Pengelolaan dan Pemanfaatan Dana Kapitasi (Monitoring dan Evaluasi Jaminan Kesehatan Nasional di Indonesia)

ABSTRACTBackground: The Indonesian National Health Insurance (JKN)was commenced in early 2014. BPJS Kesehatan (parastatal organization appointed as JKN management entity) and the primary health centers (PHCs) are dealing with challenges and bottlenecks in providing quality health service to JKN beneficiaries. One of the challenges is the management and utilization of the capitation fund, which is used as the payment model for PHC. The monitoring and evaluation of the capitation fund are imperative to improve the attainment of universal health coverage through JKN program.Objective: To analyze the management and utilization of capitation fund in PHC including the bottlenecks and to generate solutions in the implementation of JKN.Method: This is a descriptive study using quantitative and qualitative approaches. A total of 384 PHCs in 7 regionals and 20 districts were selected using random sampling. Primary data were collected through series of interviews and FGDs using a standardized questionnaire. Secondary data on capitation fund and health care services (2014-mid 2015) were collected from primary health centers and BPJS Kesehatan database. Qualitative data were analyzed using thematic approach and quantitative data were descriptively analyzed to show the capitation fund and health care utilization trend at PHC level.Result: Although an increase in overall income from capitation fund was observed in the majority of PHCs, there was a higher increase in patient utilization leading to lower actual capitation income generated by PHCs. Such finding is applicable morely to Private GP Practice (Dokter Praktik Perorangan) and Private Primary Clinic (Klinik Pratama). Quantitative findings show that most private PHCs experienced deficit. Most Puskesmas used Head of District decree/district regulation as the main legal basis for capitation fund management and utilization. However, many of the local regulations are not completely in line with central-level mainly because of the rapid changes at the central-level. Such disconnection of policies between levels of government has led to confusion at the PHC level in fund management and use. As the sole purchaser, BPJS Kesehatan is considered to be not yet well involved in district capitation fund planning and budgeting. Such practices were perceived to be even less condusive in the monitoring and evaluation of capitation fund usage.Conclusion: To ensure the quality of care and the sustainability of PHCs as JKN providers, capitation fund should be increased. Local government needs to support JKN implementation by issuing clear guidelines that follow central policies on how PHCs should plan and manage capitation fund. Continuous monitoring and evaluation of capitation fund is important to ensure that JKN program targets are achieved at the primary care level.Keywords: capitation, management, utilizationABSTRAKLatar Belakang: Jaminan Kesehatan Nasional (JKN) mulai diselenggarakan di Indonesia sejak tahun 2014. BPJS Kesehatan (badan yang ditunjuk sebagai penyelenggara JKN)dan fasilitas kesehatan tingkat pertama (FKTP) menghadapi tantangan dan hambatan dalam penyediaan pelayanan kesehatan yang berkualitas kepada peserta JKN. Salah satu tantangannya adalah dalam pengelolaan dan pemanfaatan dana kapitasi sebagai model pembayaran FKTP. Monitoring dan evaluasi penyelenggaran dana kapitasi menjadi penting untuk meningkatkan capaian jaminan kesehatan semesta melalui program JKN.Tujuan: Menganalisis pengelolaan dan pemanfaatan dana kapitasi di FKTP, termasuk kendala dan alternatif solusi dalam penyelenggaraan JKN.Metode: Studi deskriptif ini menggunakan pendekatan kuantitatif dan kualitatif. Sampel 384 FKTP di 7 regional dan 20 kabupaten/ kota dipilih secara acak. Data primer dikumpulkan melalui serangkaian wawancara dan FGD dengan kuesioner terstan- dar. Data sekunder terkait dana kapitasi dan pelayanan kese- hatan (2014 – pertengahan 2015) dikumpulkan dari FKTP dan BPJS Kesehatan. Data kualitatif dianalisis menggunakan pendekatan tematik sementara data kuantitatif dianalisis secara deskriptif untuk menunjukkan tren dana kapitasi dan utilisasi pelayanan kesehatan di FKTP.Hasil: Meski peningkatan penerimaan dari dana kapitasi ditemukan di sebagian besar FKTP, namun tingginya utilisasi pasien cenderung menurunkan kapitasi aktual di FKTP. Temuan tersebut terutama dialami dokter praktek perorangan dan klinik pratama. Analisis kuantitatif juga menunjukkan sebagian besar FKTP swasta mengalami defisit. Sebagian besar Puskesmas menggunakan SK Bupati/ Peraturan Daerah (Perda) sebagai dasar hukum utama dalam pengelolaan dan pemanfaatan dana kapitasi. Namun, banyak kebijakan dari Perda yang tidak sepenuhnya sejalan dengan kebijakan Pusat, terutama karena perubahan kebijakan yang cepat di tingkat Pusat. Kondisi ini menyebabkan kebingungan bagi FKTP dalam mengelola dan memanfaatkan dana kapitasi. Sebagai satu-satunya pembayar, BPJS Kesehatan dianggap belum terlalu terlibat dalam perencanaan dan penganggaran dana kapitasi di daerah. Hal ini kurang kondusif dalam mendukung monitoring dan evaluasi penggunaan dana kapitasi.Kesimpulan: Untuk memastikan kualitas pelayanan kesehatan dan keberlanjutan FKTP sebagai penyedia layanan, dana kapitasi sebaiknya ditingkatkan. Perda juga diperlukan untuk mendukung penyelenggaraan JKN dengan menerbitkan pedoman yang jelas dan mengikuti kebijakan Pusat terkait bagaimana FKTP sebaiknya merencanakan dan mengelola dana kapitasi. Monitoring dan evaluasi kapitasi secara berkelanjutan sangat penting untuk memastikan ketercapaian sasaran program JKN di tingkat pelayanan primer.Kata Kunci: dana kapitasi, pengelolaan, pemanfaata

