Background: Adopting Universal Health Coverage for implementation of a national health insurance system [Jaminan Kesehatan Nasional (JKN)/Badan Penyelenggara Jaminan Sosial or the Indonesian National Social Health Insurance Scheme (BPJS)] targets the 255 million population of Indonesia. The availability, accessibility, and acceptance of healthcare services are the most important challenges during implementation. Referral behavior and the utilization of primary care structures for underserved (rural/remote regions) populations are key guiding elements. In this study, we provided the first assessment of BPJS implementation and its resulting implications for healthcare delivery based on the entire insurance dataset for the initial period of implementation, specifically focusing on poor and remote populations.Methods: Demographic, economic, and healthcare infrastructure information was obtained from public resources. Data about the JKN membership structure, performance information, and reimbursement were provided by the BPJS national head office. For analysis, an ANOVA was used to compare reimbursement indexes for primary healthcare (PHC) and advanced healthcare (AHC). The usage of primary care resources was analyzed by comparing clustered provinces and utilization indices differentiating poor [Penerima Bantuan Iur (PBI) membership] and non-poor populations (non-PBI). Factorial and canonical discrimination analyses were applied to identify the determinants of PHC structures.Results: Remote regions cover 27.8% of districts/municipalities. The distribution of the poor population and PBI members were highly correlated (r2 > 0.8; p < 0.001). Three clusters of provinces [remote high-poor (N = 13), remote low-poor (N = 15), non-remote (N = 5)] were identified. A discrimination analysis enabled the >82% correct cluster classification of infrastructure and human resources of health (HRH)-related factors. Standardized HRH (nurses and general practitioners [GP]) availability showed significant differences between clusters (p < 0.01), whereas the availability of hospital beds was weakly correlated. The usage of PHC was ~2-fold of AHC, while non-PBI members utilized AHC 4- to 5-fold more frequently than PBI members. Referral indices (r2 = 0.94; p < 0.001) for PBI, non-PBI, and AHC utilization rates (r2 = 0.53; p < 0.001) were highly correlated.Conclusion: Human resources of health availability were intensively related to the extent of the remote population but not the numbers of the poor population. The access points of PHC were mainly used by the poor population and in remote regions, whereas other population groups (non-PBI and non-Remote) preferred direct access to AHC. Guiding referral and the utilization of primary care will be key success factors for the effective and efficient usage of available healthcare infrastructures and the achievement of universal health coverage in Indonesia. The short-term development of JKN was recommended, with a focus on guiding referral behavior, especially in remote regions and for non-PBI members.

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Penguatan pelayanan kesehatan primer telah digaungkan sejak lama oleh para pemangku kepentingan dalam rangka meningkatkan efektivitas dan efisiensi pelaksanaan Program Jaminan Kesehatan Nasional. Namun demikian, implementasinya belum optimal. Salah satu tolok ukurnya adalah performa FKTP yang masih belum sesuai dengan target yang ditetapkan. Penelitian ini bertujuan untuk memberikan saran dan rekomendasi guna mewujudkan pelayanan kesehatan primer yang berkualitas. Penelitian ini menggunakan pendekatan kualitatif dengan teknik pengumpulan data desk research (secondary data), serta proses triangulasi untuk memastikan validitas dan reliabilitas data yang digunakan. Temuan penting dalam penelitian ini adalah secara umum Indonesia belum memiliki tata kelola yang komprehensif dalam setiap aspek yang termasuk dalam mata rantai penting yang diperlukan untuk menentukan kualitas pelayanan kesehatan primer. Oleh sebab itu, dibutuhkan pembenahan secara bertahap dan berkesinambungan yang dilakukan secara bersama-sama oleh seluruh stakeholder terkait.

The practice of human resource management has developed rapidly. Various figures and experts have explained theories and best practices about HR management in an organization. Employees are no longer considered just a resource that will run out over time. Currently, organizations in various sectors have placed employees as valuable assets that must be managed properly so that they are expected to be able to make an optimal contribution in supporting the achievement of organizational targets. BPJS Kesehatan as the only public legal entity that organizes the National Health Insurance-Indonesian Health Card (JKN-KIS) program is deemed necessary to place the function of HR management as one of the strategic aspects that must be managed optimally. This study aims to provide an overview of the suitability of the implementation of HR management at BPJS Kesehatan with various existing literature references and best practices in companies or other organizations that have succeeded in becoming market leaders in their fields. This study uses a literature study based on references in the form of books and previous research on HR management. An important finding in this study is the implementation of HR management at BPJS Kesehatan is following the HR Four Role Model proposed by Ulrich (1997) which has been recognized as one of the references in HR management practices in organizations.

The policy of protecting the rights of the Kajang customary law community through Regional Regulation Number 9 of 2015 concerning the strengthening of rights, and the protection of the rights of the Ammatoa customary law community in the duties and authorities of the Ammatoa Kajang customary law community, namely to fulfill, maintain, and preserve Pasang as a guideline for community life. However, it is undeniable that many regional regulations that have been made in an area sometimes only become legal documents or have minimal implementation. In this study using qualitative methods. The results showed that the innovation of the application of the Ammatoa customary law Regional Regulation on the Kajang indigenous people based on individual factors, structural factors and cultural factors was in accordance with community expectations and the rules applicable to customary law communities related to tolerance acculturated by the local government through Regional Regulation no. 9 of 2015, the legislative product of the Regional Regulation is an achievement that is beneficial for the Ammatoa Kajang indigenous people and the government's program has been achieved.