THE VIOLATION ON THE RIGHT OF SOCIAL HEALTH INSURANCE PARTICIPANTS IN SERVICES OF HOSPITALS.

Dedi 1 , Andi Muhammad Sofyan 2 and Muhammad Said Karim 2 . 1. Graduate School, Faculty of Law, Hasanuddin University. 2. Faculty of Law, Hasanuddin University. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


ISSN: 2320-5407
Int. J. Adv. Res. 6(4), 1046-1055 1047 In Human rights is a very important thing in the life of mankind. Every human being born is inherent in his human rights. Other people can't interfere with the human rights of each individual. Therefore, human rights must be understood by everyone. as a condition for becoming a good citizen must understand and be aware of human rights. 2 Universal Declaration of Human Rights (UDHR) 1948, human lives in freedom, equality and protection. Everyone recognized their basic rights. This requires that everyone be without exception to recognize the basic or natural rights of others, including the state and its enforcement. As expressed by Muhtaj "UDHR is the culmination of universal human rights conceptualization", meaning UDHR content applies to all nations of the world, including the Indonesian nation. 3 With the importance of health, the nation performs one of the goals of national development, these foundations are derived from the mandate of the 1945 Constitution of the State of the Republic of Indonesia, which is intended in Article 28H of the 1945 Constitution of the State of the Republic of Indonesia. "The organizer of health efforts is regulated by the government, so the need for public health insurance, it is implemented by the government by implementing the National Health Insurance System. 4 For the National Social Security System, it is a State program aimed at providing certainty of protection and social welfare for all people as mandated in the 1945 Constitution of article 28H and Article 34 which assigns the Government to develop Social Security for all the people. Article 28H Paragraph (1) states that "Every person shall have the right to live a spiritual and spiritual life, to live and to obtain a good and healthy living environment and to be entitled to health care". In paragraph (2), it is stated: "Everyone shall have the right to special convenience and treatment to have equal opportunities and benefits in order to achieve equality and justice". In paragraph (3), it states that "Every person shall have the right to social security which enables his complete development as a dignified human being". In Article 34 Paragraph (2) of the 1945 Constitution, it states: "The State develops a social security system for all people and empowers the weak and incapable of humanity". In paragraph (3), it is stated: "The State is responsible for the provision of appropriate health service facilities and public service facilities". In paragraph (4), it is stated: "Further provisions concerning the implementation of this article shall be governed by law".

Law Number 36
Year 2009 on Health indicates that individuals, families and communities are entitled to protection of their health, and the state is responsible for regulating the fulfillment of the right to a healthy life for its citizens, including the poor and needy. Efforts to realize the right of the government should provide health services that are equitable, fair and affordable for all levels of society. Therefore, the government should make efforts to ensure equal access for all residents in obtaining health services.
Indonesia as a developing country is still faced with the problem of low public access to quality health services. The delivery of health services is unable to address the complexities of health care delivery and financing that are increasingly dependent on increasingly expensive and complex health technologies. 5 A technology-intensive and costly healthcare system demands professional handling organized by reliable institutions and demands a method of organization that is capable of working effectively, efficiently, and at the same time satisfying.
Regarding health services, the 1945 Constitution of the Fourth Amendment, Article 34 paragraph (3) mandates that "the State is responsible for the provision of health service facilities and appropriate public service facilities". The phrase "worthy" can be interpreted to mean that the state is not only responsible for providing health care facilities, but health facilities of certain standards deemed appropriate. 1048 As a legal term, health services can be found in Law Number 40 of 2004 on National Social Security. In Article 22 paragraph (1) affirmed: "Health insurance is a public service in the form of health services that includes promotive, preventive, curative and rehabilitative services, including medicines and medical consumables needed".

