E-Hope Application as an Innovative System for Health Policy
Evaluation: Possibilities and Challenges
Firrizqi Krisdila Fauzi
Faculty of Public Health, Universitas Airlangga, Mulyorejo, Surabaya, Indonesia
Keywords: National health insurance, Evaluation, Policy, Application.
Abstract: Health is one of the most important things in daily life. Health care facilities should provide maximum
health services to improve public health status and be affordable to all citizens. National health insurance is
one way to access health services. It is implemented as The Social Health Insurance Agency (Badan
Penyelenggara Jaminan Kesehatan Nasional). However, there are still many complaints and management
problems such as bureaucracy, registration and payment. Hence, national health insurance needs to be
evaluated. The aim of this study is to create an application system that can measure the success of the
associated policies. A literature study is the method which has been used in this study. There are three
factors that can be used to measure the success of a policy. These are the degree of compliance, smoothness,
lack of disruption, leading to the desired performance and impacts. e-Hope would be an innovative
application system that contains the above factors to measure health policies. This system provided a forum
to share, monitor, evaluate health national insurance policy for primary, secondary, tertiary health care,
community, and government. Furthermore, the top alternative solutions will be displayed in the system. It
can be used to suggest improvements for national health insurance.
1 INTRODUCTION
Health is an important thing in life. Health care
services need to be improved and developed
continually. Improving and developing health
services should include developing health care
facilities, strengthening the referral system,
instituting accreditation and standards for medical
care to maintain standards at health care service
facilities, improving human resources in health care,
developing the pharmaceutical and medical device
sectors, drawing up standards and costs of health
care rates, and introducing relevant regulations.
Furthermore, health policies have to be obeyed by
all of the health care facilities to maximise their
services to the citizens.
Every citizen who live in Indonesia have to apply
for National Health Insurance (NHI).This insurance
is conducted based on social insurance principles,
equity and includes promotive, preventive, curative
and rehabilitative programmes. This insurance
system is managed by Badan Penyelenggara
Jaminan Kesehatan (BPJS). Team for the
Acceleration of Poverty Reduction (2015) said that
even though National Health Insurance (NHI) has to
be followed by all Indonesian citizens, but
approximately 36.8 percent people do not yet have
any form of health coverage. It includes those who
work in the informal sector althoug they consume
more than they earn. If they are sick, they will have
lost their productivity and began a possible descent
into poverty. It can be concluded that participation in
National Health Insurance programmes still does not
cover all of the people it intends to assist. The
government makes sure that all people pay only a
small proportion of their health care costs.
The National Health Insurance (NHI) Policy has
to be evaluated in order to improve the
implementation of the insurance system. There are
three factors that can be used to measure policies.
These three factors are the degree of compliance
level, smoothness/lack of disruption to a policy or
the smooth implementation of the functional routine
leading to desired performance and the impact from
leading performance and the desired implementation
impact (Ripley and Franklin,1986) Each factor has
some indicators which can be used as a
measurement of policy implementation.
These factors can be described below:
1. Degree of compliance level
Fauzi, F.
E-Hope Application as an Innovative System for Health Policy Evaluation: Possibilities and Challenges.
In Proceedings of the 4th Annual Meeting of the Indonesian Health Economics Association (INAHEA 2017), pages 161-164
ISBN: 978-989-758-335-3
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Success must be measured by the level of
compliance from the subordinates in the given
bureaucracy or with a level of compliance to the part
of the bureaucracy in general in relation to the
special mandates contained in law. The compliance
perspective only talks about bureaucratic behaviour.
2. Smoothness/Lack of disruption for any
disruption to a policy or the smooth implementation
of the functional routine
The existence of smoothness and lack of
interference means that this perspective reminds us
of what we have observed about policy
implementation. Usually the success of the
implementation will generally only be in the arena
of distributive and competitive regulation.
