Analisis Tindakan Indikator Rujukan Rawat Jalan Non Spesialistik dan Peserta Prolanis Terkendali pada Kapitasi Berbasis Kinerja di Klinik Pratama Makmur Jaya: Analysis of Non-Specialistic Outpatient Referral Indicator Measures and Controlled Prolanis Participants on Performance-Based Capitation at the Makmur Jaya Pratama Clinic - Multazam, Andi Muhammad; Nurlinda, Andi; Irfan, Ahmad Azmul Asmar (Journal of Aafiyah Health Research (JAHR), 2024)
ABSTRAK Latar Belakang: Kapitasi Berbasis  Kinerja (KBK) merupakan penyesuaian besaran tarif kapitasi berdasarkan hasil penilaian pencapaian indikator pelayanan kesehatan perseorangan yang disepakati berupa komitmen pelayanan Fasilitas Kesehatan Tingkat Pertama dalam rangka peningkatan mutu pelayanan.  Terdapat 3 indikator yaitu Angka Kontak (AK, target >150 permil), Rasio Rawat Jalan Kasus Non Spesialistik (RRNS, target <2%), dan Rasio Peserta Prolanis Terkendali (RPPT, target >5%). Tujuan: Penelitian ini bertujuan mengkaji tindakan pencapaian RRNS dan RPPT pada KBK di Klinik pratama Makmur Jaya, karena belum terpenuhinya kedua indikator tersebut. Metode: Penelitian ini menggunakan metode kuasi kualitatif. Terdapat 6 informan pada penelitian ini, yaitu 1 informan kunci, 3 informan utama, dan 2 informan tambahan. Analisis data menggunakan model analisis interaktif yang terdiri dari reduksi data, sajian data, verifikasi. Hasil: Hasil penelitian ini didapatkan   terdapat kendala pencapaian pada (1) input  (man) yaitu petugas Klinik Makmur Jaya tidak megetahui secara spesifik bahwa RRNS dan RPPT termasuk dalam program KBK, kedisiplinan pada entry data, (machine) terdapat alat pemeriksaan penunjang yang belum tersedia dan (method) belum adanya pedoman khusus yang dimiliki Klinik Makmur Jaya.  (2) Pada process  terdapat kendala untuk mencapai RNNS seperti pasien belum sembuh setelah diberikan penangana awal di klinik sehingga perlu dirujuk, masih banyak pasien yang langsung meminta untuk dirujuk, rujukan kebanyakan dilakukan oleh dokter pengganti.  Kendala pada proses RPPT diantaranya peserta prolanis tidak aktif mengikuti kegiatan prolanis karena alasan pribadi, masih banyak pasien yang menyangkal kondisi DM atau hipertensi sehingga tidak mau diperiksa, masih banyak yang mengira reminder melalui Whatsapp sebagai pesan tubian (spam) atau bahkan penipuan. ABSTRACT Background: First Level Health Facilities may adjust their capitation rates in an effort to improve service quality, in accordance with performance-based capitation (KBK). This adjustment is predicated on the fulfillment of service commitments that represent agreed-upon individual health service indicators. Contact Rate (AK, target >150 per mil), Outpatient Ratio for Non-Specialized Cases (RRNS, target <2%), and Controlled Prolanis Participant Ratio (RPPT, target >5%) are the three indicators set forth. The objective of this research was to assess the performance of controlled prosthetic patients in performance-based capitation and the outpatient ratio for non-specialized cases at the Pratama Makmur Jaya Clinic. Objective: These two metrics had not been fulfilled thus far, and the purpose of this study was to determine their adherence. Method: This study employs a quasi qualitative methodology. The study included a total of 6 informants, comprising 1 key informant, 3 main informants, and 2 other informants. Data analysis employs an interactive approach that includes data reduction, data presentation, and verification. Results: The study revealed several hindrances to obtaining optimal input. Firstly, the employees did not know the specifics that RRNS and RPPT are included in the KBK program. Moreover, there was a lack of discipline in data entry by the individuals involved. Secondly, there was a dearth of available inspection tools to support the process. Lastly, the Makmur Jaya Clinic lacked particular recommendations to facilitate the input procedure.  Another finding is that during the process, there were challenges in obtaining RRNS. Some patients did not recover after receiving initial treatment at the clinic and needed to be referred. Additionally, there were many patients who directly requested to be referred. The majority of referrals were made by substitute doctors.  Challenges in the RPPT process involved Prolanis participants who were not actively engaging in Prolanis activities due to personal reasons. Additionally, there were numerous patients who refused to acknowledge their condition of Diabetes Mellitus or hypertension and consequently declined to undergo examination. Furthermore, many patients mistakenly regarded reminders sent via WhatsApp as spam messages or even fraudulent.