International Journal of Law

Authors
Wempi Potale, Wulanmas APG Frederik, AJ Lonan, Ronny A Maramis

Abstract
A new change in hospital liability as the BPJS becomes a major part of the national health care system. BPJS (board of national social security) is now has significant role in the health care system in Indonesia. As according to the law every citizenmust be under health care insurance program and the program under the auspices of BPJS. Over billion rupiah are been invest to this national health insurance program each year by the Indonesian government and every citizen in Indonesia is coverage by this program with only very small low insurance fee per month. This national health insurance program is now become very prestigious program under the new government. Follow to this program, actually Indonesia now is developing a new model of health care system what so called manage care. Some experience in several western country such as United States shown that manage care that is quality and cost control policy basis has its legal effect mainly because the structur of legal relationship among and between the BPJS and the patient (BPJS Participants) and the BPJS and the Hospital/Doctors in other party. There is no legal existence in between hospital and the patient since the patients are under limited choices. They should go to the BPJS hospital/doctor, follow the referral system. Since this structure is new in the liability system thus the theoretical approach in law must be reconciled. This study is conducted to one major private hospital in the capital city of North Sulawesi. Legal method is one of preferred method to explore the existence of the legal relationship among and between BPJS and the hospital and BPJS and the patient in other part with legal content analysis technics. The relations between doctor and patient are under individual contract after one accreditation procedures. Another legal document that are using is the Act of Health No. 36 Year 2009 the Act No. 24 Year 2011 about National Social Security Program, the Act of Hospital No. 36 Year 2009 and the Act No. 29 Year 2004 about Medical professional. The conclusion of this study show that liability in this new scheme of relationship especially under the national health insurance run by the BPJS has brought much legal risk to the hospital. The hospitals are now face double risk they are dealing with conventional liability where every hospital must liable every service that they provided but now that may have another risk to be sued by the BPJS’s patient as well.