3. Leads to desired performance
Successful implementation leads to the desired
performance and impact of the program being
analysed. First, there is no way around the fact that
the desired outcome is not objective, and that the
concept is neutral. Desire is associated with values
held by one or more people. In some cases, almost
all related sides may agree on the desired
performance traits and the impact. In other cases, the
actors tend to disagree. An analysis of the
implementation should be conducted when there is a
value conflict, to become more aware of the
specifics of the conflict and to calculate the conflict
itself. This means that the analyst can judge the
success of several different value perspectives
(including his own, as long as it is clearly labelled)
at the same time. And, depending on the content of
their perspective, the same program’s
implementation can be labelled a success from one
perspective and a failure from another.
Second, program impact is a very complicated
concept. There are different levels of impact, and
impacts can take very time long time to appear.
Consider development programs for local health
centres, for example. Using or not using the patient
as a measurement centre, this is just one direct
example.
Policy is a law, regulation, procedure,
administrative action, incentive or voluntary practice
of governments and other institutions. Policies can
influence complex systems that can improve the
health and safety of population. Regulation is
implemented at all levels. Policy evaluation applies
evaluation principles and methods to examine the
content, implementation or impact of a policy
(CDC,2011)
Evaluation is the activity through which we can
develop an understanding of the merit, worth, and
utility of a policy. Policy evaluation uses a range of
research methods to systematically investigate the
effectiveness of policy interventions,
implementation and processes, and to determine
their merit, worth, or value in terms of improving the
social and economic conditions of the different
stakeholders (CDC,2011)
The implementation of National Health
Insurance (JKN) by BPJS has received many
complaints from citizens. The citizens’ have
complained about bureaucracy, registration, a long
queue system as well as payment-related problems.
The aim of this study is to create an application
system that can measure the success of policies.
2 METHOD
This study used a literature study as a research
method. The data obtained has been presented
descriptively so as to show the study underlying the
idea. The results and studies have been further
developed and applied. The techniques of collecting
data are to do with information related to social
health insurance, BPJS, barriers in BPJS and
application systems. This information was obtained
from various items of literature such as scientific
journals, the internet and relevant publications. After
doing the research and data collection, it will be
explained further to solve the problems discussed.
The issues discussed are barriers in the health
insurance system in Indonesia, as well as the
evaluation of the national health insurance system
policies through applications.
3 RESULT
From the literature study that has been done, it is
necessary to measure the success of health policies
especially the National Health Insurance (NHI)
Policy. One innovation that can be developed is to
create an E-Hope (Health Insurance Policy
Evaluation) application. This innovation is an idea
or concept that can be developed. In addition, to
measure a policy, this application must contain three
indicators. The indicators used are the degree of
compliance level, smoothness/lack of disruption for
any disruption to performance and impact.
Furthermore, this system is expected to be a
suggestion for the government to help them to
improve the implementation of NHI and other health
insurance policies.
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4 DISCUSSION
An evaluation is an activity that contains the
consideration of the value of a phenomenon. Public
policy evaluations are divided into two; namely the
outcomes of public policy implementation that refer
to the policy objectives and the process of public
policy implementation (Mustopadidjaya, 2002). The
process of public policy implementation refers to an
evaluation based on implementation and technical
guidelines. According to Team for the Acceleration
of Poverty Reduction (2015), the government of
Indonesia launched National Health Insurance (NHI)
or known as Jaminan Kesehatan Nasional (JKN) in
Indonesia, which aims to protect the Indonesian
public from the shock of sudden health crises.
NHI/JKN is being implemented in stages, intending
to provide universal health coverage to the
population by 2019.
The health insurance system in Indonesia needs
to be evaluated to overcome the existing barriers and
to increase the effectiveness of the program.
National Health Insurance (NHI) can be used for
using health services in health care facilities. In
accordance with the research that had been
conducted by Marisah (2016), participants of BPJS
could choose first level health care facilities that are
in cooperation with BPJS Health. In the
implementation of National Health
Insurance/Jaminan Kesehatan Nasional (NHI/JKN),
there are many obstacles that have arisen. Besides
that, a rresearch that had ben conducted by Putra
(2014) mentioned the obstacles that existed during
the implementation of NHI/JKN including the
delayed disbursement of claims, the difference in the
value of service tariffs, information technology that
often experiences disturbance and a lack of human
resources. This is in line with the research that had
been conducted by Andita (2016), where the factor
of delay in claims was a health insurance barrier.
