e-ISSN 2598-3849       print ISSN 2527-8878

Vol 2, No 2 (2017)

Analisis Praktik Koordinasi Manfaat (Coodination of Benefit) Layanan Rawat Inap di Indonesia

Fera Mutiara Dewi, Budi Hidayat

Abstract


Abstrak

Kepemilikan lebih dari satu asuransi (double insured) telah membuka peluang praktik Coordination of Benefit (COB) di Indo­nesia. Pada era JKN saat ini, setiap orang selain memiliki asuransi yang bersifat wajib mereka pun memiliki asuransi keseha­tan tambahan yang kepesertaanya bersifat tidak wajib. Pada praktiknya, beberapa penerapan COB masih ditemukan belum sesuai dengan prinsip universal asuransi. Penelitian ini bertujuan untuk menganalisis praktik COB dan besaran biaya COB yang terjadi di Indonesia. Metode yang digunakan adalah rancangan studi observasional dengan desain cross sectional. Pe­modelan dengan ekonometrik (two-part model) dilakukan untuk memisahkan proses antara praktik COB dengan besaran biaya COB. Hasil penelitian menyatakan kovariat Usia, LOS dan penyakit sistem sirkulasi menunjukkan efek yang signifikan dalam pengujian secara statistik. Kurangnya koordinasi antar provider dengan asuradur atau asuradur dengan asuradur yang lain menyebabkan meningkatnya potensi moral hazard yang dilakukan baik oleh peserta maupun provider sehingga peserta berpotensi mendapatkan cakupan ganda. Perlu dibuat organisasi khusus untuk mengelola COB dan dibuatnya regulasi COB.

Abstract

Nowadays, some people may have double insurance. Besides having compulsory insurance that regulated by government, they also have additional health insurance which is not mandatory. This condition has opened up opportunities for Coordi­nation of Benefit (COB) in Indonesia, especially in JKN era. Unfortunately, in practice COB still not executed according to the principle of general rules of insurance. This research seeks to analyze the practice of the COB and COB fee scale in Indonesia. The method used is the observational study with cross sectional design. The modeling uses an econometric approach that is a two-part model which separates the process between the COB practice and the COB funds. The result of the research states that age covariate, LOS, and circulatory system diseases show significant effects in statistical testing. Lack of coordi­nation between providers and assurer or between assurer and assurer, causes increasing potential moral hazard by both participants and providers so that participants may get double coverage. The suggestions of this research are first the need to create an independent organization that manages COB and second the need to made regulation of COB.

 


Keywords


coordination of benefit; regulasi cob; two-part model

References


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Full Text: PDF

DOI: 10.7454/eki.v2i2.2149

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