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All Journal Jurnal Jaminan Kesehatan Nasional Jurnal Ilmu Informasi, Perpustakaan, dan Kearsipan
Darmasurya, Aditya
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Decision Sciences, Operations Research & Management Dentistry Health Professions Library & Information Science Medicine & Pharmacology Public Health

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Did The Horizontal Referral Policy in Indonesia Create Cost Savings? Darmasurya, Aditya; Anindita, Rahma; Ikhda, M Candra
Jurnal Jaminan Kesehatan Nasional Vol. 1 No. 1 (2021): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (527.319 KB) | DOI: 10.53756/jjkn.v1i1.14

Abstract

Background: In Indonesia, the referrals to hospitals by Primary Care Providers (PCPs) is high. In 2018, more than 15 per cent of patients visiting PCPs were referred to hospitals, while the cost for outpatient visits reached 51.2 trillion rupiahs. As of September 2019, Indonesia’s Body of Social Security for Health of Indonesia (BPJS Kesehatan) enacted a horizontal referral policy. PCPs will refer patients to other PCPs with more resourced facilities. Objectives: To assess the impact of horizontal referral on hospital outpatient visits and how cost savings were made. Methods: This study is a non-experimental big-data analysis by observational descriptive method. Results: Data results were classified into two groups in order to separate data analysis affected by external COVID-19 pandemic factors. Group I consisted of data from September to December 2019 and group II consisted of data from January 2020 to October 2020. In data Group I, a total of 8.140 cases were referred horizontally and not referred to hospitals. Referral ratio decreased from 16,50% prior the policy enactment to 15,71% in December 2019. In data Group II, horizontal referral showed an increasing trend from January to October 2020 with 56.875 total cases being referred among primary care providers. Cost savings from September 2019 to October 2020 reached 25.891.347.236 rupiahs. Conclusions: The horizontal referral policy in Indonesia reduced the number of patients referred to hospitals, hence creating cost savings. It proposes collaboration among primary care providers, thus controlling unnecessary referrals to hospitals.
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

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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 Anindita, Rahma Aryani, Ari Dwi Ikhda, M Candra Ritonga, Rahmad Asri Trisnanto, Tedo Arya Trisnasari, Trisnasari Tsani, Pranatawati Nur Yudanto, Bayu