Sistem Pembayaran Mixed Method INA-CBGs dan Global Budget di Rumah Sakit: Tahap 1 Uji Coba Mixed Method INA-CBGs-Global Budget di Indonesia

AbstrakTidak ada sistem pembayaran pelayanan kesehatan yang sempurna dalam penerapannya termasuk sistem pembayaran DRG (Diagnosis-Related Groups) yang lebih dikenal dengan nama INA-CBGs (Indonesia Case-Based Groups) di Indonesia. Beberapa negara yang mengadopsi DRG telah menerapkan kebijakan pembayaran mixed method DRG-Global Budget dengan variasi implementasinya demi menjaga kesinambungan sistem jaminan kesehatan nasional di negaranya. BPJS Kesehatan menginisiasi studi operasional penerapan sistem pembayaran rumah sakit mixed-method INA-CBGs dan Global Budget mulai tahun 2018. Terdapat tiga tahapan dalam uji coba sistem pembayaran rumah sakit mixed-method INA-CBGs dan Global Budget ini. Tahap pertama adalah Global Budget Tanpa Resiko yang bertujuan untuk menguji metode penghitungan global budget dan mengidentifikasi tantangan yang dihadapi bila kebijakan mixed method INA-CBGs dan Global Budget ini diberlakukan. Studi dilakukan di 5 (lima) kabupaten/kota di 30 rumah sakit (RS). Hasil studi menunjukkan bahwa metodologi penghitungan global budget yang diterapkan cukup akurat untuk memprediksi realisasi klaim di RS. Penghitungan global budget di tingkat kabupaten/kota lebih akurat hasilnya dibandingkan dengan menghitung global budget di tingkat RS karena mengakomodir shifting pasien dari RS yang satu ke RS yang lainnya akibat perubahan kapasitas RS. Perubahan kapasitas RS di tahun berjalan dan adanya pandemi COVID-19 menyebabkan adanya selisih antara penghitungan global budget dan realisasi klaim.AbstractWhen it comes to provider payment system, no one shoe fits all including DRG payment system which in Indonesia are known as INA-CBGs. In some countries that used DRG have mixed it with Global Budget in various mechanisms to maintain the sustainability of the national health insurance system in their countries. BPJS Kesehatan initiated a three-stage pilot study on the implementation of the mixed-method hospital payment system INA-CBGs and Global Budget starting in 2018. The first stage is the Non-Risk stage which aims to test the accuracy of the global budget calculation and prediction and to identify the challenges faced when the mixed-method payment is implemented. The pilot was conducted in 5 districts in 30 hospitals. Initial results show that the calculation and prediction method is accurate to predict the actual hospital claims in the following year. The calculation of the global budget at the district level is more accurate than the hospital level because it accommodates patient transfer from one hospital to another due to changes in hospital capacity. Changes in hospital capacity in the current year and the COVID-19 pandemic requires some adjustments to the budget calculation

