Tools to reach this strategy are analysis cost hospital services better known as Unit Cost. This consideration will obtain recommendation rates, efficiency strategy and System Account Design overall in hospital.

Keywords: health insurance, health service system, high quality health

DOI: https://doi.org/10.22146/jmpk.v13i02.2603

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