Prinsip asuransi sosial program JK

Prinsip asuransi sosial program JK dalam SJSN meliputi kepesertaan yang bersifat wajib dan non diskriminatif bagi kelompok formal, iuran berdasar persentase pendapatan menjadi beban bersama antara pemberi dan penerima kerja sampai batas tertentu, sehingga ada kegotong-royongan antara yang kaya-miskin, resiko sakit tinggi-rendah, tua-muda dengan manfaat pelayanan medik yang sama (prinsip ekuitas), dan pelayanan dapat diakses secara nasional (portabilitas), bersifat komprehensif, dengan manfaat pelayanan kesehatan promotif, preventif, kuratif dan rehabilitatif, termasuk obat dan bahan medis habis pakai. Pengelolaannya dilakukan dengan prinsip kehati-hatian, nirlaba, transparansi dan akuntabilitas yang tinggi. Dana program merupakan dana amanat yang digunakan sebesar-besarnya untuk kepentingan peserta.
Kekhususan program JK dalam SJSN adalah bahwa Badan Penyelenggara harus mengembangkan sistem pelayanan kesehatan, sistem kendali mutu pelayanan dan sistem pembayaran pelayanan kesehatan untuk meningkatkan efisiensi jaminan kesehatan. Penyelenggaraan jaminan kesehatan menerapkan prinsip-prinsip managed healthcare concept, misalnya penerapan konsep dokter keluarga, konsep rujukan, konsep wilayah serta pembayaran prospektif (Prospective Payment System) misalnya kapitasi, tariff paket, dan DRG’s (Diagnosis Related Groups). Pelayanan obat diberikan sesuai dengan daftar dan harga tertinggi obat-obatan, serta bahan medis habis.
D. PERUBAHAN PEMBIAYAAN
a. Perubahan ekonomi, Krisis ekonomi, beban utang, politik, nilai mata uang, pengurangan belanja pemerintah,perubahan harga, pemerintah,perubahan harga, pengangguran
b. Perubahan demografi,Fertilitas, angka harapan hidup, morbiditas, mortalitas, profil umur, urbanisasi
c. Perubahan epidemiologi, Penyakit infeksi/kronik, wabah Flu burung,DBD, AIDS, SARS, kecelaka an.
d. Perubahan social budaya, Pendidikan, komunikasi, transportasi, gaya hidup, gizi, struktur sosial/kelu gaya hidup, gizi, struktur sosial/kelu arga
e. Perubahan politik, Demokrasi, kebijakan,organisasi, manajemen, pelayanan.

E. SISTEM PEMBIAYAAN KES/ ASURANSI KESEHATAN
Adalah Besarnya dana yg harus disedia kan utk menyelenggarakan dan atau kan utk menyelenggarakan dan atau memanfaatkan pelbagai upaya kes. yg diperlukan oleh perorangan, kelompok dan masyarakat.
Dua sudut biaya kesehatan antara lain :
1. Health provider = penyedia yankes ad. Besarnya dana yg harus disedia kan utk dpt menyelenggarakan upaya kes. kes.
2. Health consumer = pemakai jasa kes. ad. Besarnya dana yg harus dise diakan utk dpt memanfaatkan jasa pelayanan.


BAB III
PENUTUP
A. Kesimpulan

Pembiayaan yang bersumber dari asuransi kesehatan merupakan salah satu cara yang terbaik untuk mengatasi mahalnya biaya pelayanan kesehatan. Konsep asuransi dalam pembiayaan kesehatan telah berkembang melalui berbagai pendekatan yakni sosial (social health insurance) dan komersial (commercial health insurance). Dantara keduanya berkembang regulated Health Insurance yang dalam laporan Bank Dunia ( 1993) disarankan untuk dilaksanakan sebagai pengganti prinsip Commercial/ Private Helath Insurance.
Pembiayaan kesehatan semakin meningkat dari waktu ke waktu dan dirasakan berat baik oleh pemerintah, dunia usaha terlebih-lebih masyarakat pada umumnya. Untuk itu berbagai Negara memilih model sistem pembiayaan kesehatan bagi rakyatnya, yang diberlakukan secara nasional. Berbagai model yang dominan yang implementasinya disesuaikan dengan keadaan di Negara masing-masing.

B. Saran
Demikian makalah ini disusun. cukup sekian kata penutup yang disampaikan. “Tak ada gading yang tak retak”. Dalam makalah ini penyusun merasa masih banyak kekurangan. Oleh karena itu saran dan kritik yang dapat membangun perbaikan makalah ini sedikit banyak kami ucapkan terima kasih.

Hasil (Inggris) 2:

JK principle of social insurance in the Social Security program includes participation mandatory and non-discriminatory for formal groups, dues based on the percentage of revenues to load shared between the giver and the recipient of the work to a certain extent, so there cooperativeness between rich and poor, high-risk illness low, young and old with the same benefits of medical services (principle of equity), and the service can be accessed nationally (portability), is comprehensive, with the benefit of health care promotive, preventive, curative and rehabilitative services, including drugs and medical materials consumables. Management is done with the precautionary principle, non-profit, transparency and accountability are high. Funds program is a trust fund that is used as much as possible for the benefit of participants.
Specificity JK in the Social Security program is that the Administering Agency must develop a health care system, quality control system service and health service payment system to improve the efficiency of health care. Implementation of health insurance to apply the principles of managed healthcare concept, for example, the application of the concept of the family doctor, the referral concept, the concept of territory and the prospective payment (Prospective Payment System) for instance capitation, tariff package, and DRG's (Diagnosis Related Groups). Drug services provided in accordance with the list and the highest price of medicines and medical materials discharged.
D. CHANGES IN FINANCING
a. Economic change, economic crisis, the debt burden, political, currency values, a reduction in government expenditures, changes in prices, the government, price changes, unemployment
b. Demographic changes, fertility, life expectancy, morbidity, mortality, age profile, urbanization
c. Changes in epidemiology, infectious disease / chronic, outbreaks of bird flu, dengue fever, AIDS, SARS, kecelaka's.
D. Social changes in culture, education, communication, transportation, lifestyle, nutrition, social structure / mute lifestyle, nutrition, social structure / numb arga
e. Political change, democracy, policy, organization, management, service. E. KES FINANCING SYSTEMS / HEALTH INSURANCE is a large volume of funds that must be disedia the For the For organizing and or organize or utilize various efforts cases. required by individuals, groups and communities. Two points of health care costs, among others: 1. Health providers = provider yankes ad. The amount of funds that must be disedia the organizing effort interchangeable For cases. kes. 2. Health consumer = kes service users. ad. The amount of funds that must dise diakan For interchangeable utilize services. CHAPTER III CLOSING A. Conclusion Funds from health insurance is one of the best ways to address the high cost of health care. The concept of insurance in health financing has evolved through various approaches that social (social health insurance) and commercial (commercial health insurance). Dantara both developing regulated Health Insurance that in a World Bank report (1993) is recommended to be implemented as a substitute for the principle of Commercial / Private Helath Insurance. Health funding is increasing from time to time and felt the weight either by the government, the business world all the more society in general. For the various countries choose health financing system models for their people, who applied nationally. Various models of the dominant implementation tailored to the circumstances in each country. B. Suggestions Similarly, the paper is organized. that's all delivered closing remarks. "There is no ivory that is not cracked". In this paper the authors feel there are still many shortcomings. Therefore, suggestions and criticisms that can build a little much improvement this paper we thank you.