Perlindungan Hukum Pasien dalam Pelayanan Asuransi Kesehatan: Perspektif Perundang-undangan dan Asas Keadilan

Abstract

Background: Health insurance serves as a principal instrument to ensure public access to healthcare services. However, in practice, the relationship between patients and healthcare insurance providers often poses legal challenges, particularly when rigid or disproportionate administrative systems constrain patients’ rights. This situation generated disparities in legal protection and substantive injustice within healthcare services.

Objective: This study aimed to analyze legal protection for patients in the context of healthcare insurance services based on the prevailing legislative framework in Indonesia, and to evaluate its conformity with the principle of justice as a fundamental legal norm in public service delivery.

Methods: This study employed a normative-juridical approach through an analysis of laws, presidential regulations, and institutional documents governing the national health insurance system. Data were analyzed descriptively and qualitatively using thematic categorization and normative interpretation techniques.

Results: Although regulations normatively stipulated patients’ rights, their implementation did not fully reflect substantive justice. Patients were often placed in a legally subordinate position, faced difficulties in filing objections, and lacked legal assistance. The principle of justice had not been comprehensively internalized within insurance-based healthcare services, particularly in the benefit system, tiered referral mechanisms, and medical treatment refusals.

Conclusion: Legal protection for patients in healthcare insurance services continued to encounter gaps between normative law and practical implementation. Institutional reforms, improved legal literacy, and the establishment of dispute resolution mechanisms oriented toward substantive justice were required to realize an inclusive and responsive national health insurance system.

Latar belakang: Asuransi kesehatan merupakan instrumen utama dalam menjamin akses pelayanan kesehatan masyarakat. Namun dalam praktiknya, relasi antara pasien dan penyelenggara jaminan kesehatan kerap menghadirkan tantangan hukum, terutama ketika hak pasien dibatasi oleh sistem administratif yang kaku atau tidak proporsional. Hal ini menimbulkan ketimpangan perlindungan hukum dan ketidakadilan substantif dalam layanan kesehatan.

Tujuan: Penelitian ini bertujuan untuk menganalisis perlindungan hukum pasien dalam konteks pelayanan asuransi kesehatan berdasarkan kerangka perundang-undangan yang berlaku di Indonesia, serta mengevaluasi kesesuaiannya dengan asas keadilan sebagai prinsip hukum dasar dalam pelayanan publik.

Metode: Penelitian menggunakan pendekatan yuridis-normatif melalui analisis terhadap undang-undang, peraturan presiden, serta dokumen kelembagaan yang mengatur jaminan kesehatan nasional. Data dianalisis secara deskriptif-kualitatif dengan teknik kategorisasi tematik dan penafsiran normatif.

Hasil: Meskipun regulasi telah mengatur hak-hak pasien secara normatif, implementasinya belum sepenuhnya mencerminkan keadilan substantif. Pasien sering kali berada dalam posisi subordinat secara hukum, menghadapi kesulitan dalam mengakses keberatan, dan tidak mendapatkan pendampingan hukum. Asas keadilan belum diinternalisasi secara utuh dalam pelayanan berbasis asuransi kesehatan, terutama dalam sistem manfaat, rujukan berjenjang, dan penolakan tindakan medis.

Kesimpulan: Perlindungan hukum pasien dalam layanan asuransi kesehatan masih menghadapi kesenjangan antara hukum normatif dan praktik implementatif. Diperlukan reformasi kelembagaan, peningkatan literasi hukum, serta sistem penyelesaian sengketa yang berpihak pada keadilan substantif demi mewujudkan sistem jaminan kesehatan yang inklusif dan responsif.