Jurnal Jaminan Kesehatan Nasional
Vol. 5 No. 1 (2025): Jurnal Jaminan Kesehatan Nasional

Stakeholders’ Perceptions of Performance-Based Capitation Design Using Chronic Disease Indicators at Primary Health Care Facilities

Sitorus, Susy Hartati Novintry (Unknown)



Article Info

Publish Date
30 Jun 2025

Abstract

Based on BPJS Kesehatan’s utilization review data (Social Security Administrative body for Health) until December 2023, only 32% of 273 primary healthcare facilities met the fourth level for the Controlled prolanis participant ratio (RPPT) indicator. This indicator reflects the percentage of Prolanis-registered patients diagnosed with Diabetes Mellitus (DM) or Hypertension (HT) who have achieved controlled fasting blood glucose (for DM) or controlled blood pressure (for HT), with a performance target of ≥ 5%. Meanwhile, 42% of facilities reached the Angka Kontak (AK/Contact Number) target, which measures the number of participants who contacted Primary Health Care Facilities (FKTP) compared to the total registered participants, multiplied by 1,000; the target is ≥ 150 per mille. However, 83% of facilities achieved the Non-Specialist Referral Ratio (RRNS) target, which compares the number of non-specialist case referrals to total referrals; the target is ≤ 2%. These findings highlight the need for stronger motivation mechanisms, such as financial incentives, to support FKTP in achieving better scores in the Performance-Based Capitation (KBK) model. This study explores stakeholder perceptions regarding an incentive-based KBK model using the RPPT indicator in FKTPs in Medan. Stakeholders shared several key perspectives: (1) RPPT targets should range between 5% and 10%, with incentives tied to rating levels; (2) intermediate outcome indicators should include HbA1c for DM and blood pressure for HT; (3) incentive payments should be allocated to FKTPs and managed to strengthen chronic disease services; and (4) these payments must be consistent and sustainable.

Copyrights © 2025






Journal Info

Abbrev

jjkn

Publisher

Subject

Decision Sciences, Operations Research & Management Dentistry Health Professions Medicine & Pharmacology Public Health

Description

Jurnal Jaminan Kesehatan Nasional merupakan salah satu bentuk upaya pengembangan dan menjadi rujukan ilmiah bagi para akademisi dan praktisi terkait Jaminan Kesehatan Nasional. Jurnal ini memuat artikel-artikel terkait bidang Jaminan Kesehatan Nasional melalui berbagai pendekatan ilmiah yang ...