*Muhammad Arief Rosyid Hasan, **Puput Oktamianti, **Dumilah Ayuningtyas. * Makassar School of Health Science

Transcription

1 JOURNAL OF INDONESIAN HEALTH POLICY AND ADMINISTRATION VOLUME 1 NOMOR 2 An Analysis of The National Health Insurance Policy Implementation in 2014 (Presidential Regulation No. 12 And 111/2013 on Health Insurance) from The Regulator s Position *Muhammad Arief Rosyid Hasan, **Puput Oktamianti, **Dumilah Ayuningtyas * Makassar School of Health Science ** Department Health Administration and Policy, Building F, 1 st Floor, Faculty of Public Health Universitas Indonesia, Depok muhammaders@gmail.com Abstract. JKN (National Health Insurance) is a government program that aims to provide health assurance for all Indonesian citizens for a healthy, productive, and prosperous life. In the two years after JKN was implemented, various problems occurred. This research used the qualitative approach with the Edward II implementation theory. Results of the research indicated that there were problems in communication, stemming from the lack of socialization and inharmonic regulations, there was also the problem of the lack of healthcare resources. From the disposition side, the policy makers often obstructs the implementation preparation, this is evident from the information on determining the premium size. From the organization structure, all the stakeholders have been well coordinated. We conclude that we are not ready to implement the JKN. We recommend that mass and effective socialization program to be performed using various methods of communication and involve the community. To reduce the disparity of healthcare services, we recommend that the regional government to establish various healthcare facilities to accelerate health development. There should also be regulations that allocates healthcare staff in every corner of the country to achieve Universal Health Coverage in 2019, as stated in the National Health Insurance Road Map. Keywords: policy analysis, national health insurance, universal health coverage Abstrak. JKN (Jaminan Kesehatan Nasional) adalah program Pemerintah yang bertujuan memberikan kepastian jaminan kesehatan yang menyeluruh bagi seluruh rakyat Indonesia untuk dapat hidup sehat, produktif dan sejahtera. JKN yang dioperasionalkan oleh BPJS Kesehatan hingga saat ini sudah berjalan dua tahun. Namun segala permasalahan masih terjadi. Penelitian ini dilakukan dengan pendekatan kualitatif menggunakan teori implementasi Edward III. Hasil penelitian menunjukan adanya permasalahan komunikasi yaitu kurangnya upaya sosialisasi dan adanya aturan yang dinilai belum harmonis dan adanya disparitas pelayanan kesehatan dari sisi sumber daya. Dari sisi disposisi, para pemangku kepentingan kebijakan Jaminan Kesehatan Nasional memiliki sikap yang menghambat kesiapan implementasi yang dapat dilihat dari informasi penetapan besaran iuran premi. Dari sisi struktur organisasi sudah terjalin koordinasi dengan baik antar atau antara pemangku kepentingan. Kesimpulannya adalah tidak siapanya implementasi Jaminan Kesehatan Nasional. Saran yang dapat dilakukan agar implementasi dapat berakselerasi dengan baik adalah sosialisasi hendaknya dilakukan secara masif dan efektif dengan menggunakan berbagai cara dan perlu adanya melibatkan masyarakat. Saran untuk mengurangi disparitas pelayanan kesehatan adalah mendorong pemerintah daerah untuk segera mendirikan berbagai fasilitas kesehatan di daerah upaya untuk akselerasi pembangunan kesehatan. Selain itu perlu aturan yang menetepkan penempatan tenaga kesehatan di seluruh Indonesia agar tujuan Universal Health Coverage dapat tercapai di 2019 sesuai dengan Road Map Jaminan Kesehatan Nasional. Kata kunci: analisis kebijakan; jaminan kesehatan nasional; universal health coverage INTRODUCTION To guarantee the prosperity of our citizens, law no. 40/2004 on the national social insurance system was issued on October 19 th 2004 by the Majelis Permusyawaratan Rakyat (MPR). The law was detailed in the SJSN law, the Presidential Law no. 12 and 111 in 2013 on Health Insurance. The law contains the general regulations for health insurance, membership and participation, membership entry and data change, payments, benefits, benefit coordination, healthcare provision, health facilities, quality and cost control, customer care, and closing regulations. As a public policy, the national health insurance (JKN) passed through a rigorous process of approval, from the formulation, implementation, monitoring and evaluation, and evaluating the results and impact of the policy. The analysis process also follows several stages, from problem identification, agenda setting, formulating the policy proposal, policy legitimation, implementation, and evaluation of the policies (Agustino, 2008).According to Edward III in Agustino (2008), there are four variables that determines the 79

