Journal of Law, Poliitic and Humanities
Vol. 5 No. 3 (2025): (JLPH) Journal of Law, Politic and Humanities

Performance Based Capitation Settings in the National Health Insurance Program for Primary Healthcare Facilities

Yulia Susanti (Unknown)
Khairani (Unknown)



Article Info

Publish Date
13 Mar 2025

Abstract

The National Health Insurance Program by the Health Social Security Administration Agency aims to provide access to quality, safe, and affordable health services. A capitation payment system is implemented for Primary Healthcare Facilities based on the number of registered participants, but this system faces obstacles in encouraging service quality improvement. To address this, Performance-Based Capitation was developed with key indicators such as contact numbers, non-specialist referral ratios, and controlled Prolanis participant ratios. This study uses normative juridical methods to analyze the regulations, implementation, and challenges of Performance-Based Capitation in National Health Insurance. The data was analyzed qualitatively through a study of laws and regulations, scientific literature, and related reports. The results of the study show that the implementation of Performance-Based Capitation is effective in increasing the utilization of Primary Healthcare Facilities, reducing the referral rate to an advanced level, and improving the management of chronic diseases. However, there are obstacles in the form of limited infrastructure, resource inequality, and lack of coordination between stakeholders. To increase the success of Performance-Based Capitation, it is necessary to strengthen regulations, increase the capacity of human resources, utilize information technology, and provide performance-based incentives.

Copyrights © 2025






Journal Info

Abbrev

JLPH

Publisher

Subject

Humanities Law, Crime, Criminology & Criminal Justice Social Sciences

Description

Journal of Law, Poliitic and Humanities is a research journal in Law, Humanities and Politics published since 2020 by the Dinasti Research. This journal aims to disseminate research results to academics, practitioners, students, and other parties who are interested in the fields of Law, Humanities ...