KEBIJAKAN INSENTIF DAN DISINSENTIF PEMBAYARAN KAPITASI BAGI FASILITAS KESEHATAN TINGKAT PERTAMA BERBASIS PEMENUHAN KOMITMEN PELAYANAN (KBK) (KESIAPAN FKTP DAN PENGEMBANGAN INDIKATOR PENILAIAN DI DI YOGYAKARTA)

Abstract

Incentives and disincentives of capitation payment to the first level of health facilities (the FKTP) are to improve the quality and performance of services. These effort have been made by the first level of health facilities (the FKTP) in the form of capitation, based on the fulfillment of Health Services Commitment, which started in 2015. The study aimed to examine the FKTP readiness and development of the first level of health facilities (the FKTP) performance appraisal indicators.   It was conducted in Yogyakarta Province, and then two districts and one city were selected (Sleman and Kulonprogo)

and Yogyakarta City purposively. In each district/city, it selected two primary health centers /PHCs (inpatient and non- inpatient PHCs), two primary clinics, two private doctors and two private dentists, with a criteria having many the National Social Scheme patients. Results show that in the view from aspects of the human resources, PHCs and primary clinics are ready as health service provider of the National Social Scheme, while private practice doctors or dentists are not yet, so it needs to adjust and improvements for family doctors. Credentialing as to be feasible as provider the National Social Scheme are needed. The recipients of assistance members at the primary clinics, private doctors or dentist are still low, and utilization of capitation funds at the first level of health facilities is good although promotive and preventive efforts are very low. Indicators to determine the capitation at the first level of health facilities (the FKTP) should be based on the first level of health facilities (the FKTP) function as gate keeper. The first level of health facilities score indicate that the developed indicators are comprehensiveness, sustainability of the prolanis program, the first contact visit, contact rate of indoor and outdoor services, beyond standard of the BPJS services. Therefore, it suggests to develope calculation of incentives and disinsentives by the 5 indicators considering abilities and competencies of the first level of health facilities (the FKTP’s).

ABSTRAK

Pemberian insentif dan disinsentif pada pembayaran kapitasi kepada FKTP dilakukan, agar FKTP dapat meningkatkan mutu dan kinerjanya. Upaya tersebut telah dilakukan FKTP dalam bentuk Kapitasi berbasis pada pemenuhan komitmen pelayanan kesehatan (KBK), yang dimulai sejak tahun 2015. Penelitian ini bertujuan untuk mengkaji kesiapan FKTP dan pengembangan indikator penilaian kinerja FKTP. Penelitian ini dilakukan di Provinsi DI Yogyakarta, dan dipilih 2 Kabupaten secara purposive (Sleman dan Kulonprogo) serta Kota Yogyakarta. Masing-masing Kabupaten/Kota dipilih 2 puskesmas (rawat inap dan non rawat inap), 2 klinik pratama, dan 2 dokter praktek dan 2 dokter gigi praktek perseorangan, dengan kriteria pasien JKN nya banyak. Hasil penelitian menunjukkan bahwa jika ditinjau dari aspek ketenagaannya, puskesmas dan klinik pratama siap sebagai provider pelayanan kesehatan peserta JKN. Praktek dokter dan dokter gigi praktek swasta belum siap, sehingga perlu menyesuaikan menjadi dokter keluarga dan melakukan perbaikan. Perlu penilaian kembali (credentialing) kelayakan sebagai provider JKN. Kepesertaan PBI di klinik pratama, dokter praktek dan dokter gigi praktek perseorangan masih sangat kecil, dan pemanfaatan dana kapitasi di FKTP sudah cukup baik walaupun upaya promotif dan preventif sangat sedikit. Indikator yang digunakan untuk menilai kapitasi di FKTP seharusnya berbasis pada fungsi FKTP sebagai gate keeper. Skor pendapat dari FKTP menunjukkan bahwa indikator yang dikembangkan adalah comprehensiveness, sustainability prolanis, kunjungan first contact, contact rate pelayanan di dalam dan di luar gedung dan pelayanan di luar standar BPJS. Sehingga disarankan untuk melakukan pengembangan perhitungan dengan menggunakan kelima indikator tersebut dengan memperhatikan faktor kemampuan/kompetensi FKTP.