2 MUHAMMAD ARIEF ROSYID HASAN, AN ANALYSIS OF THE NATIONAL HEALTH INSURANCE POLICY IMPLEMENTATION success of a policy, they are communication, resources, disposition, and bureaucratic structure. This implementation model is a top-down prespective, it begins at the central and decisions are made by the central. Presidential Law (Perpres) no. 12 and 111 in 2013 on Health Insurance is a policy issued to provide health care assurance to all Indonesian citizens. According to the national health insurance implementation road map, the ministry of health stated in 2011 that the JKN will be implemented gradually in the whole nation from January 1 st 2014 until it covers 100% of the citizens in The implementation of those laws required preparation of many aspects and subjects. Government commitment needs to be followed with preparation of implementation. This would require a combination of good communication, well stocked resources, high disposition, and a good bureaucratic structure. According to Edward III in Agustino (2008), these four elements dictates the success of the implementation of a policy and are not separable, particularly for public policies. This theory is the cornerstone of the implementation preparedness analysis of the national insurance policy. A national health insurance would provide easy access for the public to obtain healthcare, in return, this would increase the demand for healthcare. However, our healthcare system still needs to be improved, as the distribution of healthcare access is imbalanced in every aspect, from the healthcare providers to its human resources. This was the reason why this research was performed. Policy analysis is an applied social science discipline that uses various research methods and arguments to produce and transfer information relevant to the policy, therefore it can be used at the political level to solve policy problems (Dunn, 1998). Which means public policy analysis aims to provide recommendations to assist the policy makers in solving public problems by presenting various alternative policies as consideration or input. To ease the implementation process of Perpres no. 12 and 111 of 2013 on health insurance, new regulations that support the law is necessary. The presidential alws must be further detailed into various regulations that discussed the membership/participation and the benefits of the packages. Policy implementation preparedness analysis is an important stage, because this process determines the success of future implementations. Therefore, the JKN program should be evaluated. THEORETICAL OVERVIEW Implementation study reviews the implementation process of a policy. Implementing a policy, in actuality, is a complex process. There are two main subjects that is involved in the implementation of a policy, they are: the target of a policy and activities to achieve the target. It is a dynamic process, where activities are done to reach the targeted results. According to Lester and Stewart Jr in Agustino (2008), implementation is a process and an output. The success of the implementation of a policy is measured by the number of goals or targets achieved. In the development of policy implementation studies, there are two approaches that can be taken, the top-down approach and the bottom-up approach. Edward III as one of the figures that developed the topdown approach stated that the four variables that determine the success of the implementation of a policy are communication, resources, disposition, and bureaucratic structure. For public policy implementation, these four elements cannot be done separately. Communication is how a policy is conveyed to organizations and/or the public, also the attitude and response of the involved parties. According to Edward III, communication means delivering messages/information on the policy from the policy makers to the policy implementors. Knowledge on the policy, such as the what are the facts of the policy, how it must be implemented, the norms, evaluation of the policy, etc is transferred. However, several things must be kept in mind, they are the way the information is delivered, clarity of information, and consistency of delivery (Edward, 1980). Decisions and orders must be continued to the correct personnel before it can be followed. The communication must also be accurate and easy to comprehend. However, there are many problems that may occur during the transmission and this may hinder the implementation process (Nugroho, 2012). During the message delivery process, noise or disturbances may distort the message. According to Edward III, this may be caused by using an indirect method of communication. A layered bureaucratic structure may prevent the policy maker to send their message directly (the policy) to the field operators. Communication between the policy maker and the field operators goes through many layers of communicators and communicants, each going through their own encoding and coding process. the number of layers correspond to the distortion potential (Nugroho, 2012). Message distortion could also be caused by the free will of the communicant and policy implementor. The implementor may selectively perceives the messages that they receive. Things that they consider to not comply with their values, would be denied or even rejected consciously or not. Or, if he cannot reject it, he would reluctant to implement it. This would make the implementation incomplete. According to Edward, the clarity of the message is also important. Clarity means that there are no ambiguous 80

