Main Article Content

Abstract

To increase the effectiveness of the special capitation payment scheme implemented by the primary care providers (PCPs), to expand health service coverage and to provide additional incentives for the health workforce in remote areas, a commitment agreement with the primary care provider has been established. However, the PCP's achievement after implementing the commitment agreement was unclear. Hence, this study aims to analyse the commitment and achievements of the PCP in the special capitation payment scheme in 2021 and 2022. About 178 PCPs in 2021 and 191 PCPs in 2022 across Indonesia were included in this descriptive analysis using the quantitative method. The results reflected that special capitation payments accompanied by commitment agreements might influence increasing the capacity, access, and quality of health services. There was a 58% increase in the number of PCPs that achieved all PCP commitment indicators for capitation recipients in 2022 compared to 2021. The highest commitment indicator attained by PCP recipients of special capitation is the sending of health personnel. The quantity of capitation rates received, the simplicity of using capitation funds, the accessibility of physicians and other health professionals, and the assessment of service commitment accomplishments, which will affect payment, all influence the achievement of commitment indicators.

Keywords

Capitation Payment Primary Care Provider Commitment Indicator Remote Area

Article Details

How to Cite
Anindita, R., Aryani, A. D., Ritonga, R. A., Darmasurya, A., Trisnanto, T. A., Tsani, P. N., Yudanto, B., & Trisnasari, T. (2024). Evaluating Primary Care Providers’ Compliance with Special Capitation in Indonesia’s National Health Insurance. Jurnal Jaminan Kesehatan Nasional, 4(2), 109–121. https://doi.org/10.53756/jjkn.v4i2.206

