Abstract

Social Health Insurance (SHI) in Indonesia is still facing many obstacles, especially the financial aspects from 2014 to 2017 due to the SHI financial losses that has received more attention from the public and the government in Indonesia. Therefore, this study intends to provide financial strategy recommendations that will get a stability revenue over cost. Dynamic system simulation approaches are used to obtain optimal financial strategies that take into account variable costs and income decisions. The parameter of the load variable is medical costs while the income variable is obtained from the participant premium rate factor. The data come from 2016 and 2017 related data to membership, especially PBPU (Participants Not Wage Recipients). Then, the equation used to find the right strategy is Income ≥ Expenditures. In conducting simulations, scenarios are designed to reduce the level of financial losses that occur in SHI. The scenario of this research is a scenario that changes the parameters of premium rates and benefit costs. The combination of medical cost and premium scenarios is a recommendation from the SHI financial strategy because it gets optimal results so that financial SHI does not occur in a losses. In addition, the results of this study can contribute to the resolution of BPJS Health financial problems in Indonesia which continue to experience a losses.

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