Jurnal Health Sains

Scoping Review: Factors Causing Claim Pending in Indonesian Hospitals

2025-08-23T04:08:34+00:00

Pending claims are one of the crucial problems often faced by hospitals in the National Health Insurance (JKN) financing system. This condition not only causes disruptions to hospital cash flow but also reflects weaknesses in the claims management system administratively, technically, and systemically. This study aims to identify and map various factors causing pending BPJS Kesehatan claims in Indonesian hospitals through a scoping review approach. The review process was carried out with reference to the Arksey and O'Malley framework and the PRISMA-ScR guidelines, using literature sources from Google Scholar, Garuda, PubMed, and Neliti databases. Article selection was conducted systematically for publications from 2022–2024, in Indonesian, available in full-text form, and indexed at least SINTA 3. Of the 268 articles identified, 10 met the inclusion criteria and were further analyzed. The results of the synthesis show that the causative factors of pending claims can be grouped into five main themes: inaccuracy in coding diagnosis and procedures, incompleteness of claim documents, limitations of information systems, low competence of human resources, as well as inconsistencies in the implementation of SOPs and weak coordination between units. This study concludes that pending claims are multifactorial and interrelated, requiring comprehensive intervention in the form of strengthening human resource capacity, optimizing the digital claims system, and improving hospital claims policies and governance systemically.

The Influence of Defecation Behavior, Drinking Water Sources, and Handwashing Habits N Stunting in the Work Area of Merek Community Health Center

2025-08-23T04:11:20+00:00

This research was conducted due to the low motivation of the community in the work area of the Brand Health Center to build CTPS facilities, healthy latrines, and clean water management systems. The limited ownership of these facilities is a major factor contributing to the failure to achieve key indicators of STBM, such as the high prevalence of open defecation. This study employed an action research design with an observational approach and educational interventions. The process began with problem identification through observation and surveys, followed by community education and assistance in constructing CTPS facilities, managing clean water, and building latrines. Before the intervention, residents in several villages within the Brand Health Center area were less motivated to develop CTPS facilities, clean water systems, and latrines, due to low knowledge, financial constraints, and limited awareness of the importance of a clean and healthy lifestyle. After direct education and mentoring, there was an increase in motivation and independent efforts by the community to establish these facilities. The results showed improvements such as a reduction in open defecation, the adoption of handwashing with soap, and better practices in managing drinking water. To ensure sustainability, it is recommended that regular supervision and continued assistance be provided so that these achievements remain consistent in the long term.