LEGAL REVIEW OF PATIENTS' RIGHTS IN THE HEALTH INSURANCE SYSTEM

Abstract

The health insurance system is a mechanism that provides financial protection against health risks for the community. This study aims to review the legal framework related to patient rights in the health insurance system in Indonesia and evaluate legal certainty regarding patient rights. The research method used is a literature study approach. Findings from the literature study show that Indonesia has a fairly comprehensive legal framework to protect patient rights in the health insurance system, although there are still challenges in implementation and legal certainty. Identified problems include lack of clarity in regulations, complex claims processes, potential denial of claims, and lack of emphasis on consumer protection. In developing regulations, it is recommended to increase regulatory detail and clarification, standardization of the claims process, transparency regarding claim rejections, and stronger integration with the Consumer Protection Law. Challenges faced in developing a health insurance system include ambiguity and complexity in regulations as well as the need for stability in these regulations