The Effectiveness of Capitation Fund Management for the National Health Insurance Program (JKN) at Health Clinics in Surabaya: -

Ary Rahmat  HIDAYAT; Bayquni BAYQUNI; Marlini  ALIANITA

doi:10.38142/ijesss.v6i6.1648

Authors

Ary Rahmat HIDAYAT Hayam Wuruk University (PERBANAS), Indonesia
Bayquni BAYQUNI Esa Unggul University, Indonesia
Marlini ALIANITA University of Indonesia, Indonesia

DOI:

https://doi.org/10.38142/ijesss.v6i6.1648

Keywords:

Health Sector Development, Capitation Fund Management, Efficiency and Accountability, Healthcare Access

Abstract

The development of the health sector in Indonesia, particularly through the National Health Insurance Program (JKN), aims to provide equitable and quality healthcare access for all citizens. However, the effectiveness of capitation fund management within JKN at Primary Health Facilities (FKTP) still faces various challenges, especially in East Java Province. This study focuses on analyzing the effectiveness of capitation fund management at PT. Kimia Farma Diagnostika's Jatim 1 Business Unit clinics, emphasizing aspects of direction, control, accountability, efficiency, and coordination.

The research employs a qualitative descriptive approach with a case study design, involving in-depth interviews, observations, and documentation studies. The findings indicate that capitation fund management at FKTP is not yet optimal, hindered by issues such as planning that is not based on actual needs, weak internal oversight, and low managerial capacity. This study aims to provide significant contributions to the development of regional-based health financing governance models and enhance the effectiveness of JKN implementation in Indonesia.

With a better understanding of capitation fund management, it is hoped that JKN's objective of providing quality health guarantees for all citizens can be optimally achieved. This research not only offers practical recommendations for Klinik Kesehatan di Surabaya, Jawa Timurbut also for other stakeholders in efforts to improve the overall effectiveness of the JKN programme.

Downloads

Download data is not yet available.

References

Christian Undap, I., Kalangi, L., & Manossoh, H. (2017). Analisis Pengelolaan Dana Kapitasi JKN Pada Fasilitas Kesehatan Tingkat Pertama (FKTP) Di Kota Bitung.

Conquest, J. H., Gill, N., Sivanujan, P., Skinner, J., Kruger, E., Tennant, M., & Letvak, S. (2021). Systematic Literature Review of Capitation and Fee-for-Service Payment Models for Oral Health Services: An Australian Perspective. Oral Health Services: An Australian Perspective. Healthcare, 2021, 1129. https://doi.org/10.3390/healthcare

Dubey, S., Deshpande, S., Krishna, L., & Zadey, S. (2023). Evolution of Government-funded health insurance for universal health coverage in India. In The Lancet Regional Health - Southeast Asia (Vol. 13). Elsevier Ltd. https://doi.org/10.1016/j.lansea.2023.100180

Etzioni, A. (1975). A Comparative Analysis of Complex Organizations: On Power, Involvement, and Their Correlates. Free Press.

Hasan, A., & Adisasmito, W. (2017). Analisis Kebijakan Pemanfaatan Dana Kapitasi JKN Pada FKTP Puskesmas Di Kabupaten Bogor Tahun 2016. Jurnal Kebijakan Kesehatan Indonesia, 6, 127.

Hutchinson, J., Hammond, J., Sutton, M., & Checkland, K. (2021). Equity and the funding of Primary Care Networks. British Journal of General Practice, 71(710), 422–424. https://doi.org/10.3399/bjgp21X717029

Insyte Consulting. (2025). Case Study: Tyson Foods – Implementing Lean Manufacturing and Six Sigma Tools.

Kurniawan, F., Siswoyo, B., Mansur, F., Aisyah, W., Revelino, D., & Gadistina, W. (2016). Pengelolaan Dan Pemanfaatan Dana Kapitasi (Monitoring Dan Evaluasi Jaminan Kesehatan Nasional Di Indonesia). Jurnal Kebijakan Kesehatan Indonesia, 5, 122–131.

Lesmana, A. E., Oktamaria Sihole, P., & Wasir, R. (2024). Meningkatkan Kualitas Dan Efisiensi Layanan Kesehatan : Strategic Purchasing Dalam Program Jaminan Kesehatan Nasional Di Indonesia. 5(2).