Law Number 40
Year 2004 is the implementation of Article 28H and Article 34 of the 1945 Constitution of the State of the Republic of Indonesia, so that the health services referred to in the law, in accordance with the meaning referred to in the 1945 Constitution. That is, the health services referred to in the 1945 Constitution are not as narrow as those imagined in practice, but include promotive, preventive, curative and rehabilitative services, not only with regard to individual or individual services.
In the application of Universal Health Coverage (UHC) is a state ensuring all citizens of access to health care ensures all cost difficulties, improves health care, and improves public health. Many things that need to be considered by a State in organizing UHC based health insurance system such as finance, policy, quality of health services, quality of health personnel, and much more. 6 Health financing is often a benchmark on a health system implemented by a State. For example, health-care health insurance-based health insurance "Bismarck" (social health insurance "Bismarck" system) or system "Beveridge" which is a health financing comes from the tax (general tax-funded "Beveridge" system). 7 In addition, social security covers pension, pension, death, accident, and health insurance including maternity benefits. For the guarantee of all citizens of Indonesia, in order to anticipate any economic risks and social conditions that may affect one's health and work. In 2004 the Government issued Law Number 40 on the National Social Security System, is one form of social protection to ensure that every participant can fulfill basic needs of life that is at least reasonable to achieve a just social welfare for all the people. 8 Law Number 40 on the National Social Security System aims to ensure accessibility to health services. In it there is a provision on health insurance which is organized based on the principle of social insurance and the principle of equity. However, the health insurance in question, has limitations that only protect the participants, and the participants are everyone who has paid the dues. Therefore, for the sake of justice, then the people who are poor and unable to pay the dues, then the dues must be paid by the Government, so they can become participants. Because without the dues there will be no access, and without access there is no right to health. 9 Law Number 40 of 2004 mandates that the social security is compulsory for all citizens of the population including the National Health Insurance. In Article 52 of Law Number 40 of 2004 on the National Social Security System mandates the establishment of the Social Security Administering Agency and the institutional transformation of Limited Liability Insurance Companies, Limited Liability Insurance Companies, Limited Liability Companies, Insurance Companies and Insurance Companies The Republic of Indonesia becomes the Social Security Administering Body. The transformation was followed by the transfer of participants, asset programs, and liabilities, employees, and rights and obligations. 10 Mentioned that the organizers of health efforts regulated by the government, so that the need for public health insurance, it is implemented by implementing the National Health Insurance System, the government in implementing health insurance form a rule in the form of Presidential Regulation of the Republic of Indonesia number 12 of 2013 on Health Insurance, 11  The main task of the Social Security Administering Body is to organize a National Health Insurance for Indonesian citizens. Health services guaranteed by the Social Security Administering Body include promotive, preventive, curative and rehabilitative services including medicinal and medical supplies services as required. 15 Implementation of health insurance, the Social Security Administering Body cooperates with health service providers as partners in serving Social Security Administering Body organizers such as Government and Private Hospital, Health Clinics, Physician Practices, Pharmacies, and Optics, and others. In the partnership partnership engagement is set forth in the draft agreement in the form of a Memorandum of Understanding that regulates rights and obligations between each party. The Health Insurance Administering Body in running its program is still not optimal as expected by the Government of Indonesia as a legal entity that organizes the National Health Insurance. 16 The noble duties of the Social Security Administering Body can gradually provide assurance to all Indonesian people, in order to obtain good and quality health services. But in fact there are still many participants in the Social Security Administering Body complaining about the provision of services available in the hospital. Other findings occur on false claims, inflation of medication bills and medical devices, pseudo referral patients, prolonged maintenance periods can be done in various modes. There is also manipulation of treatment classes, procedural irregularities and requesting cost sharing is not in accordance with the provisions of legislation.
Another case with the case in Makassar City. the Makassar City Government registered the Beneficiaries but not all of them were accepted. Though the City Government is ready to bear the cost of the dues of the poor data available, but the data submitted is not up to 50 percent received while the city government filed a name that definitely payment is ready.
Not only that, unscrupulous officials of the Social Security Administering Agency at the Hospital in the form of cheating is the participants have routinely pay monthly dues but when used the card treatment can't be used.
Moreover, from the providers of medicine often don't meet the needs of medicines and or medical equipment in accordance with legislation. such as the case of Medicine ration reduction by prescribing 3x1 for the next 10 days. But after the recipe is exchanged to the pharmacist instead reduced by 2x1 ration used for 7 days. The types and sources of data used in this study include: 1. Primary data, ie data collected directly by researchers obtained in the field through interviews with relevant parties. The interview was one of the data collection tools, which explored the questions both using interview guides and questionnaires. 18 2. Secondary data, ie data obtained through literature studies include official documents, books, research results tangible reports, diaries, and so on.
In the data collection techniques are divided into two types, namely primary and secondary data. Primary data collection techniques in empirical legal research, including: 1. Interview: Conducting direct interviews with relevant parties in this study, ie respondents and resource persons related to this research. In this case is the patient as a participant of the Social Health Insurance Administering Agency who received service at the Regional General Hospital I Lagaligo East Luwu. 1051 2. Observation: This method of observation is done to collect data by measuring attitude of respondent (interview and questionnaire), but also can be used to record various phenomenon that happened every situation and condition.