3 JOURNAL OF INDONESIAN HEALTH POLICY AND ADMINISTRATION VOLUME 1 NOMOR 2 interpretation. It does not mean providing extra information. However, extra information might reduce the flexibility of the implementation (Nugroho, 2012). Several factors that may cause ambiguity are complexity, public rejection, no common goal, the newness of the program, and unaccountable policies (Edward, 1980). For the implementation process to be effective, the orders must be consistent and clear. Conflicting orders (laws) would be difficult to implement (Nugroho, 2012). Resources covers the available supporting resources, in particular human resources, because it is related to the capabilities of the policy implementor in carrying out a policy. The resources are resources available to the policy implementors. Edward III (1980) stated that to make a public policy applicable, the available resources must be also considered. This includes the quality and quantity of staff, information availability, authority for the staff to act, and facilities that support the staff in implementing the policy. Motivation is also another basic condition that must be taken into consideration to implement a public policy effectively. Information is also an important resource. There are two types of information, first, how to implement the policy, and secondly, data on personnel compliance. The implementors must know what they are doing and how they must do it. The implementor must know whether the persons involved will comply with the law or not (Nugroho, 2012). The program implementors must also be provided an office to perform their activities, physical facilities and equipment is also important (Gani, 2006). Disposition is related to the willingness of the implementors to carry out the policy, which requires their commitment in implementing the policy. The disposition (tendency) of the policy implementors is the third factor that is important for an effective implementation process. If the implementors have a good attitude, it means that they support it, therefore, the possibility that they would perform the desired activities is higher. And vice versa, if the (Nugroho, 2012). The implementors also must have the capabilities to perform the activities that must be done, to prevent any bias during the implementation process. The bureaucratic structure is related to whether or not the bureaucratic organization is appropriate as the managers of public policy (Nugroho, 2012). Bureaucracy is the most common type of implementor. It inadvertently chooses collective agreement to solve social problems in the modern life. According to Edward, the two main characteristics of bureaucracy are work procedures called Standard Operating Procedures (SOP) and Fragmentation. The first characteristic, SOP, developed as an internal response to the limited time and resources of the implementors, and a desire for uniformity in the complex and divided organization. This means, that every person/institution in the system has their own main duties and functions based on thie responsibilities. The second characteristic, fragmentation, originates from pressures out of the bureaucratic unit, such as the legislative committee, interested groups, executive officers, the constitution and policies that imfluences the governmental bureaucratic organization. The lack of coordination and cooperation between state institutions and/or the government often causes inefficiency in the implementation process (Nugroho, 2012). A broken organization structure would increase the possibility of communication failure. The more people that receives orders, the larger the possibility of distortion. Fragmentation limits the ability of high-level officers to coordinate all the available resources for a jurisdiction (Nugroho, 2012). Fragmentation also affects other things. Forming many other organizations with limited or small responsibilities would stimulate the development of parochial attitudes. This would cause bureaucratic friction and reduce cooperation. It also extends the window for private interests. This would increase the chances for those interests to pressurize the implementors to act based on personal interests and