KAJIAN CAPAIAN INDIKATOR KAPITASI BERBASIS PEMENUHAN KOMITMEN PELAYANAN (KBK) BPJS DI FKTP KOTA JAMBI

ABSTRACT Background: The implementation of capitation payments based on fulfilling service commitments (KBK) is assessed by achieved indicators including contact rate, RRNS and RPPB. Based on data monev Jambi 2019 showed that indicators of KBK BPJS in province Jambi are not reached the target. This research to analyze the factors that affect the achievement of the targets of the BPJS indicators in the Contact rate, RRNS and RPPB in the FKTP in the city of Jambi in 2019. Method: This study used a quantitative descriptive. This study done in 34 primary health care in Jambi city. The questionnaire filled by head of primary health care and p-care staffs as a respondent. Result: The result in this study showed the dominant trouble in reaching the indicator contact rate was exorbitant of target was too high 29 (42.6%). The problem of RRNS indicator was increasing the demand of hospital referral which 48 (70,6%) samples answered. RPPB target was too high 35 (51.5%). Conclusion: The implementation of Capitation Based on Service Commitment in primary health care in Jambi City had not been done maximally. Keywords : KBK, FKTP, BPJS ABSTRAK Latar Belakang : Pelaksanaan pembayaran kapitasi berbasis pemenuhan komitmen pelayanan (KBK) dinilai berdasarkan pencapaian indikator meliputi Angka Kontak, Rasio Rujukan Rawat Jalan Non Spesialistik (RRNS) dan Rasio Peserta Prolanis Rutin Berkunjung (RPPB). Berdasarkan data yang dilakukan oleh team Monev Provinsi Jambi 2019 indikator KBK BPJS di provinsi Jambi masih belum memenuhi target yang telah ditetapkan. Penelitian ini bertujuan menganalisis faktor-faktor yang mempengaruhi belum tercapainya target pemenuhan indikator KBK BPJS pada Angka Kontak, RRNS dan RPPB pada FKTP dikota Jambi tahun 2019. Metode : Penelitian ini menggunakan metode deskriptif kuantitatif. Penelitian ini dilakukan di 34 Fasilitas Kesehatan Tingkat Pertama (FKTP) kota Jambi. Instrumen penelitian ini menggunakan wawancara dengan panduan kuesioner kepada kepala FKTP serta petugas p-care diFKTP sebagai responden. Hasil : Hasil penelitian menunjukkan bahwa kesulitan yang paling dominan dalam memenuhi target indikator Angka Kontak adalah terlalu tingginya target yang ditetapkan 29 (42.6%), kesulitan dalam RRNS adalah meningkatnya permintaan rujukan 48 (70.6%), dan kesulitan RPPB adalah terlalu tinggi target yang ditetapkan 35 (51.5%). Kesimpulan : pelaksanaan sistem Kapitasi Berbasis Komitmen Pelayanan di FKTP kota Jambi belum terlaksana secara maksimal. Masih ada faktor yang menyebabkan belum tercapainya indikator KBK sehingga membuat FKTP berada di zona tidak aman. Kata kunci : KBK, FKTP, BPJS

Medicaid Capitation Payments by State

Congress has repeatedly proposed changing Medicaid from an entitlement to a block grant. Each state would receive a fixed amount instead of a Federal payment influenced by state decisions on eligibility, coverage, and pricing. This paper uses existing data series to simulate redistributing the annual $353 billion Federal payment among Medicaid’s 56 state (and territorial) programs. Capitation by general population would shift $52 billion, mainly from large Northeastern and West Coast states to large Southern and Mountain states. Capitation by population below the Federal Poverty Line (FPL) would shift $60 billion in a similar pattern. Policymakers should understand likely state-to-state effects when considering Medicaid legislation. States could then prepare for possible changes in their Federal payment for Medicaid.

