ANALISIS PENGELOLAAN KLAIM PROLANIS DI KLINIK PUSDIKARHANUD
DOI:
https://doi.org/10.32585/jmiak.v9i1.8004Abstract
Penyakit kronis seperti diabetes melitus dan hipertensi berkontribusi besar terhadap peningkatan beban pelayanan kesehatan di Indonesia. Program Pengelolaan Penyakit Kronis (Prolanis) yang diselenggarakan oleh BPJS Kesehatan bertujuan meningkatkan kualitas hidup peserta melalui pengelolaan kesehatan berkelanjutan di fasilitas kesehatan tingkat pertama. Namun demikian, pengelolaan klaim dan rendahnya partisipasi peserta masih menjadi tantangan dalam keberlanjutan program. Penelitian ini bertujuan menganalisis implementasi pengelolaan klaim Prolanis di Klinik Pusdikarhanud. Penelitian menggunakan pendekatan deskriptif kualitatif dengan enam informan yang dipilih secara purposive, terdiri dari tenaga medis, perawat, dan petugas administrasi. Data dikumpulkan melalui wawancara mendalam, observasi, dan telaah dokumen, kemudian dianalisis menggunakan model Miles dan Huberman meliputi reduksi data, penyajian data, dan penarikan kesimpulan. Hasil penelitian menunjukkan bahwa mekanisme klaim telah berjalan secara sistematis, namun belum optimal karena ketidaklengkapan dokumentasi, keterbatasan integrasi sistem informasi, serta rendahnya partisipasi peserta dalam kegiatan senam. Kondisi tersebut berdampak pada keterlambatan dan kegagalan klaim. Diperlukan penguatan monitoring administrasi, optimalisasi sistem informasi, serta strategi peningkatan keterlibatan peserta untuk menjamin efektivitas dan keberlanjutan program.
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