National Health Insurance Participants' Distribution at Primary Health Center in Gubeng District, Surabaya
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Background: The amount of capitation received by primary healthcare facilities under Indonesia National Health Insurance is based on the number of participants registered in the facilities. The imbalance in the number of participants per primary healthcare facilities causes disparities in the distribution of its capitation funds. The uneven distribution of participants also causes the imbalance of health risks managed by the primary healthcare facilities.
Objective: This study aims to describe the distribution of National Health Insurance participants at First Level Health Facilities in Gubeng District, Surabaya City based on the type of FKTP and the location of the health facility in the village.
Method: This study analyzes the Indonesia National Health Insurance membership data for 2021 at the BPJS Kesehatan KCU Surabaya. The case study in Gubeng Subdistrict, Surabaya was chosen to illustrate how the distribution of participants in the primary healthcare facilities is in an area that has relatively no problems with geographic access or the availability of referral health facilities.
Results: The number of private primary healthcare facilities (clinics and private medical practice) in Gubeng Subdistrict is higher than the government's primary healthcare facilities (Puskesmas, TNI/POLRI Clinics) but the largest ratio of participants is in government primary healthcare facilities. Kelurahan Mojo in Gubeng had the largest number of primary healthcare facilities, but the largest ratio of participants was in Kelurahan Airlangga. At least 43.7% of the primary healthcare facilities in Gubeng Subdistrict had a ratio of participants above the average ratio of participants per primary healthcare facilities in the sub-district.
Conclusion: The distribution of JKN participants to primary healthcare facilities in Gubeng District is uneven.
Eggleston, K. (2000) ‘Risk Selection and Optimal Health Insurance-Provider Payment Systems', The Journal of Risk and Insurance, 67(2), p. 173. Available at: https://doi.org/10/c6rx2g.
Emanuel, E.J., Mostashari, F. and Navathe, A.S. (2021) ‘Designing a Successful Primary Care Physician Capitation Model', JAMA, 325(20), p. 2043. Available at: https://doi.org/10/gjz4h4.
Esmaeili, R. et al. (2016) ‘The Experience of Risk-Adjusted Capitation Payment for Family Physicians in Iran: A Qualitative Study', Iranian Red Crescent Medical Journal, 18(4). Available at: https://doi.org/10/gnhtc4.
Hasan, A.G. and Adisasmito, W.B.B. (2017) ‘Analisis Kebijakan Pemanfaatan Dana Kapitasi JKN pada FKTP Puskesmas di Kabupaten Bogor Tahun 2016', Jurnal Kebijakan Kesehatan Indonesia, 6(3), p. 127. Available at: https://doi.org/10/gpb73d.
Khoeriyah, G.A., Mardiah, I. and Hidayati, M. (2021) ‘Analisis Faktor Yang Mempengaruhi Kapitasi Berbasis Komitmen (KBK) Di Puskesmas Cikancung Dinas Kabupaten Bandung', Cerdika: Jurnal Ilmiah Indonesia, 1(8), p. 6.
Kongstvedt, P.R. (ed.) (2013) Essentials of Managed Health Care. 6th ed. Burlington, MA: Jones and Bartlett Learning.
Kongstvedt, P.R. (2020a) Health insurance and managed care: what they are and how they work. Fifth edition. Burlington, MA: Jones & Bartlett Learning.
Kongstvedt, P.R. (2020b) Health insurance and managed care: what they are and how they work. Fifth edition. Burlington, MA: Jones & Bartlett Learning.
Langenbrunner, J.C., O'Duagherty, S. and Cashin, C.S. (eds) (2009) Designing and Implementing Health Care Provider Payment Systems: ‘How-to' Manuals. The World Bank. Available at: https://doi.org/10.1596/978-0-8213-7815-1.
Lipson, D., Soper, M.H. and Ensslin, B. (2016) Developing Capitation Rates for Medicaid Managed Long-Term Services and Supports Programs: State Considerations, p. 13.
Manurung, J. (2021) ‘Analisa capaian indikator kapitasi berbasis komitmen (KBK) pelayanan terhadap pembayaran dana kapitasi di Puskesmas Hutabaginda Kecamatan Tarutung Kabupaten Tapanulis Utara Tahun 2019', Jurnal AKRAB JUARA, 6(2), pp. 189–200.
Rice, N. and Smith, P. (1999) Approaches to capitation and risk adjustment in health care: an international survey. York: University of York.
Tan, S.Y. and Qian, J. (2019) ‘An unintended consequence of provider payment reform: The case of capitation grants in the National Health Insurance reform of Indonesia', The International Journal of Health Planning and Management, 34(4). Available at: https://doi.org/10.1002/hpm.2883.
Wiggins, K. and Hadley, J. (1986) ‘Capitation and the Medicare Program: History, Issues, and Evidence', Health Care Financing Review, p. 12.
Wynia, M.K. et al. (2002) ‘Patient protection and risk selection: Do primary care physicians encourage their patients to join or avoid capitated health plans according to the patients' health status?', Journal of General Internal Medicine, 17(1), pp. 40–47. Available at: https://doi.org/10/dpww5c.
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