Fraud in healthcare services has the potential to reduce the quality of health services, harming patients, and state finances. However, the implementation of fraud prevention in healthcare services has not been fully carried out. The purpose of this study is to determine the cost control-based fraud detection algorithm and detect potential healthcare services fraud in hospitals. The study was conducted at 4 hospitals in East Java-Indonesia. Data retrieval is done by the method of documentation and interviews. With interactive analysis generated, 10 cost control-based algorithms that can be used to detect fraud potential in the hospitals. Based on the time series linear regression analysis, the results show that the data groups that can show the fraud potential in the sample hospitals are (i) outpatient cases with special procedures; (ii) inpatient cases with special drugs; (iii) outpatient cases with special drugs; and (iv) inpatient cases with special prosthesis. Data groups that have not been proven to have the fraud potential are (i) a comparison of the number of JKN inpatients with the number of bills of INA-CBGs inpatients; (ii) comparison of the number of JKN outpatients with the number of bills of outpatient INA-CBGs; (iii) disease severity level; (iv) Inpatient cases bills to BPJS Health; (v) Outpatient case bills to BPJS Health; and (vi) inpatient cases with special procedures.

Beberapa permasalahan UKM termasuk UKM Batik antara lain proses produksi masih menggunakan cara-cara tradisional dan keterbatasan dalam memasarkan produknya. Berangkat permasalahan tersebut kami melakukan kegiatan pengabdian masyarakat Program Pengembanganan Produk Unggulan Daerah pada mitra “Batik New Colet”, Desa Jatipelem Kecamatan Diwek Kebupaten Jombang. Persoalan yang muncul  pada setiap tahunnya terutama musim penghujuan adalah proses penjemuran memerlukan waktu lama bahkan tidak bisa kering karena hujan atau cuaca mendung dalam sehari. Kondisi ini akan memperlambat proses produksi dan menurunkan kualitas produk karena hasil pewarnaan berubah karena proses pengeringan tidak sempurna. Pada sisi pemasaran produk, mitra juga mengalami kendala karena hanya mengandalkan cara getok tular sehingga saat pandemi Covid-19, penjualan merosot tajam. Tujuan program ini adalah meningkatkan dan menjaga konsistensi kapasitas produksi serta mengurangi produk cacat pada proses pengeringan. Kedua, memperluas wilayah pemasaran serta mengembalikan dan meningkatkan  trend penjualan seperti saat sebelum pandemi Covid-19. Metode program ini adalah perancangan dan pembuatan rumah oven batik, pelatihan dan pendampingan penggunaan rumah oven batik. Kedua, pelatihan dan pendampingan strategi pemasaran berbasis digital marketing.  Program ini menghasilkan: 1) waktu proses pengeringan kain batik menjadi enam kali lebih cepat dan kapasitas produksi meningkat 22,25%; 2) produk tidak cacat meningkat menjadi 98%; 3)penjualan meningkat sebesar 14,66% dibanding tahun sebelumnya.

This study aimed to develop a patient trust model that contributes to patient satisfaction and quality healthcare services by focusing on the role of patient health condition as a moderator. Data were collected from three regional general hospitals in East Java, Indonesia, using a questionnaire administered to patients or the families of patients. The proposed model consists of seven constructs. Four represent the quality of healthcare: quality of interaction (five variables), physical environment quality (four variables), outcome quality (three variables), and justice quality (six variables). One construct represents the patient’s health condition (two variables), another represents patient satisfaction (six variables), and the last one is patient trust (six variables). The model was tested using structural equation modeling based on WarpPLS. The goodness-of-fit statistic supported the patient trust model. The hypothesis testing results indicated that physical environment quality, outcome quality, justice quality, and health conditions could predict patient satisfaction. The health condition construct was found to moderate the effect of justice quality on patient satisfaction. Moreover, interaction quality, outcome quality, health condition, and patient satisfaction had an influence on patient trust.

The National Health Insurance ( JKN) system is designed to provide the availability of quality health services, but until now JKN participant have not felt the quality health care. The purpose of this study is to identify threats and weaknesses in health care quality control and formulate the implications of its strategy. The study was conducted at four Regional General Hospital (RSUD) in East Java - Indonesia, namely RSUD IbnuSina Gresik, RSUD NgudiWaluyoWlingiBlitar, RSUD dr. H. SlametMartodirdjoPamekasan, and RSUD dr. H. KoesnadiBondowoso. The sampling of research samples was conducted by purposive sampling and data retrieval with questionnaires and interviews. Analysis techniques used are external factor analysis, internal factor analysis, and SWOT analysis. The results of the study found that the barriers to quality control of JKN health services are the delay in payment of hospital claims by the Social Security Regulatory Agencyof Health (BPJS Health), INA-CBGs rate, BPJS Health Regulations and low people awareness for a healthy lifestyle. In terms of internal hospitals, fraud prevention systems have not been affective. The implication of the strategy is that hospitals must develop and implement fraud prevention information systems properly. Keywords: JKN; BPJS; quality control; health services

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