Implementation of health services for Participants of the Social Security Administering Body at the Hospital
Each organizer and the implementation of health services are entitled to receive health services that include promotive, preventive, curative and rehabilitative services including medical and pharmaceutical services and medical consumables in accordance with the necessary medical needs and existing facilities and infrastructure. 19 In the provision of health services in the granting of the rights of participants of the Board of Health Insurance Providers in the Hospital is also regulated in Chapter 4 on Health Services in the Regulation of the Minister of Health of the Republic of Indonesia Benefits provided to participants in the form of comprehensive health services based on necessary medical needs.
Health services provided at health facilities that have entered into cooperation agreements with the Social Security Administering Body or in certain circumstances (medical emergencies) may be performed by health facilities not cooperating with the Social Security Administering Body.
Health services in the National Health Insurance program are gradually, effectively and efficiently implemented by the principles of quality control and cost control.
Health services are implemented in stages starting from first level health services. Second level health services can only be provided for referrals from first-rate health services. Third-level health services can only be provided for referrals from second or first level health services, except in emergency situations, specificity of patient health issues, geographical considerations, and consideration of facility availability.
Referral Recipient Health Facilities Referral recipients shall refer the National Health Insurance participant with answers and follow-up to be performed if medically the participant can already be served at the First Level Health Facility referring.
Referring to chronic diseases (diabetes mellitus, hypertension, heart, asthma, chronic obstructive pulmonary disease, epilepsy, schizophrenia, stroke and lupus Erythematosus syndrome) should be performed when the patient's condition is stable, accompanied by a referral certificate which is made by a specialist / sub-specialist. The Benefit of National Health Insurance consists of 2 (two) types, namely medical benefits and non-medical benefits. Medical benefits in the form of comprehensive health services (promotive, preventive, curative and rehabilitative) in accordance with medical indications that are not bound by the amount of contributions paid. Nonmedical benefits include accommodation and ambulance. The benefits of accommodation for inpatient services are in accordance with the rights of the participants' treatment classes. The ambulance benefit is only provided for referral patients between health facilities, with certain conditions as recommended by the doctor.

Forms of Violation of Rights of Participants of the Body of the Provider of Social Security of Health in the Service at the Hospital:-
To know the extent of granting the rights of participants of the Health Insurance Administering Body in the provision of medicine at I Lagaligo Hospital. Here's an excerpt from the interview: According to Larmin, Participant of the Organizer Body of Social Security Social Insurance of 1st grade who get treatment at I Lagaligo Hospital. "The care for personnel at I Lagaligo Hospital, I think is good from the standard of the local hospital. But even better, if this hospital can complete the provision of medicine in hospital pharmacies for patients, so I no longer buy medicine outside the hospital pharmacy to buy medicine outside the area" 22 Susanti Participants of the Organizer Body of Social Security Self-care Class 1 who received treatment at I Lagaligo Hospital. "It was the third day I was treated in this hospital and counted twice I was told to buy medicine outside the pharmacy in the hospital. He said the pharmacies, the medicine needs to me out. When I asked the nurse in this room my need medicine was also covered by the Social Security Administering Body" 23 21 Ibid., 22 Live interview of participants of the Social Health Insurance Administering Body at the I Lagaligo Hospital 23 Live interview of participants of the Social Health Insurance Administering Body at the I Lagaligo Hospital 1053 Ica Participant of the Social Health Insurance Provider Body paid by the local government who received treatment at I Lagaligo Hospital. "After getting the action by the doctor because I had given birth, the health care workers prescribe medicine to buy medicine outside the hospital pharmacies and medicine that are also quite cheap" 24 Rusnaeni Participants of the Social Health Insurance Provider Board paid by the local government who received treatment at I Lagaligo Hospital. "Same with mother beside, I also buy medicine outside hospital pharmacy. So I did not ask a lot because the Medicine I bought out the same, let alone the Medicine can still be classified as able to be purchased and the midwife also said that the Medicine is also borne by the Social Security Administering Body  In providing guarantees for participants of the Social Security Administering Body in cooperation with the health service facilities one of them is at I Lagaligo Hospital. One of the most important forms is known to be able to not violate the law from all actions that have been done, namely the violation of the right to the participants of the Social Health Insurance Administering Body in the provision of services in the Hospital.

