ANALISIS BESARAN BIAYA KAPITASI DAN PREMI BERDASARKAN BIAYA KLAIM DAN UTILISASI JPK PT JAMSOSTEK DIY

Abstract

Introduction: Debate on the issue of contributory Social
Security Agency (BPJS) for health have yielded disappointing
results. The majority of workers wanting health insurance
dues BPJS as lowHowever, the premium that is too low
resulting in payments to health care provider also low. The
amount of the payment of low will affect the quality of services
and satisf action participants over a health care benefit
program.
Methods: This study is a descriptive research design with a
case study involving two data sources, primary and secondary
data. Primary data obtained through interviews and secondary
data obtained from reports the DIY branch office PT.Jamsostek.
Results: Based on data of claim costs and utilization of service:
In 2008, capitation Rp1.876,00 PMPM and premium Rp11.070,00;
in 2009, capitation Rp1.973,00 PMPM and premium Rp11.085,00;
in 2010, capitation Rp2.398,00 PMPM and premium Rp13.425,00;
in 2011, capitation Rp2.403,00 PMPM and premium Rp14.921,00;
in 2012, capitation Rp3.416,00 PMPM and premium Rp15.923,00.
Perceptions of the family physician capitation date suggests
that capitation received lower with the services they have to
provided.
Conclusion: The capitation and premium is calculated using
data cost of claims and the utilization of its value lower than
standard the capitation and premiums set on PT Jamtsostek
branch DIY and PT Askes. The results of calculation of cost a
capitation is also lower than the amount of capitation and
premium on the implementation of the National Health Insurance
(JKN) in 2014 who sets capitation Rp8.000,00 to Rp10,000,00
PMPM. Need of further studies concerning the benefit service
clinic 24 hours in effect in jamsostek; an absence of adjustment
between magnitudes payment the capitation with the open
service and performance the doctors family.
Keywords: capitation, premium, family physician perceptions