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All Journal Jurnal Jaminan Kesehatan Nasional Kesmas: Jurnal Kesehatan Masyarakat Nasional (National Public Health Journal) Jurnal Ilmu Informasi, Perpustakaan, dan Kearsipan
Aryani, Ari Dwi
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Decision Sciences, Operations Research & Management Dentistry Health Professions Library & Information Science Medicine & Pharmacology Public Health

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The Structural Equation Modelling of First Level Health Facilities’ Performance-Based Capitation Payment in National Health Service Aryani, Ari Dwi; Bachtiar, Adang; Candi, Cicilya
Kesmas Vol. 19, No. 1
Publisher : UI Scholars Hub

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Abstract

The BPJS Healthcare Security implemented performance-based capitation/Kapitasi Berbasis Kinerja(KBK) payments to conduct structured and ongoingmonitoring of the First Level Health Facilities/Fasilitas Kesehatan Tingkat Pertama(FKTP)'s performance throughout Indonesia. This study aimed to examinethe direct and indirect effects of FKTP capacity on KBK and FKTP performance. This study was conducted in February 2023, and Structural EquationModelling analysis was performed with secondary data from the BPJS Healthcare Security system database in 2021. Human resources were defined as theavailability of doctors in FKTP, infrastructure as credentialing value, ownership and type of FKTP, and KBK, and performance as first contact, non-specialistoutpatient referral ratios, and Chronic Disease Management Program/Program Pengelolaan Penyakit Kronis(Prolanis) participant ratio. The analytical resultsrevealed that human resources directly and positively affected the KBK. The indirect effect analysis results suggested that only human resources impactedFKTP performance. In conclusion, human resources are critical in achieving the KBK and FKTP performance.
Evaluating Primary Care Providers' Compliance with Special Capitation in Indonesia's National Health Insurance Anindita, Rahma; Aryani, Ari Dwi; Ritonga, Rahmad Asri; Darmasurya, Aditya; Trisnanto, Tedo Arya; Tsani, Pranatawati Nur; Yudanto, Bayu; Trisnasari, Trisnasari
Jurnal Jaminan Kesehatan Nasional Vol. 4 No. 2 (2024): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v4i2.206

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.
Big Data Analysis on Indonesia’s Primary Care Pay-For Performance Darmasurya, Aditya; Aryani, Ari Dwi; Ritonga, Rahmad Asri; Anindita, Rahma; Tsani, Pranatawati Nur; Yudanto, Bayu; Trisnanto, Tedo Arya; Trisnasari, Trisnasari
Jurnal Ilmu Informasi, Perpustakaan dan Kearsipan Vol. 26, No. 2
Publisher : UI Scholars Hub

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Abstract

In Indonesia’s social security program (JKN), there are more than 1,6 million visits in primary care providers each day. Indonesia's Social Security Administrative Body for Health (BPJS Kesehatan) manages the healthcare data recorded by the providers. In late 2019, the new Performance-Based Capitation (KBK) was introduced to primary care providers. They are assessed every month before the due for capitation payment. There are three indicators in the KBK scheme which are contact rate, non-specialty referral ratio, and proportion of PROLANIS disease management program members with controlled clinical outcome (PROLANIS indicator. This study analyzes data insights of KBK through big data analysis to determine whether the policy shows improvement of primary care providers. It is a non-experimental big-data analysis by observational descriptive method. Data was retrieved from BPJS Kesehatan Business Intelligence program. There has been improvement in the indicator target achievement every year. However, only non-specialty referral ratio has reached the intended target. In July 2024, contact rate reached 149,56%, non-specialty referral ratio reached 0,85%, and PROLANIS indicator reached 4,71%.. KBK data shows the policy has improved quality of primary care providers. Further collaboration among all stakeholders is needed to increase the achievement.
Co-Authors Adang Bachtiar Anindita, Rahma Candi, Cicilya Darmasurya, Aditya Ritonga, Rahmad Asri Trisnanto, Tedo Arya Trisnasari, Trisnasari Tsani, Pranatawati Nur Yudanto, Bayu