Fungsi Kelembagaan Independen Dalam Penguatan Mekanisme Penyelesaian Sengketa Jaminan Kesehatan Nasional

摘要

The Healthcare BPJS (BPJS-Kesehatan) is one of the Financial Services Institutions that is supervised by the Financial Services Authority (OJK). According to the OJK Regulation No. 1/POJK.07/2014 on Alternative Dispute Resolution Institution in Financial Services Sector, Financial Services Institution must be a member of the Alternative Dispute Resolution Institution in the fi nancial services sector. However, there is a difference in the dispute resolution mechanism in the National Health Insurance (JKN) program. The difference is related to the existence of the government’s role or intervention as the organizer of JKN. The method of the study was normative juridical with qualitative data analysis. The potential disputes in JKN from the complaints basis are caused by the existence of direct connections between the members (patients) and the BPJS-Kesehatan as well as connection between the members (patients) and the Health Facilities. Meanwhile, the disputes that are originated from the basis other than complaints occur because of the connection between Health Facilities and BPJS-Kesehatan as well as the connection between Health Facilities Association and BPJS-Kesehatan. This varied pattern of relationships needs to be accommodated in an independent institution to oversee the implementation of JKN in the fi eld such as the late payment on claims, diagnosis coding, independent participants who could not ascend the treatment class, cooperation agreement with BPJS-Kesehatan, and other issues. The existence of independent institutions is essential as a form of alternative dispute resolution system strengthening and minimizing the infl ux of the disputes to the court. The establishment of an independent institution that also functions as an arbiter in the JKN disputes needs to be reorganized to facilitate the government’s regulatory and supervisory functions.