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All Journal Jurnal Pendidikan Kesehatan (e-Journal) Indonesian Journal of Health Insurance and Medical Records (IJHIMR)
Eko Rahman Setiawan
Poltekkes Kemenkes Malang
Education Health Professions Nursing Public Health

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PEMBAYARAN KAPITASI BERBASIS KINERJA PADA FASILITAS KESEHATAN TINGKAT PERTAMA (FKTP) KOTA MALANG Anggi Ardhiasti; Eko Rahman Setiawan
Jurnal Pendidikan Kesehatan Vol 10 No 2 (2021): Jurnal Pendidikan Kesehatan
Publisher : Poltekkes Kemenkes Malang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31290/jpk.v10i2.2268

Abstract

JKN applies the performance baxed capitation payment or called KBKP or Kapitasi Berbasis Komitmen Pelayanan in Primary health Care or FKTP, with 3 indicators, namely Contact Rate, Non Specialistic Referral Ratio, and Routine Visiting Prolanis Participant Ratio. The preliminary study for January until July 2019, the KBKP of Malang City is still low. The purpose of this research is to explore the application of KBKP from the point of view of policy implementation theory.The research method is a mix method with informants 8 FKTP, Malang Health Office, and BPJS Kesehatan KC Malang.The results showed that no one FKTP had received full capitation in 2019. The implementation of the socialization and evaluation policy has been running. Constraints in the availability of resources related to the operation of the p care application. The implementation of budgeting is adequate both from capitation, BOK and BLUD. The FKTP heads play a role in encouraging the fulfillment of the KBKP by motivating them to achieve targets, but there are FKTP heads who do not care much about the implementation of the KBKP. The Health Office has not implemented a reward and punishment policy in encouraging efforts to fulfill the KBKP. The fulfillment of the 2019 KBK at the FKTP in Malang City is still not optimal, competence in the FKTP is still an obstacle, and the Health Office has not implemented incentive and disincentive policies in fulfilling the KBKP indicators.
Strategi Manajemen Pelaksanaan Pengajuan Klaim Non Kapitasi BPJS Kesehatan di Puskesmas Lekok Zahwa Fairus Haq; Eko Rahman Setiawan; Subi Hariyanto
Indonesian Journal of Health Insurance and Medical Records (IJHIMR) Vol. 3 No. 2 (2026): Indonesian Journal of Health Insurance and Medical Records (IJHIMR)
Publisher : Kementerian Kesehatan Poltekkes Malang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31290/ijhimr.v3i2.7063

Abstract

Proses pengajuan klaim Non Kapitasi di Puskesmas Lekok menghadapi kendala administrasi dan sarana prasarana, yang berdampak pada keterlambatan pengajuan klaim serta kerugian pendapatan. Penelitian ini bertujuan untuk mengetahui proses pengajuan klaim Non Kapitasi BPJS Kesehatan di Puskesmas Lekok. Metode yang digunakan adalah penelitian kualitatif dengan pendekatan deskriptif studi kasus. Informan penelitian berjumlah 3 orang, terdiri atas 1 informan kunci dan 2 informan pendukung yang dipilih dengan teknik purposive sampling. Penelitian ini berfokus pada aspek Input yang meliputi man, material, method, dan machine; aspek Process yang meliputi kelengkapan berkas dan proses entri klaim Non Kapitasi; serta aspek Output yang meliputi status klaim dan hambatan yang terjadi. Pengumpulan data dilakukan melalui wawancara mendalam dan telaah dokumen, dengan keabsahan data diperiksa melalui triangulasi metode dan sumber. Hasil penelitian menunjukkan bahwa petugas klaim di Puskesmas Lekok masih merangkap jabatan, belum terdapat SOP tertulis khusus untuk pengajuan klaim Non Kapitasi, serta fasilitas yang tersedia sudah cukup memadai, namun masih ditemukan klaim pending akibat belum dientrinya data SOAP dan adanya irisan klaim dengan FKRTL. Puskesmas Lekok disarankan untuk menunjuk petugas khusus, menyusun SOP klaim Non Kapitasi, serta mengevaluasi proses pengajuan klaim secara berkala guna meminimalisasi kesalahan pengajuan.
Co-Authors Anggi Ardhiasti Subi Hariyanto Zahwa Fairus Haq