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

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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 Anindita, Rahma Aryani, Ari Dwi Darmasurya, Aditya Ritonga, Rahmad Asri Trisnasari, Trisnasari Tsani, Pranatawati Nur Yudanto, Bayu