CHALLENGES OF STANDARD INPATIENT CLASS POLICY IN INDONESIA: SCOPING REVIEW

The standard inpatient class policy in Indonesia has been stated in legislation since 2021 with twelve criteria and must be fully met by December 2024. This study aims to get an overview of the readiness of hospitals in Indonesia to meet the policy and an overview of the community's perspective in responding to standard inpatient classes. Scoping Review with Arksey and O'Malley and Beyond's approach. Online article search on Scopus, Science Direct, SpringerLink, garuda, and Google Scholar, published in 2020-2023, articles published in English and Indonesian, with search keywords: 'kris' or 'jk' or 'bpjs and kesehatan' or 'bpjs and health' or 'inpatient and room' or 'health and policy and jkn', in October 2023 and carried out Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. Hospitals in Indonesia studied in 2022 are not ready, but hospital research in 2023 states that they are ready to carry out Standard Inpatient Classes (KRIS). The community as patients and consumers in the use of health services from the Social Security Organizing Agency (BPJS) Health provides support in the implementation of Standard Inpatient Classes. Meanwhile, from the legality aspect, there is a discrepancy in regulations from the highest to its derivatives, there is even no clarity on legal sanctions if the Hospital does not meet the criteria for the Standard Inpatient Class according to the specified time limit.


Introduction
Indonesia has a national health insurance system managed by BPJS Kesehatan with the principles of social insurance and equity.(Indonesia, 2021(Indonesia, , 2022) ) The principle of social insurance in question is the provision of basic needs guarantees for all communities with the concept of mutual assistance, while the expected equity is the equality of health service receipts according to medical indications without being affected by the amount of contributions paid.In the process of achieving this principle, one of the steps taken by the Government of Indonesia to establish Standard Inpatient Classes is further clarified by the issuance of the Decree of the Director General of Health Services Number HK.02.02/I/1811/2022 concerning Technical Guidelines for the Readiness of Hospital Infrastructure Facilities in the Application of Inpatient Classes of National Health Insurance Standards.(Arntanti, 2023) There are twelve standard inpatient class criteria contained in the juniors, including building components that do not have high porosity; air ventilation; room lighting; bedding; Nightstand; air temperature and humidity; inpatient rooms divided by gender, age, and disease; room density and bed quality; curtain; bathroom in inpatient room, bathroom accessibility; and oxygen outlets.These twelve criteria are applied by January 1, 2023, and all must be met by December 2024.(Indonesia, 2021(Indonesia, , 2022) ) Trial implementation of Standard Inpatient Classes has also been carried out by the government in 2022-2023.The first phase of trials was carried out at four hospitals, including Tadjuddin Chalid Hospital, J Leimena Hospital, Surakarta Hospital, and Rivai Abdullah Hospital.Furthermore, the second phase of trials was carried out at ten hospitals, including RSUD Dr. Sarjito, Soedarso Regional Hospital, Sidoarjo Regional Hospital, Sultan Syarif Alkadri Regional Hospital, Santosa Kopo Hospital, Santosa Central Hospital, Awal Bros Batam Hospital, AI Islam Hospital, Ananda Babelan Hospital, Edelweiss Hospital.Interestingly, from this implementation test, the Ministry of Health of the Republic of Indonesia in the presentation The implementation of Standard Inpatient Classes which was carried out on 10-12 May 2023 stated that the trial results showed that Standard Inpatient Classes had no impact on reducing community satisfaction and hospital income.The trial results also show that the reduction in beds does not have a significant impact on Bed Occupation Rate and access to hospital services.Based on these findings, the government is increasingly determined to implement Standard Inpatient Classes in all hospitals collaborating with BPJS Kesehatan, with a maximum period of December 2024, so that by 2025 all hospitals in Indonesia will have fulfilled it.(Indonesia, 2023) Health legislation in Indonesia was issued in August 2023 through Law number 17 of 2023 concerning Health.One of the laws that was repealed was Law Number 44 of 2009 concerning Hospitals.However, all laws and regulations that are implementing regulations of the Law are declared to be still valid as long as they do not conflict with the latest statutory provisions.(Indonesia, 2023) One of the implementing regulations that are still relevant is the Government Regulation of the Republic of Indonesia Number 47 of 2021 concerning the Implementation of the Hospital Sector.Article 18 states that standard-class inpatient services account for at least 60% of all beds for governmentowned hospitals and 40% of all beds for private-owned hospitals.With the continued provision, the number of intensive care beds is at least 10% of all hospital beds (6% of intensive care unit services and 4% of neoplastic intensive care and pediatric intensive care services), the space that can be used as isolation places is at least 10% of all beds (Sari, Omar, Pasinringi, Zulkifli, & Sidin, 2023).
The latest health legislation in Indonesia does not change or abolish this standard inpatient class, hence as previously stipulated the standard must be implemented.Therefore, a scooping review of standard inpatient classes was carried out to see an overview of the readiness of hospitals in Indonesia to carry out KRIS obligations, getting an overview of public opinion, as well as legal or legality views on the regulation.The study was conducted by scoping review from articles about the hospital, the perception of the public, and the legality that containing Standard Inpatient Classes using the approach of Arksey and O'Malley and Beyond with the following steps: (Westphaln et

