e-ISSN 2598-3849       print ISSN 2527-8878

Vol 4, No 2 (2019)

Kajian Literatur Sistematis: Skema Pengendalian Biaya dalam Asuransi Kesehatan Nasional di Beberapa Negara

Eka Pujiyanti, Ery Setiawan, Euis Ratnasari Jasmin, Indah Pratiwi Suwandi



Pengendalian biaya merupakan salah satu dari beberapa strategi untuk memastikan keseimbangan finansial dari skema asu­ransi kesehatan nasional. Beberapa model pengendalian biaya yang umum digunakan secara global yaitu seperti cost-shar­ing, capping, dan sebagainya. Review ini dilakukan dengan tujuan untuk menentukan biaya dan dampak dari implementasi skema kebijakan sebagai instrumen pengendalian biaya di berbagai negara. Review sistematis dilakukan dengan mengambil data dari beberapa database yaitu Proquest, Pubmed, dan Cochrane Library dengan intervensi utamanya yaitu menggu­nakan metode cost-sharing. Hasil dari review difokuskan pada skema pengendalian biaya dari perspektif pemerintah, yaitu lingkup asuransi sosial yang dapat berupa modifikasi sistem pembayaran, cost-sharing, capping/quota, dan waiting period. Berdasarkan salah satu studi di Kanada, dapat dilihat bahwa dihasilkan dampak yang signifikan pada sistem kesehatan, mengurangi pengeluaran dan penggunaan obat yang tidak esensial, serta secara tidak langsung meningkatkan efisiensi pasar obat melalui kepedulian peserta dalam penggunan obat. Dalam penelitian ini dapat disimpulkan bahwa implementasi dari skema pengendalian biaya dapat mengurangi risiko bahaya dari perspektif peserta dengan kontribusi tambahan pada penggunaan pelayanan kesehatan.



Cost-containment is one of several strategies to ensure the financial sustainability of the National Health Insurance scheme. Sev­eral cost-containment models were commonly globally, such as cost-sharing, capping, and others. This review aims to determine the costs and impacts of implemented policy schemes as cost-containment instruments in various countries. We performed a systematic review from several primary databases (Proquest, Pubmed, and Cochrane Library) with the primary intervention are the cost-sharing methods. The results of our review focused on the cost containment scheme from the government perspective, in which the context of social insurance can be a modification of payment systems, cost-sharing, capping/quota, and waiting period. From one of the studies in Canada, we can see that the result has a significant impact on the health system, reducing the expendi­ture and the use of drugs that are not essential, and also indirectly improve the technical efficiency of the drug market through the care of participants in drug utilisation. In this research, it can be concluded that the implementation of cost containment schemes can reduce the moral hazard risk from the perspective of participants with additional contributions to the utilisation of healthcare services


JKN; strategic health purchasing; prospective payment; cost containment


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DOI: 10.7454/eki.v4i2.3460


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