References

  1. Agustina, R., Dartanto, T., Sitompul, R., Susiloretni, KA., Suparmi, Achadi, EL., Taher, A., Wirawan, F., Sungkar, S., Sudarmono, P., Shankar, AH., Thabrany, H., Agustina, R., Dartanto, T., Sitompul, R., Susiloretni, KA., Suparmi, Achadi, EL., Taher, A. Khusun, H. (2019). Universal Health Coverage in Indonesia: Concept, progress, and challenges. The Lancet, 393(10166), 75–102. https://doi.org/10.1016/s0140-6736(18)31647-7
  2. Amporfu E., Arthur E. Ghana’s Experience with Changing Provider Payment to Capitation in Primary Health. (2022). https://www.lshtm.ac.uk/media/59821
  3. Boerma, T., Eozenou, P., Evans, D., Evans, T., Kieny, M.-P., & Wagstaff, A. (2014). Monitoring progress towards universal health coverage at country and Global Levels. PLoS Medicine, 11(9). https://doi.org/10.1371/journal.pmed.1001731
  4. Gebru, T., & Lentiro, K. (2018). The impact of community-based health insurance on health-related quality of life and associated factors in Ethiopia: A comparative cross-sectional study. Health and Quality of Life Outcomes, 16(1). https://doi.org/10.1186/s12955-018-0946-3
  5. Haven, N., Dobson, A. E., Yusuf, K., Kellermann, S., Mutahunga, B., Stewart, A. G., & Wilkinson, E. (2018). Community-based health insurance increased healthcare utilisation and reduced mortality in children under five around Bwindi Community Hospital, Uganda, between 2015 and 2017. Frontiers in Public Health, p. 6. https://doi.org/10.3389/fpubh.2018.00281
  6. Hendratini Y, Muttaqien, Mukti AG, & Abdullah AA. (2018). (rep.). Kajian Efektifitas Pembayaran Kapitasi Khusus Untuk daerah Terpencil, Perbatasan dan Kepulauan . Yogyakarta, Indonesia: Gadjah Mada University
  7. Hidayat B, Pujiyanti E, Andalan A, Aisyah W, & Dhanalvin E. (2017). Studi Evaluasi Sistem Pembayaran FKTP Era JKN: Efektifitas KBK Dan Implikasinya Terhadap Efisiensi Dan Mutu Layanan.
  8. Hogan, D.R. et al. (2018). ‘Monitoring Universal Health coverage within the Sustainable Development Goals: Development and Baseline Data for an index of Essential Health Services’, The Lancet Global Health, 6(2). doi:10.1016/s2214-109x(17)30472-2
  9. Hogan, D. R., Stevens, G. A., Hosseinpoor, A. R., & Boerma, T. (2018). Monitoring Universal Health coverage within the Sustainable Development Goals: Development and Baseline Data for an index of Essential Health Services. The Lancet Global Health, 6(2). https://doi.org/10.1016/s2214-109x(17)30472-2
  10. ITO, T., Kounnavong, S., & Miyoshi, C. (2021). Financial Burden and Health-Seeking Behaviors Related to Chronic Diseases under the National Health Insurance Scheme in Bolikhamxay Province, Lao PDR: A Cross-Sectional Study. https://doi.org/10.21203/rs.3.rs-885719/v2
  11. Joshi, R., Pakhare, A., Yelwatkar, S., Bhan, A., Kalantri, S., & Jajoo, U. (2020). Impact of community-based health insurance and economic status on utilisation of healthcare services: A household-level cross-sectional survey from rural central India. The National Medical Journal of India, 33(2), 74. https://doi.org/10.4103/0970-258x.310921
  12. Kurniawan MF, Siswoyo BE, Novelira A, Sulistiawan D, Aisyah W, & Gadistina W. (2017). Pengelolaan Sisa Lebih Dana Kapitasi Di Fasilitas Kesehatan Tingkat Pertama Milik Pemerintah (Monitoring Dan Evaluasi Jaminan Kesehatan Nasional Di Indonesia)
  13. Ministry of Health of Indonesian Republic, 90 Providing Health Services in Health Service Facilities in Remote and Very Remote Areas (2015). Jakarta, Indonesia
  14. Ministry of Health of Indonesian Republic, 6 Use of Health Services and Support for Operational Costs of Health Services in the Utilization of National Health Insurance Capitation Funds in First Level Health Facilities Owned by Regional Governments (2022). Jakarta, Indonesia
  15. Nyberg, A. J., Pieper, J. R., & Trevor, C. O. (2016). Pay-for-performance’s effect on future employee performance. Journal of Management, 42(7), 1753–1783. https://doi.org/10.1177/0149206313515520
  16. President of Republic of Indonesia, 32 Management and Utilization of National Health Insurance Capitation Funds in First Level Health Facilities Owned by Regional Governments (2014). Jakarta, Indonesia
  17. President of the Republic of Indonesia, 64 Regulation of the President of the Republic of Indonesia Number 64 of 2020 Concerning Second Amendment to Presidential Regulation Number 82 of 2018 Concerning Health Insurance (2020). Jakarta, Indonesia
  18. President of the Republic of Indonesia, 46 Amendments to the Management and Utilization of National Health Insurance Capitation Funds in First Level Health Facilities Owned by Regional Governments (2021). Jakarta, Indonesia
  19. Purnamasari T, & Puspandari DA. (2019). Analisis Persepsi Stakeholder Terhadap Penetapan Kriteria Daerah Terpencil Dan Sangat Terpencil Dalam Kebijakan Baru Sistem Kapitasi Khusus Di Kabupaten Bengkuli Utara Provinsi Bengkulu
  20. Sharma, P., Yadav, D. K., Shrestha, N., & Ghimire, P. (2021). Dropout analysis of a National Social Health Insurance Program at Pokhara Metropolitan City, Kaski, Nepal. International Journal of Health Policy and Management. https://doi.org/10.34172/ijhpm.2021.171
  21. Sriram, S., & Khan, M. M. (2020). Effect of health insurance program for people with low incomes on out-of-pocket inpatient care cost in India: Evidence from a nationally representative cross-sectional survey. BMC Health Services Research, 20(1). https://doi.org/10.1186/s12913-020-05692-7
  22. Syukran M, & As Shidieq FH. (2020). Dampak Kapitasi Khusus Terhadap Capaian Kinerja Fasilitas Kesehatan Tingkat Pertama di Kabupaten, 23
  23. WHO. (2016). (rep.). Health financing country diagnostic: a foundation for national strategy development. Geneva: WHO
  24. World Bank Group. (September 25). Going universal: How 24 countries are implementing universal health coverage reforms from the bottom up. World Bank. https://www.worldbank.org/en/topic/universalhealthcoverage/publication/going-universal-how-24-countries-are-implementing-universal-health-coverage-reforms-from-bottom-up
  25. Xu, M., & Yang, W. (2021). Who will drop out of voluntary social health insurance? Evidence from the New Cooperative Medical Scheme in China. Health Policy and Planning, 36(7), 1013–1022. https://doi.org/10.1093/heapol/czab017