Abstract:
Background: The National Health Insurance System
organized by the government as an effort to provide affordable
and excellent health care, including for mental health services.
In practice there is a potential of fraud that allegedly could be
detrimental either directly or indirectly. Supervision of the
potential fraud in the health sector has begun to catch the
attention of the Corruption Eradication Commission, because
the potential losses caused could be enormous.
Aim: To determine the effect of potential fraud in the
implementation of the national health insurance system versus
quality services in The Mental Hospital. Methods: This study was cross-sectional design. The sample
of this study were schizophrenia patients in the inward services
in dr. Radjiman Wediodiningrat Mental Hospital Lawang during
implementation of the National Health Insurance system.
Result: The potential fraud that may occur in mental hospitals
include attempts to extend or shorten the average length of
stay (AvLOS), fictitious invoice on medical anamneses and
proceeding treatment, and hospitalization inpatients without
clear indication. This is supported by initial data obtained that
AvLOS is decrease when the health insurance system apply
packaged payment system, nevertheless there is increased
rates up to five times of re-hospitalization. This shows that the
indication of potential fraud could affect the output quality of
mental hospital.
Conclussion: There is a potential fraud in the implementation
of the national health insurance system that affects the quality
of services in a mental hospital.
