Akibat Hukum dan Kesenjangan Regulasi Dalam Implementasi INA-CBGs di Indonesia

Abstract

This study aims to analyze the implementation of Law Number 40 of 2004 concerning the National Social Security System in the context of the Indonesia Case Base Groups (INA-CBGs)-based healthcare financing scheme managed by BPJS Kesehatan. The main focus of the study is directed at identifying legal and technical issues arising from the implementation of the package tariff system, as well as the urgency of strengthening legal certainty in the implementation of national healthcare insurance. This study uses a normative juridical method with a descriptive-analytical approach, where data is collected through a literature review covering legislation, legal doctrine, academic literature, and theories of legal implementation and dispute resolution. The analysis is conducted qualitatively to assess the conformity between legal norms and the implementation practices of INA-CBGs. The research findings indicate that the implementation of the INA-CBGs system has the potential to cause various problems, such as the risk of medical errors, alleged malpractice, claim fraud, and unfair financing for patients with high levels of disease complexity. In addition, the dispute resolution mechanisms through both non-litigation and litigation channels are considered to be less than optimal. The implications of this research emphasize the need for strengthened regulations, improved competency of healthcare workers and claims administrators, and transparency of the financing system to prevent recurrent disputes. The research's uniqueness lies in its integrative approach, which comprehensively links legal aspects, healthcare financing practices, and dispute resolution mechanisms within the INA-CBGs scheme, an area not widely explored in previous research.

Penelitian ini bertujuan untuk menganalisis penerapan Undang-Undang Nomor 40 Tahun 2004 tentang Sistem Jaminan Sosial Nasional dalam konteks skema pembiayaan layanan kesehatan berbasis Indonesia Case Base Groups (INA-CBGs) yang dikelola oleh BPJS Kesehatan. Fokus utama penelitian diarahkan pada identifikasi persoalan hukum dan teknis yang muncul akibat penerapan sistem tarif paket, serta urgensi penguatan kepastian hukum dalam penyelenggaraan jaminan kesehatan nasional. Penelitian ini menggunakan metode yuridis normatif dengan pendekatan deskriptif-analitik, di mana data dikumpulkan melalui studi kepustakaan yang mencakup peraturan perundang-undangan, doktrin hukum, literatur akademik, dan teori implementasi hukum serta penyelesaian sengketa. Analisis dilakukan secara kualitatif untuk menilai kesesuaian antara norma hukum dan praktik pelaksanaan INA-CBGs. Temuan penelitian menunjukkan bahwa penerapan sistem INA-CBGs berpotensi menimbulkan berbagai permasalahan, seperti risiko kesalahan medis, dugaan malpraktik, penyimpangan klaim (fraud), serta ketidakadilan pembiayaan bagi pasien dengan tingkat kompleksitas penyakit yang tinggi. Selain itu, mekanisme penyelesaian sengketa baik melalui jalur nonlitigasi maupun litigasi dinilai belum berjalan optimal. Implikasi penelitian ini menegaskan perlunya penguatan regulasi, peningkatan kompetensi tenaga kesehatan dan administrator klaim, serta transparansi sistem pembiayaan guna mencegah sengketa berulang. Keaslian penelitian terletak pada pendekatan integratif yang mengaitkan aspek hukum, praktik pembiayaan kesehatan, dan mekanisme penyelesaian sengketa dalam skema INA-CBGs secara komprehensif, yang belum banyak dikaji dalam penelitian sebelumnya.