Measuring equity in per capita primary care investment in Ontario: Challenges for data linkage and analysis

IntroductionFifteen years ago almost all primary care physicians (PCPs) were paid fee-for-service. Now, many physicians receive other payments as well, including capitation payments, incentives and bonuses and funding for other health professionals. It is challenging to track these changes in primary care payment and understand how they relate to individual patients. Objectives and ApproachThe objectives of this study were to assess changes in PCP payments from 2002/03 to 2011/12 and examine differences in per capita investment by urban-rural status, recent arrival (proxy for immigrant status) and income quintile. This required a three-step approach: assigning payments to physicians, assigning patients to physicians and then apportioning the payments by patient. Payments were apportioned based on the type of payment and how the data were captured. For example, capitation payments were paid monthly, but without any detail as to which patients they were for, so all capitation payments were summed and apportioned among all rostered patients. ResultsAll PCPs for whom we had payment data and to whom patients could be assigned were included. Three types of physician-patient 'relationships' were identified: the patient was on the physician's formal roster; the patient was 'virtually' rostered to the physician who provided the plurality of their care; or the patient was part of the physician's overall panel, which includes all patients seen during the year, rostered and not. The type of relationship determined which payment were allocated to each patient. When the $3.5B in payments were apportioned and different populations compared, we found inequities in new primary care investment by income, immigrant status and rurality. For example, we found a disproportionate investment in interdisciplinary teams for non-immigrant Ontarians living in more well-off suburban areas. Conclusion/ImplicationsEstimating per capita primary care investment is a challenging but worthwhile undertaking. The results of this study suggest that the Government of Ontario should facilitate increased participation in new primary care models by immigrants and people living in major urban centres.

Impact of primary care funding on secondary care utilisation and patient outcomes: a retrospective cross-sectional study of English general practice

BackgroundIn international studies, greater investment in primary health care is associated with improved population health outcomes.AimTo determine whether investment in general practice is associated with secondary care utilisation, patient satisfaction, and clinical outcomes.Design and settingRetrospective cross-sectional study of general practices in England, 2014–2015.MethodPractice-level data were stratified into three groups according to GP contract type: national General Medical Services (GMS) contracts, with or without the capitation supplement (mean practice income guarantee), or local Personal Medical Services (PMS) contracts. Regression models were used to explore associations between practice funding (capitation payments and capitation supplements) and secondary care usage, patient satisfaction (general practice patient survey scores), and clinical outcomes (Quality and Outcomes Framework [QOF] scores). The authors conducted financial modelling to predict secondary care cost savings associated with notional changes in primary care funding.ResultsMean capitation payments per patient were £69.82 in GMS practices in receipt of capitation supplements (n = 2784), £78.79 in GMS practices without capitation supplements (n = 1672), and £84.43 in PMS practices (n = 3022). The mean capitation supplement was £5.72 per patient. Financial modelling demonstrated little or no relationship between capitation payments and secondary care costs. In contrast, notional investment in capitation supplements was associated with modelled savings in secondary care costs. The relationship between funding and patient satisfaction was inconsistent. QOF performance was not associated with funding in any practice type.ConclusionCapitation payments appear to be broadly aligned to patient need in terms of secondary care usage. Supplements to the current capitation formula are associated with reduced secondary care costs.

How Does Risk Selection Respond to Risk Adjustment? New Evidence from the Medicare Advantage Program

To combat adverse selection, governments increasingly base payments to health plans and providers on enrollees' scores from risk-adjustment formulae. In 2004, Medicare began to risk-adjust capitation payments to private Medicare Advantage (MA) plans to reduce selection-driven overpayments. But because the variance of medical costs increases with the predicted mean, incentivizing enrollment of individuals with higher scores can increase the scope for enrolling “overpriced” individuals with costs significantly below the formula's prediction. Indeed, after risk adjustment, MA plans enrolled individuals with higher scores but lower costs conditional on their score. We find no evidence that overpayments were on net reduced. (JEL G22, H51, I13, I18)