not their orders (Nugroho, 2012). Social security policy is covered by Law no. 40 of 2004 on the national social security system (SJSN) and law no. 24 of 2009 on the National Social Security Management Board (BPJS). These laws require more detailed regulations to implement it. That is why the government issued Perpres No. 12 of 2013 that was further detailed by Perpres No. 111 of 2013 on Health Insurance. However, a more detailed regulation is still necessary for its implementation in the field. RESEARCH METHOD There are four variables that determine the success of an implementation of a policy, they are communication, resources, disposition, and bureaucratic structure (Edward III, 1980). This research used the qualitative approach, achieved by collecting data through in-depth interviews with the informants and literature studies. The research was performed in DKI Jakarta, where the offices of the informants is located during March-April The informants were selected based on their capacities as an officer, decision maker, and implementor in the JKN policy implementation process. it is based on the appropriateness and adequacy principles. The informants were purposedly selected based on their involvement as a stakeholder in the implementation of the JKN policy. The data was processed using 81

4 MUHAMMAD ARIEF ROSYID HASAN, AN ANALYSIS OF THE NATIONAL HEALTH INSURANCE POLICY IMPLEMENTATION computers and video recorders/tape recorders. The data is then transcribed into an interview transcript. The transcript was then simplified, then entered into a matrix according to the question points. The contents were then analyzed. A summary in a matrix is then analyzed and explained in narration, then the data is conceptualized and reconfigured. We endeavored to guarantee data validity by triangulating the data, firstly through technical triangulation by performing in-depth interviews and documentary research, secondly source triangulation by checking the obtained data through several sources and comparing one informant to another, and lastly triangulating the data by involving another person. Peer debriefing, reference examination and adequacy was also performed to be analyzed as a comparison. To guarantee transferability or external validity, a detailed interview transcript was compiled. This was then transformed into a report that provided clear, specific, and systematic details. To guarantee dependability or realibility, we audited the whole research process by providing guidance and consultation during the research. A confirmability or objectivity test states that a research is objective if the results were approved by many people. The objectivity of the research depends on the agreement, views, and discovery of the subjects and object. RESULTS There were 7 informants selected from 4 institutions, 2 from the BPJS (the director of the BPJS and the Head of the Law and Regulation Group of the BPJS), 2 from the IX commission of the DPR RI (one expert staff and the head of the DJSN), 2 from the ministry of health (the vice minister of health who represented the Head of the Work Group for the Health BPJS and the Subdivision Head of the P2JK Monev Information System). The interview duration was 30 to 90 minutes. The informants education level varied, 3 had Doctoral degrees and 4 had Masters degrees. The interview and documentary reviews indicated that the main problem of Perpres no. 12/2013 is that it did not set the size of the premium that should be paid, whether for the PBI (Payment Assistance Recipient or transferal from Jamkesmas) or non PBI members. The size of the premium was determined by Permenkes 111/2013. According to the informants, determining the size of the premium is a complex matter. Communication According to the SJSN Law for PBI beneficiaries, the government will cover those that are considered underpriviledged or cannot afford it. Then, the stakeholders would determine the size of the payment s economical value. The economical value is the value of the benefits received by all the stakeholders of the JKN program, the patients satisfaction in the services received, providing the providers sufficient funds to cover their costs, and the health staff s satisfaction on the pay that they receive for services provided. Also, providing enough funds for the BPJS to cover their operational costs and the charges from the provider. Synchronizing all these requirements is the main problem in setting the size of the premium payment. Socialization of the JKN was performed by the informants at the provincial and kabupaten/city level. The people it was socialized to were the Health Department, hospitals, puskesmas, and other public elements. There were many methods used to socialize it, such as public lectures in seminars, advertisements in the radio, television, pamphlets, brochures, etc. However, there is a