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

Authors

  • Yulia Susanti Faculty of Law, Andalas University, Padang, Indonesia
  • Khairani Faculty of Law, Andalas University, Padang, Indonesia

DOI:

https://doi.org/10.38035/jlph.v5i3.1545

Keywords:

National Health Insurance, Performance-Based Capitation, Primary Healthcare Facilities

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.

References

Anggraini, M. R., Permatasari, P., Azahra, S., & Astuti, W. D. (2023). Efektivitas penilaian kinerja dan penggajian berbasis kinerja dalam peningkatan kualitas layanan kesehatan. Indonesian Journal of Health Science, 4(6), 883–892.

Anindita, R., & Nadjib, M. (2024). Hubungan Status Pemberlakuan Konsekuensi Dengan Capaian Indikator Kapitasi Berbasis Kinerja Pada Puskesmas Dalam Program Jaminan Kesehatan. Jurnal Cahaya Mandalika ISSN 2721-4796 (Online), 2020–2030.

Ari Dwi Aryani, Adang Bachtiar, C. C. (2024). The Structural Equation Modelling of First Level Health Facilities’ Performance-Based Capitation Payment in National Health Service. In Department of Health Policy and Administration. Universitas Indonesia.

Ari Dwi Aryani. (2022). Factors Affecting the Achievements of Performance-Based Capitation: A Scoping Review. Jurnal Jaminan Kesehatan Nasional (JJKN), 2(1), 53–65. https://doi.org/10.53756/jjkn.v2i1.52

Chatila Maharani, et. a. (2024). Perjalanan Asuransi Kesehatan Dan Sistem Pembayaran Kapitasi Di Indonesia. Bookchapter Kesehatan Masyarakat Universitas Negeri Semarang, 5, 86–133. https://doi.org/https://doi.org/10.15294/km.v1i5.197

Djamhari, Eka A., et al. (2020). Defisit Jaminan Kesehatan Nasional (JKN): Mengapa dan Bagaimana Mengatasinya? Perkumpulan PRAKARSA. https://repository.theprakarsa.org/

Fadila, R., & Katmini. (2022). Determinan Pencapaian Indikator Kapitasi Berbasis Kinerja pada Fasilitas Kesehatan Tingkat Pertama: Tinjauan Sistematik. Jurnal Kesehatan Komunitas, 8(3), 408–417. https://doi.org/10.25311/keskom.vol8.iss3.1272

Grace E. C. Korompis. (2021). Jaminan Kesehatan Nasional Buku Ajar. CV. Patra Media Grafindo.

Hendrartini, Y. (2008). Determinan Kinerja Dokter Keluarga Yang Dibayar Kapitasi. Jurnal Manajemen Pelayanan Kesehatan, 11(2), 77–84.

HUMAS MENPANRB. (2022). KBK, Inovasi BPJS Kesehatan yang mengukur Kinerja Fasilitas Kesehatan. https://www.menpan.go.id/site/berita-terkini/kbk-inovasi-bpjs-kesehatan-yang-mengukur-kinerja-fasilitas-kesehatan

Kementerian Kesehatan. (2024). FS Kapitasi Berbasis Kinerja dalam JKN. Badan Kebijakan Pembangunan Kesehatan.

Nanda Elok Juwita, D. S. (2023). Analisis Komunikasi Efektif Terhadap Capaian Kapitasi Berbasis Kinerja di Fasilitas Kesehatan Tingkat Pertama Kabupaten Bengkayang. Jurnal Jaminan Kesehatan Nasional, 3(2), 37–55.

Novat Pugo Sambodo, et. a. (2023). Effects Of Performance-Based Capitation Payment On The Use Of Public Primary Health Care Services In Indonesia. Soc Sci Med, 327. https://doi.org/10.1016/j.socscimed.2023.115921

Putri, A. E. (2014). Paham SJSN Sistem Jaminan Sosial Nasional. In DJSN. Friedrich-Ebert-Stiftung. https://doi.org/10.1017/CBO9781107415324.004

Rachmad Suhanda. (2015). Jaminan Kesehatan dan Managed Care. Jurnal Kedokteran Syiah Kuala, 15(2), 104–113.

Rian Adi Pamungkas, et. a. (2020). A health-based coaching program for diabetes self-management (DSM) practice: A sequential exploratory mixed-method approach. Ndocrinología, Diabetes y Nutrición, 30(2), 489–500.

Rizki Fadila, Mega Putri Via, AAI Citra Dewiyani, A. A. (2023). Analisis Pencapaian Indikator Kapitasi Berbasis Kinerja Pada Masa Pandemi Covid 19. Jurnal Kesehatan Qamarul Huda, 11(1), 241–249. https://doi.org/DOI: 10.37824/jkqh.v11i1.2023.446

Rizki Fadila, A. F. P. (2021). Analisis Faktor Penyebab Tingginya Rasio Rujukan Non Spesialistik Puskesmas Rawat Inap. Keskom, 7(2), 144–149.

Siti Halimatul Munawarah, Misnaniarti, I. (2020). Sumber Daya Terhadap Pencapaian Indikator Kapitasi Berbasis Pemenuhan Komitmen Pelayanan (KBPKP) di Puskesmas Kota Palembang. GASTER, 18(1), 37–49.

Suci Rahmadani. (2019). Sistem Rujukan Pelayanan Kesehatan Primer Era JKN. Uwais Inspirasi Indonesia.

Syukran, M. (2023). Implementasi Sistem Pembayaran Kapitasi pada Fasilitas Kesehatan Primer: Literature Review. Promotif?: Jurnal Kesehatan Masyarakat, 13(1), 7–14. https://doi.org/10.56338/promotif.v13i1.3743

World Health Organisation. (2017). Provider payment methods and strategic purchasing for UHC. 1–6. https://apps.who.int/iris/handle/10665/258894

Zahrina, et. al. (2023). Pelayanan Kesehatan Primer Sebagai Gatekeeper Dan Kebijakan Diskusi Peer Review: Antara Kualitas Dan Realitas Untuk Menurunkan Kasus Rujukan Non Spesialistik. Jurnal Ekonomi Kesehatan Indonesia, 8(2), 142–153. https://doi.org/10.7454/eki.v8i2.5482

Downloads

Published

2025-03-13

How to Cite

Yulia Susanti, & Khairani. (2025). Performance Based Capitation Settings in the National Health Insurance Program for Primary Healthcare Facilities. Journal of Law, Politic and Humanities, 5(3), 2271–2281. https://doi.org/10.38035/jlph.v5i3.1545

Issue

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

Section

Articles

License

Copyright (c) 2025 Yulia Susanti, Khairani

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors who publish their manuscripts in this journal agree to the following conditions:

  1. The copyright on each article belongs to the author(s).
  2. The author acknowledges that the Journal of Law, Poliitic and Humanities (JLPH) has the right to be the first to publish with a Creative Commons Attribution 4.0 International license (Attribution 4.0 International (CC BY 4.0).
  3. Authors can submit articles separately, arrange for the non-exclusive distribution of manuscripts that have been published in this journal into other versions (e.g., sent to the author's institutional repository, publication into books, etc.), by acknowledging that the manuscript has been published for the first time in the Journal of Law, Poliitic and Humanities (JLPH).