Knowledge, attitudes, and practices related to COVID-19 in Indonesia: A post delta variant wave cross-sectional study

IntroductionPublic information and regulations related to the coronavirus disease 2019 (COVID-19) have been widely published and continuously changed. The Indonesian government has responded to the emerging evidence by regularly updating its unprecedented and preventive measures against the transmission of COVID-19 to the public. It is important to understand how the public responded to these updates. This study aimed to investigate the knowledge, attitudes, and practices of Indonesians toward COVID-19 after the emergence of the delta variant wave.MethodsA cross-sectional study was conducted among the adult population of non-healthcare workers in Indonesia through an online questionnaire using the SurveyMonkey platform. A total of 1,859 respondents completed this survey from September to October 2021. The knowledge, attitudes, and practices data were analyzed descriptively to find their frequency and percentage. A multivariate analysis was conducted to confirm the factors affecting the respondents' knowledge, attitudes, and practices with a p-value of <0.05 set as significant.ResultsBeing female, having a higher education level, and having a higher frequency of access to COVID-19 news showed significant impacts on knowledge, attitudes, and practices (p<0.001). Older age stratification influenced the knowledge level (p<0.05) but had no significant effect on people's attitudes and practices toward COVID-19. Respondents' perceived probability of being exposed to COVID-19 (p < 0.05) and their COVID-19 infection frequency (p < 0.001) significantly influenced their knowledge. Household income and respondents' knowledge significantly affected their attitudes toward COVID-19. Furthermore, only their attitudes had a significant impact on the respondents' practices. Perceived severity, perceived susceptibility, and vaccination status did not significantly influence their knowledge, attitudes, and practices (p > 0.05).ConclusionAfter more than a year of the COVID-19 pandemic, Indonesians maintain their high level of knowledge, attitudes, and practices. COVID-19 disinformation must be combatted by strengthening authorized media, empowering communities, and improving governance among institutions during and post-pandemic

Why did informal sector workers stop paying for health insurance in Indonesia? Exploring enrollees' ability and willingness to pay.

Indonesia faces a growing informal sector in the wake of implementing a national social health insurance system-Jaminan Kesehatan Nasional (JKN)-that supersedes the vertical programmes historically tied to informal employment. Sustainably financing coverage for informal workers requires incentivising enrolment for those never insured and recovering enrolment among those who once paid but no longer do so. This study aims to assess the ability- and willingness-to-pay of informal sector workers who have stopped paying the JKN premium for at least six months, across districts of different fiscal capacity, and explore which factors shaped their willingness and ability to pay using qualitative interviews. Surveys were conducted for 1,709 respondents in 2016, and found that informal workers' average ability and willingness to pay fell below the national health insurance scheme's premium amount, even as many currently spend more than this on healthcare costs. There were large groups for whom the costs of the premium were prohibitive (38%) or, alternatively, they were both technically willing and able to pay (25%). As all individuals in the sample had once paid for insurance, their main reasons for lapsing were based on the uncertain income of informal workers and their changing needs. The study recommends a combination of strategies of targeting of subsidies, progressive premium setting, facilitating payment collection, incentivising insurance package upgrades and socialising the benefits of health insurance in informal worker communities