Analisis Yuridis Perjanjian Baku Antara Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan Dan Fasilitas Kesehatan Dalam Perspektif Keadilan, Kepastian Hukum, Dan Kemanfaatan

Indra Yana, Dr. Rimawati, S.H., M.Hum

2025 | Tesis | S2 ILMU HUKUM JAKARTA

Penelitian ini bertujuan untuk mengetahui dan mengkaji mengenai: (a) permasalahan dan tantangan yang muncul dalam model perjanjian baku kerja sama antara BPJS Kesehatan dengan Faskes di Indonesia; (b) perjanjian baku yang diterapkan oleh BPJS Kesehatan dengan Faskes dan bagi masyarakat peserta BPJS Kesehatan telah sesuai atau belum sesuai dengan prinsip-prinsip keadilan dalam hukum perjanjian dan (c) penerapan kepastian hukum, keadilan, dan kemanfaatan untuk mengatasi masalah perjanjian baku kerja sama antara BPJS Kesehatan dengan Faskes.

Penelitian menggunakan metode yuridis normatif  dan bersifat preskriptif dengan pendekatan peraturan perundang-undangan dan pendekatan konseptual.

Penelitian ini menyimpulkan. Pertama, permasalahan model perjanjian baku kerja sama BPJS Kesehatan dengan Faskes, meliputi; (a) ketidakseimbangan kedudukan BPJS Kesehatan dibanding Faskes; (b) kendala administrasi dan kresedensial; (c) keterlambatan pembayaran klaim; (d) terdapatnya modus fraud; dan (e) pengembalian dana kapitasi. Tantangannya: (a) revitalisasi perjanjian baku; (b) penerapan model diferensiasi perjanjian antara FKTP dan FKRTL berbasis kebutuhan lokal dan kemampuan Faskes; (c) peningkatan pengawasan internal dan eksternal; dan (d) pembagian kewenangan Pusat-Daerah melalui penguatan peran BPJS Kesehatan cabang. Kedua, perjanjian baku kerja sama BPJS Kesehatan dengan Faskes belum sesuai dengan prinsip keadilan. Ketiga, untuk mengatasi masalah perjanjian baku: (a) penerapan kepastian hukum mengabaikan rasa keadilan dan kemanfaatan; (b) penerapan keadilan belum memberikan ruang negosiasi pada Faskes; dan (c) penerapan kemanfaatan belum optimal karena belum merata dan diskriminatif dalam pelayanan kesehatan. Untuk mengatasi masalah perjanjian baku kerja sama antara BPJS Kesehatan dengan Faskes harus memperhatikan keadilan, kepastian hukum, kemanfaatan. 

This research aims to identify and examine: (a) the problems and challenges that arise in the standard agreement model of cooperation between BPJS Kesehatan and healthcare facilities in Indonesia; (b) the standard agreement implemented by BPJS Kesehatan with healthcare facilities and for the community participants of BPJS Kesehatan is in accordance with or not in accordance with the principles of justice in contract law and (c) the application of legal certainty, justice, and usefulness to address issues related to the standard agreements of cooperation between BPJS Kesehatan and healthcare facilities.

The research uses a normative juridical method and is prescriptive in nature with an approach based on legislation and a conceptual approach.

This research concludes, first, the issues concerning the standard agreement model for cooperation between BPJS Kesehatan and healthcare facilities, including; (a) the imbalance of BPJS Kesehatan's position compared to Faskes (b) administrative and credential constraints; (c) delays in claim payments; (d) the existence of fraud modus; and (e) capitation refund. The challenge: (a) revitalization of standard agreements; (b) the application of a differentiation model for agreements between primary health care facilities (FKTP) and referral health care facilities (FKRTL) based on local needs and the capabilities of health services; (c) enhancement of internal and external supervision; and (d) division of authority between Central and Regional through strengthening the role of BPJS Kesehatan branches. Second, the standard agreement of cooperation between BPJS Kesehatan and health facilities is not in accordance with the principle of justice. Third, to address the issues of the standard agreement: (a) the application of legal certainty ignores a sense of justice and utility; (b) the application of justice has not provided space for negotiation in healthcare facilities; and (c) the application of benefits is not yet optimal because it is uneven and discriminatory in health services. To address the issues of the standard cooperation agreements between BPJS Kesehatan and healthcare facilities, attention must be paid to fairness, legal certainty, and usefulness.

Kata Kunci : Perjanjian Baku, BPJS Kesehatan-Faskes, Keadilan, Kepastian Hukum, dan Kemanfaatan