problem in the amount of socialization, not everyone obtained the same amount of information or type of information, and not all of the public has full knowledge of it. Various medias has been used to socialize the program, but since this country is spread through thousands of island with many types of terrain, it is difficult. Transferring of knowledge to the public is difficult, although some methods such as public empowerment though health cadres and public organizations (religious organizations, student organizations, youth organizations, PKK) has been involved in the process. The messengers of the laws must be well educated by the ministry of health or the provincial/kabupaten/city health department, to prevent any information distortion or misperception of the message conveyed. However, the problem is in the reception of the message. Internal communication, for instance from the central BPJS to the regional BPJS, is minimal or non-existent. This was because the messenger assumed that, since recipients have the same background, they should already be well informed of it. Which did not happen when the messengers conveyed the message to the public that are health naïve or health insurance naïve. Bureaucratic Structure The implementation guidelines included how the regulations should be implemented, from the order of activities to the preparation steps. This guideline was inscribed in the road map to national health insurance. This road map also included the background for the regulation, its conceptual framework, legals aspects, membership, benefits and premium, healthcare serices covered, institution and organization, and the implementation framework. The establishing of Perpres 12 and 111 of 2013 and its supporting laws involved the ministry of health, health BPJS, DJSN, healthcare provider association, 82

5 JOURNAL OF INDONESIAN HEALTH POLICY AND ADMINISTRATION VOLUME 1 NOMOR 2 professional association, the health department, etc, as stakeholders. The institution that is responsible for issuing the policies was the ministry of health, while the technical regulations was created by the health BPJS. The technical guidelines for implementing the sozialization of Perpres 12 dan 111 of 2013 was issued by the: a. Ministry of Health, in the form of: - JKN pocket book - Q and A book of the national health insurance b. Health BPJS, in the form of: - Health BPJS information book - Gatekeeper Concept Practical Guidelines - Claim Administration at the Healthcare Facility Practical Guidelines - Etc. All those technical guidelines are available at the ministry of health s website and Health BPJS website. However, those online access information is only accessible in cities with goos internet connection. This is a problems, since there are areas with difficult internet access. As a solution, direct meetings and other types of technologies that are more common are used. The medias that were used was seminars, assemblies, brochures, radio and television. Ofcourse, the materials must be packaged in a way that is acceptable and interesting for the public. Resources for JKN Implementation The human resources (SDM) available is evaluated based on the quality and quantity of the implementing staff, available information for the staff, flexible authority for the staff, and availability of supporting facilities in implementing the policy. Motivation is also a basic condition that is neccessary for the government apparatuses to carry out public policies well. According to the informants, the human resources involved in the implementation of the regulations are competent. However, the quantity is not sufficient. The lack of manpower can be solved when all the health facilities, including clinics, are involved in the implementation of JKN. The distribution of human resources is also a problem. According to the 2011 basic health research (Riskesdas) at the puskesmas, some puskesmases with 27 doctors and 97 nurses, while other do not have any doctors or nurses. From the said research, 4.2% of puskesmases in Indonesia do not have any doctors, even in DKI Jakarta (the capital) there are 5 puskesmases without any doctors. Generally, area that lacks personnel for JKN is eastern Indonesia. There is also a disparity of personnel at hospitals. According to the 2011 Riskesdas, there are still many General Hospitals (RSU) that do not have enough personnel. 