Supporting Factors and Inhibitors of Health Services For Participants of the Social Security Administering Body at the Hospital:-
The granting of rights of the participant of the Social Security Administering Body in the patient care facility at I Lagaligo Hospital is influenced by the supporting and inhibiting factors. As for these factors, among others: Supporting factors:-Provision of service facilities at I Lagaligo Hospital for patients participating Social Security Administering Body of one of the supporting elements to fulfill the right of patients in the hospital.
Just as one of the heads of the sub-division of I Lagaligo Putu Gede Sudarsana Hospital as follows : "The National Health Insurance Program implemented by the government through the Social Security Insurance Provider Body a breakthrough as a new program to address the weaknesses of the implementation of health programs that have previously been made. The National Health Insurance Program is a government and community program that aims to provide full assurance of health care for all Indonesians so that Indonesians can live healthy, productive and prosperous justly in the provision of hospital service facilities. Moreover, the Social Security Administering Body has a principle of mutual assistance system, which can be able to help less able to pay monthly fee in accordance with its income. Better yet, the Social Security Administering Body provides legal certainty for participants of the Social Health Insurance Providers Body to be hospitalized" 26 Good communication between the Social Security Administering Body of the City branch of Palopo with its partners namely one of the Hospital I La Galigo to become supporters in providing a full service to patients participating Body Social Health Insurance Providers. Facilities and Infrastructure in the provision of health care facilities availability is needed to support the fulfillment of the right of patient health services. However, the facts and circumstances in the field show that hospital facilities are inadequate. As the number of inpatient rooms is inadequate so there are patients who complain about a full room. As well as complaints related to Medicine services at the Medicine pickup counter that slightly makes the buildup at the counter taking medicine. In accordance with the statement put forward the head of Sub Division I Lagaligo Putu Gede Sudarsana ie : "There is a lack of availability of facilities and infrastructure in the hospital so that the rights of the participants of the Social Security Administering Body have not been fully met, such as the inadequate number of inpatient room so that there are patients complaining about the full hospitalization room, so many patients consider the right of a guarantor of the Guaranteeing Body Social Health at the Hospital is not being met well. It became a complaint during this time faced at I Lagaligo Hospital" 27 Indicators to maximize health services in hospitals, one of them is health workers. this can be seen from the information from the hospital I Lagaligo which states that health personnel facilities, especially specialist doctors are still less so that patients can't choose the health workers they want as their rights, this is a factor that inhibits the legal protection of patients in health services because the right of the patient to be able to choose the desired health worker to be unfulfilled, such as Still lack of professional health personnel to perform the level of health services such as surgeons. Usually in the morning, patients in the hospital who will get outpatient stack outpatient, due to coincident doctors perform surgery. And this is an indicator of patient accumulate in hospital who get outpatient. 28 The allocation of funds for the provision of health facilities in hospitals is due to the allocation of funds sourced from the Regional Revenue Budget in East Luwu Regency is still far from sufficient to improve all facilities and infrastructure of health services at Lagaligo I Hospital of East Luwu regency, as stated by the Head of Human Resources of I Lagaligo hospital, namely: "The most basing that affects the various problems in the hospital is the allocation of funds. in hospitals has many needs such as provision of medicines, facilities, infrastructure, and other needs that the basic needs of hospitals in order to provide full rights to patients" 29 Regulation and Internal Policy of the hospital as stipulated in Hospital By Law, according to the researcher is a factor inhibiting the provision of health services for patients based on observation.