• Citra Yuliyanti School of Public Health Universitas Indonesia ; National Social Security Council, Republic of Indonesia
  • Hasbullah Thabrany Health Policy and Administration, School of Public Health, Universitas Indonesia; National Social Security Council, Republic of Indonesia


Claim management, hospital cash flow, national health insurance


Background: Indonesia commits to ensure health care access for all population through the National Health Insurance (JKN) managed by the BPJS Health. By February 2018, the JKN covered 193 million people (73% of the total population). To ensure health delivery, 2,104 public and private hospitals are contracted by the BPJS and prospective payment using Case-mix Based Group (CBG) that changes hospital managements. Hospitals become more dependent on payments by BPJS. Delay in claim payment will have serious impact on hospital managements. This study aims to identify current practices in timely payment to hospitals and finding factors correlate with delay in payments.

Methods: This study used trend analysis of the secondary claim data of BPJS with the total sample of 57,475 bundles of claims. Total claim population was used in this study. In addition, qualitative study via in-depth interview with six informants consisting of members of National Social Security Council, hospital director of three different classes, and BPJS.

Results: This study found 60% of claims were paid within one month (N-1) of claim submission, below the target of 100%. There were tendencies of delays in claim settlements since November 2017. Informants believed that late payments were correlated with non-compliance of doctor to complete medical records, incompetence coders, inadequate management information system, and financial condition of BPJS. There were three main problems faced by hospitals as a result of delay in payments: 1) disturbed drug availability, 2) decreased performance of doctors, 3) poorer maintenance of medical equipment.

Conclusion: Delayed in claim payments were occurred and led to a threat of decreasing quality of care to patients. The study suggests the government should fix the problems to protect patients from decreasing quality of care. Hospitals should provide reserve funds to protect them from financial hardship when delays occur.



Indonesian Government. Law of the Republic of Indonesia no. 40/2004 regarding The Establishment of a National Social Security System. 2004 p. 1–29.

Dewan Jaminan Sosial Nasional. Peta Jalan Menuju Jaminan Kesehatan Nasinal 2012-2019 (Roadmap National Health Insurance 2012-2019). Dewan Jaminan Sosial Nasional; 2012. 17-19 p.

Bappenas RI. Satu Tahun Pelaksanaan Jaminan Kesehatan Nasional. 2015.

Kemenkes RI. Permenkes RI No. 28 Tentang Pedoman Program Jaminan Kesehatan Nasional. Dep Kesehat RI. 2014;1–48.

Thabarany H. Jaminan Kesehatan Nasional. 2nd ed. Jakarta: Rajawali Pers; 2016.

Putri AE. Paham Sistem Jaminan Sosial Nasional (Understanding National Social Security System). Friedrich-Ebert-Stiftung Kantor

Perwakilan Indonesia. CV Komunitas Pejaten Mediatama; 2014.

Noviatri LW. Analisis Faktor Penyebab Keterlambatan Penyerahan Klaim BPJS di RS Panti Nugroho. 2016;1(1):22–6.

Aditya Pradani E, Lelonowati D, Rawat Inap Ramdani Husada K. Keterlambatan Pengumpulan Berkas Verifikasi Klaim BPJS di

RS X: Apa Akar Masalah dan Solusinya? JMMR (Jurnal Medicoeticolegal dan Manaj Rumah Sakit). 2017;6(2):112–21.

Susan FO, Arso SP, Wigati PA. Analisis Administrasi Klaim Jaminan Kesehatan Nasional Rawat Jalan RSUD Kota Semarang

Tahun 2016. J Kesehat Masy. 2016;4.

Lakukan Pembenahan Internal dan Klaim Belum Dibayar RS Sari Mutiara Mundur dari BPJS Kesehatan [Internet]. Berita Sumut.

[cited 2018 Jun 1]. Available from:


Klaim BPJS Belum Dibayar RSUD Al Ihsan Terancam Tak Bisa Layani Pasien [Internet]. Pikiran Rakyat. 2017 [cited 2018 Jun 1].

Available from:

Atinga RA, Mensah SA, Asenso-boadi F, Adjei FA. Migrating from user fees to social health insurance : exploring the prospects

and challenges for hospital management. 2012;

McCue MJ. The use of cash flow to analyze financial distress in California hospitals. Hosp Heal Serv Adm. 1991;36(2):223–41.

Ilyas Y. Mengenal Asuransi Kesehatan: Review Utilisasi Manajemen Klaim dan Fraud (Kecurangan Asuransi Kesehatan). 2nd ed. Depok: FKM UI; 2006.

BPJS Kesehatan. Makin Canggih, Kini BPJS Kesehatan Terapkan Verifikasi Klaim Digital di Rumah Sakit (More Sophisticated,

Now BPJS Health Apply Digital Claim Verification at the Hospital). 2018 Apr;

Dewan Jaminan Sosial Nasional. Hasil Monitoring Dewan Jaminan Sosial Nasional Tahun 2017 (Report of Monitoring and Evaluasi

of NHI). 2017.

Sakyi EK, Atinga RA, Adzei FA. Managerial problems of hospitals under Ghana’s National Health Insurance Scheme. Clin Gov

An Int J. 2012;17(3):178–90.

Price C a, Cameron AE, Price DL. Distress detectors: measures for predicting financial trouble in hospitals. Healthc Financ Manage.

;59(8):74–6, 78–80.



How to Cite

Yuliyanti, C., & Thabrany, H. (2018). DELAYED CLAIM PAYMENT AND THE THREAT TO HOSPITAL CASH FLOW UNDER THE NATIONAL HEALTH INSURANCE SCHEME IN INDONESIA. Proceedings of the International Conference on Applied Science and Health, (3), 122–128. Retrieved from