18.5% of Governmental General Hospitals do not have internists (SpPD), 20.4% do not have Surgeons (SpB), 24.5% do not have paediatricians (SpA), and 17.1% do not have obstetric-gynecologists (SpOG). The 2011 Hospital Risfaskes stated that there were disparities in the health personnel, healthcare, and facilities of government RSUs in Sumatra, Java, Bali and Nusa Tenggara, and other areas. This gap must be minimalized to accelerate health development. We have endeavored to prepare enough personnel to cover the necessary activities during the implementation, whether it is at the JKN management or at the healthcare facilities. However, there was no funds specifically budgeted for the implementation, this is because it is part of each unit s duty and the budget allocated was considered sufficient. The healthcare facilities and equipment required for universal coverage is considered insufficient, but not very much. The largest problem is the distribution of beds, especially if it is divided into each kabupaten/city. Because the number of beds depends on the size of the health facility, adding more beds is not an easy task. Moreover, from the field visits, we discovered that there are still cities or kabupatens without any hospitals, especially in newly developed cities/kabupatens, such as Kabupaten Bolaang Mongondow Timur, which was formerly part of Kabupaten Bolaang Mongondow in North Sulawesi. This means that the citizens there do not have equal access to affordable healthcare. Currently, there are no new laws or regulations that support the implementation. There are no funds specifically allocated for it, either. The implementing personnel should be capable and be dedicated in implementing the policy, since it involves the public. The SJSN, Ministry of Health, and Health BJS are dedicated to provide satisfactory services for the public in respect of the national health insurance. In the previous section, we mentioned that Perpres 12 of 2013 was changed into Perpres 111 of 2013 in order to determine the size of the payment. The process was very laborious, because many problems occurred. One problem was the bureaucracy, in specific, the Ministry of Finance. The Minister of Finance that decides on the size of the premium failed to set the nominal. This poses a great risk for conflict between the government organizations and ministries involved, since each of them has their own agenda. This policy is meant to provide quality healthcare for the community that is easily accessible through the national health insurance scheme, by bearing this in mind, the potential for conflict and retention is minimalized. According to Schemeer (1999) in Ayuningtyas (2014), the analysis of stakeholders is a process of combining and qualitation analysis systematically to discover who must be addressed 83

6 MUHAMMAD ARIEF ROSYID HASAN, AN ANALYSIS OF THE NATIONAL HEALTH INSURANCE POLICY IMPLEMENTATION when establishing or developing or implementing a policy or program. The stakeholder analysis would be able to identify the characteristics of the key stakeholders, evaluate the attitude of stakeholders that may influence or be influenced by the results of the policy, comprehend the relationship between each stakeholder, evaluate the reality or potential conflict of interests and expectations between each stakeholder, and to assess the capabilities of each stakeholder in establishing the policy (Nash, et al, 2006 in Ayunigtyas, 2014). A JKN Program Management Oriented to the Fulfillment of the Stakeholders s Requirements The National Health Insurance is newly established and it involves many institutions and organizations, therefore many problems and conflicts is unavoidable. This is normal, since it is a part of an organization s dynamics. According to Mazmanian and Sabatier (1983), implementation is applying the basic policies into laws or regulations or decrees from the executive or legal body. The decree usually identifies the problems faced, the target, and structure of the implementation process. This process typically follows several steps, firstly issuing the basic regulation, then the policy from the implementing agent, the actual impact and last revision of the regulation. The regulator was the Ministry of Health and the implementor was the Health BPJS. If any problems or chaos occurs at the field, the participants would complain to the manager, which are the Health BPJS and others. Unit P2JK of the Ministry of Healthis the coordinator for the national health insurance program, and routine weekly meeting are done to discover the development and the progress of the implementation process. Meanwhile, the Health BPJS also has its own meetings with the various units in the Health BPJS (National and regional meetings) to discuss the problems and development found in the field. A larger scale coordination meeting is established by inviting various stakeholders, such as the DJSN, DPR, Ministry of Health, Health BPJS, other Ministries, healthcare providers, and professional associations. This type of meeting was done when the size of the premium payment was determined. The main duties and responsibilities of each organization/institutions involved in the process are described in the national health insurance road map, it also is based on the organizational structure of each institution. This guarantees the