ANALISIS BIAYA PER KAPITA SEBAGAI UPAYA ADVOKASI PENGENDALIAN BIAYA PROGRAM JAMINAN KESEHATAN JEMBRANA

Abstract

Introductions: Jembrana Health Insurance (JHI) program is
intended to provide health insurance at first level (PPK I) for
inhabitants of Jembrana District. Up till now, financing of JHI
depends on subsidy in which it is growing up and has a trend
to be out of target. Therefore, it needs to manage cost by
implementing capitation payment system. Aim of this research
was to analyze cost per capita and to identify perceptions of
JHI stakeholders towards capitation system.
Methods: This research was case study through analyzing
secondary data and performing in-depth interview. Data on
member’s utilization and claim cost were collected using forms.
Results: Result of cost per capita calculation based on real
utilization of PPK I namely Rp5.262,- per month per member is
63 % higher than cost per capita based on normal utilization of
PPK I namely Rp1.949,- per month per member. Furthermore,
result of in-depth interview shows that both policy makers
and providers have a bad perception towards capitation
system and results of cost per capita calculation.
Conclusions: Local government could apply principles of
managed care by controlling cost and quality by developing
capitation payment system for PPK I based on normal utilization.
Keywords: health insurance, cost per capita, capitation