An application system called e-Hope will be
made to evaluate the national health insurance
policy. The design of this application innovation
idea is based on the Ripley and Franklin Theory
which includes three aspects. There were some
research that using Ripley and Franklin Theory. The
research that had been conducted by Putra (2014)
stated the successfullness of NHI/JKN policy
implementation using Ripley and Franklin Theory.
Another research that using that theory is a research
that had been conducted by Subadi (2013). The
successfull of a policy will be easier if there is an
application that provide measurement of policy
evaluation. So, this application aims to measure the
success of a policy from three aspects. Those are
degree compliance, smoothness/lack of disruption
and impact.
In spite of evaluating policy, this application can
also support the National Health Information System
in the future. It needs both human resources and the
facilities to support it. It also includes a procedure to
run the application. A research that had been
conducted by Isnawati et.al (2016) stated that there
were many challenges about Health Information
System from the input such as procedure and form;
the process needed a dependable human resources
and the good quality data as an output. The better
input and process of health infornation system, the
better outcome would be seen.
This application will need human resources,
facilities to support it and a procedure to run the
application. The internet will be used to access the
application. Because of its function, it will make this
application can be accessed or connected by
thousands of computer networks worldwide. Besides
that, this application system contains forums to
share, monitor and evaluate that can be accessed by
health experts or the leaders of the health care
facilities in Indonesia. They have to fill in three
aspects of the application.
The first aspect to be filled in is the degree of
compliance. The fulfilment of the requirements
becomes the first indicator to be seen in this aspect.
This indicator looks at whether the health care
facilities already have an MoU with BPJS so that it
can manage both parties. The MoU itself refers to
the Regulation of Indonesia Health Ministry No 28
2014 on Guidelines for Implementation of the
National Health Insurance Program (Peraturan
Menteri Kesehatan RI No 28 Tahun 2014 tentang
Pedoman Pelaksanaan Program Jaminan Kesehatan
Nasional). The MoU must contain health services,
health care facilities that organise people, the
benefits guaranteed in JKN and the procedures for
obtaining health services in Advanced Healthcare
Referral Facilities.
The second indicator in
compliance is claims reporting. The submitted
claims must be verified by the BPJS as a verifier in
order to verify the admittance of service
responsibility. The health experts have to fill in the
indicators by way of a checklist which has been
made previously.
The second aspect is smoothness/lack of
disruption. The current implementation of the
routine functions can be seen from within the
existing processes of the health services. The speed
of the health services provided to the health care
patients shall be made in accordance with MSS and
E-Hope Application as an Innovative System for Health Policy Evaluation: Possibilities and Challenges
163

SOPs as established by the government. The health
services provided are divided into two such as
outpatients and inpatients. It can be seen from the
checklist of each component of MSS whether the
health care facilities have been fulfilled or not.
The last aspect is the desired impact. The desired
impact is the end result to see whether the policy is
appropriate or not. The first indicator is the level of
patient satisfaction that can be seen from the existing
complaint box or the pre-prepared questionnaire.
The second is the income surplus for the health care
facilities. In each health care facility, there will be
seen the level of acceptance and expenditure during
the health services. If a surplus is there, then it can
be input in to this application. After these three
aspects have been filled in, then can the success of
the implementation of health insurance system
policy can be seen. This system may be used by
trained health personnel, administrations or third
persons. There is a forum between health facilities
which will mean sharing the obstacles that exist
there. Each expert's solution will be shared. The
most alternative solution to overcome the obstacles
of NHI/JKN implementation will be shown so that
the government or BPJS can use this application to
see the obstacles that exist in each of the health care
facilities and suggested solutions from the expert.
5 CONCLUSIONS
E-hope would be an innovation system idea that can
evaluate health policies. This system provides a
forum to share, monitor and evaluate national health
insurance policies in all of the health care facilities.
Furthermore, this system can be suggested to
improve the national health insurance system and
policy.
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