efficiency and effectivity of resources and facilitates coordination, because no new organizational structures are required. All the informants agree that there were no external influences in the preparation process. The many institutions or organizations involved in the creation of the supplemental regulation, for instance, only acted as informants, according to each competence and expertise. The external parties only provide input for the policy. The decision maker was the Ministry of Health. The organizations involved in the supplemental regulation were the BPJS as the implementor, the DJSN (National Social Security Board), professional organizations, Healthcare Provider Associations, and other related stakeholders as supervisors. The stakeholders are expected to provide input to create a favorable and harmonious situation during the process. Including the various aspirations of each stakeholder is also a part of the process. Harmony is necessary to cause all the involved parties to implement the policy. According to the Ministry of Health, the problems or challenges in the policy is more in the implementation process, the socialization is inadequate, it is also limited by the regional autonomy. While according to the DJSN, the problems in monitoring and evaluation is caused by the different regulations that was established beforehand. For example, the size of the premium differs from the premium set by the DJSN and set by the three minister work meeting. The informant recommends that a new regulation is established to support Perpres No. 12 and 111 of The progress evaluation has been concluded, however several improvements are necessary to adjust it to the conditions at the field and several regulation changes are also necessary. CONCLUSIONS From this study, we conclude that all the 4 factors of implementation preparedness according to Edward III communication, resources, disposition, and bureaucratic structure is considered insufficient or unprepared for implementing a national health insurance scheme. Although the JKN began in January 1 st 2014, more accelerated processes is necessary to improve communication, resources, disposition, and the bureaucratic structure. RECOMMENDATIONS 1. Socialization should use a more massive method, whether it is printed media, direct meetings, the radio or television. The language should also be simplified, to make it more accessible to the public. Public empowerment is also necessary, not only the government, religious figures and public figures, health cadres, etc should also be involved. 2. New methods to support the regional government and private sector to establish new healthcare 84

7 JOURNAL OF INDONESIAN HEALTH POLICY AND ADMINISTRATION VOLUME 1 NOMOR 2 facilities in order to satisfy the demand for healthcare after the universal coverage era begins. 3. Several methods that can be performed to reduce the disparity in manpower to accelerate health development is by supporting the regional government in hiring healthcare personnel through a work commitment that requires healthcare professional to stay at their area and not move to another area. 4. To support continuous improvement, coordination meetings at the central should be continued in order to improve the regulations that do not support the program or issue new regulations that support the program. To achieve the vision and mission of universal coverage in REFERENCES 1. Agustino, Leo Dasar-dasar Kebijakan Publik. Bandung: CV. Alfabeta Bandung 2. Badan Pengembangan dan Penelitian Kesehatan Kemenkes Laporan Akhir Riset Fasilitas Kesehatan 2011 Puskesmas. Jakarta : Balitbangkes Kemenkes 3. Badan Pengembangan dan Penelitian Kesehatan Kemenkes Laporan Akhir Riset Fasilitas Kesehatan 2011 Rumah Sakit. Jakarta : Balitbangkes Kemenkes 4. Dunn, William N Pengantar Analisis Kebijakan Publik. Yogyakarta: Gajah Mada University Press 5. Edward III, George C Implementing Public Policy. Washington: Congressional Quarterly Press 6. Gani, Abdul Yuli Andi Memunculkan Tindakan Kolektif dalam Proses Pembuatan Kebijakan Publik (Suatu Studi tentang Penataan PKL di Kota Malang dengan melibatkan Stakeholders). Jurnal Ilmiah Administrasi Publik Vol. VI, No. 2, Nugroho, Riant Public Policy. Jakarta: PT. Elex Media Komputindo 8. Peraturan Presiden Republik Indonesia Perpres No. 24 Tahun 2011 tentang Badan Penyelenggara Jaminan Sosial. Jakarta. 9. Peraturan Presiden Republik Indonesia Perpres No. 12 Tahun 2013 tentang Jaminan Kesehatan. Jakarta. 10. Peraturan Presiden Republik Indonesia Perpres No. 111 Tahun 2013 tentang Jaminan Kesehatan. Jakarta. 11. Republik Indonesia Peta Jalan Menuju Jaminan Kesehatan Nasional Jakarta. 12. Undang Undang Republik Indonesia UU No. 40 Tahun 2004 tentang Sistem Jaminan Sosial Nasional. Jakarta. 13. Undang Undang Republik Indonesia UU No. 24 Tahun 2009 tentang Badan Pelaksana Jaminan Sosial. Jakarta 85