Is the Single-Insurer a Powerful Purchaser?: In Case of Indonesia / 보건행정학회지

This study reviewed primary care purchasing issues of the Indonesian single-insurer, BPJS-K, in the context of triangular power relations between the government, the insurer, and the providers, and considered its challenges of purchasing as the national single-insurer. Some literature reviews and interviews with Indonesian stakeholders and residents were used to describe the historical and social contexts of Indonesian healthcare and social health insurance systems especially focusing legal and institutional status of BPJS-K and primary care provision and delivery conditions in remote areas. Though BPJS-K directly belongs to the presidential office of Indonesia, it has limited power in terms of purchasing as a single insurer. Mainly it was due to the lack of primary care resources, Ministry of Health's strong power as the regulator and provider as the regulator and provider, and BPJS-K’s powerlessness against monitoring and quality of care assessment. Ambiguous accountability was another issue among the insurer and the Ministry of Health. This created confusions in primary care provision. It is suggested that each agencies’ accountability should be obvious in terms of legal, political, and social contexts.

Development of a Checklist for the Detection of Lipohypertrophy at Insulin Injection Sites / 임상당뇨병

Lipohypertrophy refers to the phenomenon of subcutaneous fatty tissue becoming either softer or firmer than normal so that it becomes thickened. The presence of lipohypertrophy is associated with not rotating injection sites correctly, injecting into the same sites repeatedly, using smaller injection zones, and reusing needles. Injecting into lipohypertrophy sites can cause unexplained hypoglycemia because insulin absorption is delayed or erratic, thus potentially worsening glucose levels and even diabetes management. Therefore, developing a lipohypertrophy checklist for patients who inject insulin is necessary to detect lipohypertrophy as soon as possible in order to avoid repeatedly injecting into lipohypertrophy sites. A lipohypertrophy checklist will help patients maintain stable glucose levels by minimizing the risk of glycemic variability.