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Journal : Kesmas: Jurnal Kesehatan Masyarakat Nasional (National Public Health Journal)

Direct Medical Costs of Diabetes Mellitus Treatment for Patients with Cardiovascular and Renal Complications Fadila, Rizki; Purnamasari, Ayu Tyas; Citra Dewiyani, A.A. Istri
Kesmas Vol. 20, No. 5
Publisher : UI Scholars Hub

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Abstract

Type 2 Diabetes Mellitus (T2DM) represents a growing global health challenge with significant clinical and economic implications, notably in Indonesia. The burden is intensified by renal and cardiovascular complications, especially among National Health Insurance beneficiaries. This retrospective study evaluated the direct medical costs of hospitalized T2DM patients with such complications at a type B hospital from 2019 to 2022. Costs were analyzed from both healthcare provider and payer perspectives, covering medical services, medical support services, pharmaceuticals, and other support services. Of the 192 patients reviewed, most were male (57.8%), aged 45–64 years (72.4%), with hospital stays of 1–5 days (90,1%) and severity level E-4-10-I (100%). Renal complications incur higher treatment costs than cardiovascular complications, with medical support services dominating renal costs and medical services such as doctor and nursing procedures, examinations, and visits contributing most to cardiovascular costs. These results highlight the urgent need for preventive measures, early diagnosis, and innovative treatments to optimize T2DM management and reduce associated economic burdens.
Capitation Management Through Performance-Based Capitation Mechanism of Primary Health Care in Malang, Indonesia Purnamasari, Ayu Tyas; Ningrum, Herlinda Dwi; Ardhiasti, Anggi; Zahroh, Asri Hikmatuz
Kesmas Vol. 19, No. 5
Publisher : UI Scholars Hub

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Abstract

Primary health care (PHC) has one of the largest funding sources, capitation, which BPJS Healthcare Security transfers monthly. Capitation fund receipts were frequently insufficient due to failure to meet performance-based capitation/Kapitasi Berbasis Kinerja (KBK) targets, including for PHC in Malang City, Indonesia. This study aimed to examine the management and utilization of capitation funds through a KBK mechanism. This descriptive study used a qualitative approach supported by quantitative data. This study was conducted from July to August 2023 and purposely selected nine informants from BPJS Healthcare Security, the local health office, and PHC. The interviews were transcribed verbatim and analyzed using a thematic analysis approach. Three themes were identified from data analysis: revenue allocation, utilization allocation, and budget expenditure appropriateness. The use of capitation follows the Mayor's regulations, which allocate service and operational costs. However, remaining capitation funds always occur due to unavoidable conditions. Separating accounts between capitation and other funding sources is necessary to track capitation utilization. Therefore, BPJS Healthcare Security needs to participate in capitation reporting and monitoring.