Quality of Health Services in the First Level Health Facilities and the Role of Quality and Cost Control Team in Lampung Province

Asep Sukohar; Arli Suryawinata; Aulian Mediansyah

doi:10.22146/rpcpe.54162

Quality of Health Services in the First Level Health Facilities and the Role of Quality and Cost Control Team in Lampung Province

https://doi.org/10.22146/rpcpe.54162

Asep Sukohar^(1*), Arli Suryawinata⁽²⁾, Aulian Mediansyah⁽³⁾

(1) Department of Pharmacology; Faculty of Medicine; Universitas Lampung
(2) Department of Pharmacology; Faculty of Medicine; Universitas Lampung
(3) Department of Pharmacology; Faculty of Medicine; Universitas Lampung
(*) Corresponding Author

Abstract

Background: The National Health Insurance/Jaminan Kesehatan Nasional (JKN) program is a public health protection guarantee held by the Social Securite Management Agency/Badan Penyelenggara Jaminan Sosial Kesehatan (BPJS) to ensure that all Indonesians receive comprehensive, fair, and equitable health care benefits. The health services are provided using a tiered service system with the first stage in the First Level Health Facilities/Fasilitas Kesehatan Tingkat Pertama (FKTP) acting as a gatekeeper. In conducting these duties, they must always be maintained with good cost-efficiency to be able to provide optimal health service quality. The audit function is imposed by the Quality and Cost Control Team/Tim Kendali Mutu Kendali Biaya (TKMKB) which partners with BPJS. Until now, various efforts to improve the quality of services continue to be developed, one of which is the capitation-based service commitment/Kapitasi Berbasis Komitmen Pelayanan (KBK) payment method. Quality of health services in FKTP can be seen through the high number of FKTP that are affected by the capitation-based service commitment (FKTP KBK-K) payment. Additionally, the high number of FKTP KBK-K can also be a measure of the success of the quality and cost control program implemented by the regional TKMKB. Objective: To assess the quality of health services in FKTP and the TKMKB performance of Lampung Province. Methods: This research was a descriptive-analytic study using data from the BPJS report of Lampung Province and TKMKB in the first and second quarters of 2019. Results: There was an increase in the number of FKTP KBK-K in Lampung Province in the second quarter of 2019, not achieving the minimum contact number, with a low ratio of Prolanis Routine Participants Visiting/Rasio Peserta Prolanis Rutin Berkunjung (RPPRB) especially at the FKTP non-Primary Health Care Centers (non-Puskesmas) in Lampung Province. Conclusion: An increase in the number of FKTP KBK-K that is not accompanied by an increase in the clinical ability of primary health care providers (such as family doctors/primary care doctors) can reflect suboptimal health services in FKTP. Also, this can further serve as a benchmark that the performance of the provincial TKMKB is not yet optimal.

Keywords

FKTP; KBK; TKMKB; quality of health services

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References

1. Ministry of Health Republic of Indonesia. Ministry of health regulation no. 71 of 2013 on health services on national health insurance. Republic of Indonesia Public Letter of 2013 No. 1400. Jakarta: Ministry of Health Republic of Indonesia; 2013.

2. Putri AE. Understand BPJS: badan penyelenggara jaminan sosial/social security management agency. Jakarta: Friedrich-Ebert-Stiftung; 2014.

3. Republic of Indonesia. Act no. 24 of 2011 on social security management agency article 1 section 1. Republic of Indonesia State Gazette of 2011 No. 116. Jakarta: State Secretariat; 2011.

4. Rokx C, Schieber G, Harimurti P, Tandon A, Somanathan A. Health financing in Indonesia: a reform road map. Washington, D.C: World Bank; 2009.

5. Tandon A, Pambudi ES, Harimurti P, Masaki E, Subandoro AW, Yasmin Chrysanti P, Rajan VS, Dorkin DW, Chandra A, Boundreaux C, Pei Lyn MC, Suharno N. Indonesia - health financing system assessment: spend more, right, and better. Washington, D.C: World Bank; 2016.

6. Mboi N, Surbakti IM, Trihandini I, Elyazar I, Smith KH, Ali PB, Kosen S, Flemons K, Ray SE, Cao J, Glenn SD, Miller-Petrie MK, Mooney MD, Ried JL, Ningrum DNA, Idris F, Siregar KN, Harimurti P, Bernstein RS, Pangestu T, Sidharta Y, Naghavi M, Murray CJL, Hay SI. On the road to universal health care in Indonesia, 1990–2016: a systematic analysis for the global burden of disease study 2016. The Lancet. 2018; 392(10147): 581-91.

7. Christasani PD, Satibi S. Study of demographic factors on national health insurance patient satisfaction at first-level health facilities. Journal of Pharmaceutical Sciences & Community. 2016; 13(1): 28-34.

8. WONCA. Contributions of family medicine to improve the health system 2nd ed. Jakarta: EGC; 2017.

9. BPJS Kesehatan. BPJS kesehatan regulation no. 8 of 2016 on the implementation of quality and cost control in the implementation of the national health insurance. Republic of Indonesia Public Letter of 2016 No. 2069. Jakarta: BPJS Kesehatan; 2016.

10. Ministry of Health Republic of Indonesia, BPJS Kesehatan. Joint regulations of the secretary-general of the Ministry of Health of the Republic of Indonesia and the managing director of BPJS Kesehatan no. HK.01.08/III/980/2017 no. 2 of 2017 on technical instructions for implementing capitation payments based on fulfilling service commitments at first-level health facilities. Jakarta: Ministry of Health Republic of Indonesia, BPJS Kesehatan; 2017.

11. Ministry of Health Republic of Indonesia. Handbook on the socialization of national health insurance on the national social security system. Jakarta: Ministry of Health Republic of Indonesia; 2016. Available from: http://www.depkes.go.id/resources/download/jkn/buku-pegangan-sosialisasi-jkn.pdf

12. Syamsuri E. Capitation is based on fulfilling the commitment to optimization services and expanding implementation at private FKTP (clinic/DPP). Bandar Lampung: BPJS Kesehatan Bandar Lampung; 2019.

13. BPJS Kesehatan. BPJS Kesehatan prioritizes the quality of health facilities at the first level [Internet]. 2015. [Updated 20 January 2015; cited 5 September 2018]. Available from: https://bpjs-kesehatan.go.id/bpjs/index.php/post/read/2015/314/BPJS-Kesehatan-Pentingkan-Kualitas-Faskes-Tingkat-Pertama

14. Fachrurrazi. KBKP monev in the second quarter of 2019 in Lampung Province. Bandar Lampung: BPJS Kesehatan Bandar Lampung; 2019.

15. Starfield B. Primary care: balancing health needs, services, and technology. New York: Oxford University Press; 1998.

16. Republic of Indonesia. Presidential regulation no. 111 of 2013 on the changes of presidential regulation no. 12 of 2013 on health insurance. Republic of Indonesia State Gazette of 2013 No. 255. Jakarta: State Secretariat; 2013.

17. BPJS Kesehatan Bandar Lampung. Implementation of the referral program. Bandar Lampung: BPJS Kesehatan Bandar Lampung; 2018.

DOI: https://doi.org/10.22146/rpcpe.54162