ANALISIS LEGALITAS DAN ETIKA RESOURCE RATIONING DALAM ALOKASI SUMBER DAYA JAMINAN KESEHATAN NASIONAL: PERSPEKTIF KEADILAN DISTRIBUTIF DAN KEPASTIAN HUKUM TENAGA MEDIS

Abstract

The National Health Insurance (JKN) program in Indonesia faces significant challenges in the form of limited fiscal resources and infrastructure, which trigger the practice of resource rationing. This article aims to evaluate the legal and ethical dimensions of these restrictions through the perspective of distributive justice, the sociological impact on vulnerable groups, and legal certainty for medical personnel. This research uses a juridical-normative method with a descriptive-qualitative approach. The results show that rationing practices are often carried out implicitly through mechanisms of denial, selection, delay, deterrence, deflection, and dilution to balance claim ratios exceeding 100%. Philosophically, there is a tension between the utilitarian paradigm, which prioritizes the stability of collective systems, and John Rawls's theory of justice, which demands priority protection for the most disadvantaged groups. Legally, although Law Number 17 of 2023 concerning Health and Ministerial Regulation Number 6 of 2024 have provided a framework for minimum service standards (SPM), legal protection for medical personnel in making difficult decisions in the field still requires more explicit and transparent clinical guidelines.

ABSTRAK

Program Jaminan Kesehatan Nasional (JKN) di Indonesia, menghadapi tantangan besar berupa keterbatasan sumber daya fiscal, dan infrastruktur yang memicu praktik resource rationing. Artikel ini bertujuan, untuk mengevaluasi dimensi legalitas dan etika dari pembatasan tersebut, melalui perspektif keadilan distributif, dampak sosiologis pada kelompok rentan, serta kepastian hukum bagi tenaga medis. Riset ini menggunakan metode yuridis-normatif, dengan pendekatan deskriptif-kualitatif. Hasil penelitian menunjukkan bahwa praktik rationing sering kali dilakukan secara implisit melalui mekanisme denial, selection, delay, deterrence, deflection, dan dilution guna menyeimbangkan rasio klaim yang melampaui 100%. Secara filosofis, terdapat ketegangan antara paradigma utilitarianisme yang mengutamakan stabilitas sistem kolektif, dengan teori keadilan John Rawls yang menuntut perlindungan prioritas bagi kelompok paling tidak beruntung. Secara yuridis, meskipun Undang-Undang Nomor 17 Tahun 2023 tentang Kesehatan dan Permenkes Nomor 6 Tahun 2024 telah memberikan kerangka standar pelayanan minimal (SPM), namun proteksi hukum bagi tenaga medis dalam pengambilan keputusan sulit di lapangan, masih memerlukan pedoman klinis yang lebih eksplisit dan transparan.