Summary And Results
The data obtained is research in several different regions, including Banjarmasin, Tangerang, Bandar Lampung, and Medan.In the 2021-2022 data, it was found that the readiness rate had not reached 100%, the problems found from each hospital and region were different, and it still took time to make improvements.The problem that arises in each hospital is to adjust the existing hospital infrastructure building to be by KRIS policy.However, research conducted in 2023, research in the city of Medan states that it is ready.(Afni & Bachtiar, 2021;Arisa, Purwanti, & Diaty, 2023;Hardwiko Defityanto, Samino, Lolita Sary, 2022;Qurnaini Mz, Pane, Hutajulu, Ester Sitorus, & Ginting, 2023) Through the assessment of public perception scoping, data was taken from several studies with different numbers of responders.The community as patients who are consumers of BPJS Health and KRIS benefit users, Pramana et al reported that the community accepted the implementation of KRIS with the hope of adjusting the monthly allowance.Even Golda et al, reported that all 520 respondents consisting of patients supported the implementation of the standard inpatient class policy, but agreed to allow enough time for the policy to work, with a minimum time of 5 years.(Kurniawati et al., 2021) Adiwan et al also conducted research related to patient satisfaction and desire, this study resulted in the conclusion that the quality of hospital services and how patients assess health services creates customer satisfaction and causes the desire to pay BPJS Health contributions continuously.(Qodar, Heriadi, & Afifah, 2022) Rahmi et al conducted a study on 194 patients using BPJS Kesehatan, interesting that it was concluded that there was no relationship between community needs and product views on community readiness about standard inpatient classes, but there was a relationship between patient expectations and the environment on community acceptance readiness in implementing standard inpatient classes.(Fajarwati, Muchlis, Surahman Batara, & Masyarakat, 2023) In the legality study, BPJS Kesehatan is the only compulsory social insurance in Indonesia with the concept of Universal Health Coverage and has had several legislations and derivative regulations.(Septiono, 2023) According to Slamet et al, the President's legal study on Health Insurance, especially in Presidential Decree No. 82 of 2018 and its derivatives, needs to be made a comprehensive change to equalize values in each JKN application.(Slamet Riyanto, 2023) Regulations must be in line starting from the law as the highest regulation, to its derivatives and implementing regulations.Changes or revisions to regulations are considered unable to meet the current needs, so researchers suggest a complete change in regulations related to National Health Insurance.Deni et al also conducted research on the legislation regarding KRIS JKN, and it was concluded that until now the application of KRIS JKN is considered legally unclear, there is no clarity on the legal consequences for disobedient agencies, and there are no sanctions or regulations.(Sulistyorini & Huda, 2022) Vita et al reported that clear legality can increase trust in BPJS Kesehatan.(Permatahati, 2023)

Conclusion
Hospital research in Indonesia in 2022 is not ready to implement KRIS, but the 2023 research states that there are hospitals that are ready for KRIS.The community as patients and consumers in the use of BPJS Health provides support in the implementation of Standard Inpatient Classes.Meanwhile, from the legality aspect, there is a discrepancy in regulations from the highest to its derivatives, there is even no clarity on legal sanctions if the Hospital does not meet the criteria for the Standard Inpatient Class according to the specified time limit.

1. PRISMA Flow Chart Data Mapping [Challenges Of Standard Inpatient Class Policy In Indonesia: Scoping Review] Vol 2, No. 12, 2023
What is the public's perspective on the Standard Inpatient Classes policy?3.What is the legality of Standard Inpatient Classes in Indonesia?Online article search on Scopus, Science Direct, SpringerLink, garuda, and Google Scholar, published in 2020-2023, articles published in English and Indonesian, with search keywords: 'kris' or 'jk' or 'bpjs and kesehatan' or 'bpjs and health' or 'inpatient and room' or 'health and policy and jkn', in October 2023 and carried out Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.A total of 385 articles were obtained.PRISMA's approach is attached and articles that can be reviewed for continued scoping review totaling 11 articles.There are 11 articles included in the scoping review process, 4 articles exploring the topic of hospital readiness, 4 articles exploring consumer perceptions, and 3 articles discussing legality https://edunity.publikasikupublisher.com1553

Table 1 .
Studies on Readiness for Standard Inpatient Classes in Indonesia

Table 2 .
Studies on Perception for Standard Inpatient Classes in Indonesia

Table 3 .
Studies on Legality of Standard Inpatient Classes in Indonesia