Strategi Efektivitas Implementasi Kebijakan BPJS Kesehatan berbasis Promotif-Preventif dalam Upaya Pengendalian Biaya Jaminan Kesehatan Nasional (JKN) di Kabupaten Kudus

Heni Riswanti; A. Rohendi; Ade Mubarok

doi:10.55606/jupsim.v5i3.8085

Authors

Heni Riswanti Universitas Adhirajasa Reswara Sanjaya
A. Rohendi Universitas Adhirajasa Reswara Sanjaya
Ade Mubarok Universitas Adhirajasa Reswara Sanjaya

DOI:

https://doi.org/10.55606/jupsim.v5i3.8085

Keywords:

Cost Control, National Health Insurance, Policy Implementation, Preventive-Oriented Cost Containment Model (POCCM), Promotive-Preventive

Abstract

Indonesia’s National Health Insurance System (JKN) has achieved near-universal coverage, but its financial sustainability is under pressure from high claims for catastrophic noncommunicable diseases (NCDs). BPJS Kesehatan’s promotive-preventive policies through the Chronic Disease Management Program (Prolanis) and the Referral-Back Program (PRB) are designed to control this burden; however, their implementation across different levels has been studied only to a limited extent. This study analyzes the direction of policy reform, the alignment of implementation across different levels, and formulates a preventive-oriented cost-control model through a case study in Kudus Regency. The study employed a qualitative approach with a single-case study design and a multi-layered unit of analysis, involving ten informants from regulatory bodies, referral service organizations, and JKN participants. The results reveal a two-speed reform pattern: progress in regulation and program design has not been matched by preventive performance-based financing. The study also identified gaps in Prolanis participation, participant resistance to PRB, and information dissonance across levels that drive informal compensation mechanisms at the implementation level. These findings form the basis for the formulation of the Preventive-Oriented Cost Containment Model (POCCM), which integrates financing reforms, information governance, primary care capacity, incentives, accessibility, and community-based digital education. This study confirms that the optimization of the promotive-preventive aspects of the National Health Insurance (JKN) program primarily addresses implementation gaps across various levels, rather than merely policy design flaws.

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