PERAN PENYELENGGARA PELAYANAN KESEHATAN PRIMER SWASTA DALAM JAMINAN KESEHATAN DI KABUPATEN BANDUNG

Abstract

Background: Apart from funding, the role of health care
providers on the health insurance scheme should be taken
into account, because they are one of the components of
health insurance scheme and could play as gate keepers.
They include private and public health providers. 92.14% of
the total primary health providers in Bandung District are private
health providers, consisted of 561 doctors, 392 midwives and
154 private clinics. The objective of the study was to assess
the involvement, mechanism of payment and willingness to
participate of the private health providers in the health insurance
scheme
Method: A survey with a simple random sampling was
conducted using questionnaire for 207 respondents (153
doctors and 54 clinics).
Result: Only 23% doctors and 21% clinics that already had
contracts with 14-20 third payers. The mechanisms of payment
from the third payer to the providers were capitation (43%
doctors, 50% clinics) and claims (39% doctors, 43% clinics).
Among private providers who had not yet contracts with third
payer, only 55% doctors and 56% clinics wanted to have
contract. Factors contributed to the refusal were human
resource and facilities, finance, administration and health care
delivery
Conclusion: Private health providers should be involved, as
part of the health insurance scheme in Bandung District with
developing efforts to gain trust between the providers and
third payers and considering a proper benefit for all.
Keywords: Private Health Providers (PPK I), gate keeper,
health insurance