Lexy J. Moleong. (2013). Metodologi Penelitian Kualitatif. Remaja Rosdakarya.

Lincoln, Y., & Guba, E. (1985). Naturalistic Inquiry. Sage Publication.

Menteri Kesehatan Republik Indonesia. (2003). Keputusan Menteri Kesehatan Republik Indonesia Nomor 364/MENKES/SK/III/2023 Tentang Laboratorium Kesehatan. Sekretariat Negara.

Menteri Kesehatan Republik Indonesia. (2014). Peraturan Menteri Kesehatan Republik Indonesia Nomor 9 Tahun 2014 Tentang Klinik. Sekretariat Negara.

Menteri Kesehatan Republik Indonesia. (2015). Peraturan Menteri Kesehatan Republik Indonesia Nomor 91 Tahun 2015 Tentang Standar Pelayanan Transfusi Darah. Sekretariat Negara.

Menteri Kesehatan Republik Indonesia. (2016). Peraturan Menteri Kesehatan Republik Indonesia Nomor 1 Tahun 2016 Tentang Penyelenggaraan Optikal. Sekretariat Negara.

Menteri Kesehatan Republik Indonesia. (2017). Peraturan Menteri Kesehatan Republik Indonesia Nomor 9 Tahun 2017 Tentang Apotek. Sekretariat Negara.

Menteri Kesehatan Republik Indonesia. (2018). Peraturan Menteri Kesehatan Republik Indonesia Nomor 15 Tahun 2018 Tentang Penyelenggaraan Pelayanan Kesehatan Tradisional Komplementer. Sekretariat Negara.

Menteri Kesehatan Republik Indonesia. (2019). Peraturan Menteri Kesehatan Republik Indonesia Nomor 43 Tahun 2019 Tentang Pusat Kesehatan Masyarakat. Sekretariat Negara. www.peraturan.go.id

Menteri Kesehatan Republik Indonesia. (2022a). Peraturan Menteri Kesehatan Republik Indonesia Nomor 6 Tahun 2022 Tentang Penggunaan Jasa Pelayanan Kesehatan Dan Dukungan Biaya Operasional Pelayanan Kesehatan Dalam Pemanfaatan Dana Kapitasi Jaminan Kesehatan Nasional Pada Fasilitas Kesehatan Tingkat Pertama Milik Pemerintah Daerah. Sekretariat Negara.

Menteri Kesehatan Republik Indonesia. (2022b). Peraturan Menteri Kesehatan Republik Indonesia Nomor 38 Tahun 2022 Tentang Pelayanan Kedokteran Untuk Kepentingan Umum. Sekretariat Negara. www.peraturan.go.id

Miles, M., & Huberman, M. (1994). Qualitative Data Analysis Second Edition. Sage Publication.

Patton, M. (1990). Qualitative Research & Evaluation Methods 3 Edition (3rd ed.). Sage Publication.

Presiden Republik Indonesia. (2004). Undang-undang Republik Indonesia Nomor 40 Tahun 2004 Tentang Sistem Jaminan Sosial Nasional. Sekretariat Negara.

Presiden Republik Indonesia. (2009a). Peraturan Pemerintah Republik Indonesia Nomor 51 Tahun 2009 Tentang Pekerjaan Kefarmasian. Sekretariat Negara.

Presiden Republik Indonesia. (2009b). Undang-undang Republik Indonesia Nomor 44 Tahun 2009 Tentang Rumah Sakit. Sekretariat Negara.

Presiden Republik Indonesia. (2011). Undang-undang Republik Indonesia Nomor 24 Tahun 2011 Tentang Badan Penyelenggara Jaminan Sosial. Sekretariat Negara.

Presiden Republik Indonesia. (2016). Peraturan Pemerintah Republik Indonesia Nomor 47 Tahun 2016 Tentang Fasilitas Pelayanan Kesehatan. Sekretariat Negara.

Prinja, S., Dixit, J., Nimesh, R., Garg, B., Khurana, R., Paliwal, A., & Aggarwal, A. K. (2024). Impact of health benefit package policy interventions on service utilisation under government-funded health insurance in Punjab, India: analysis of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY). The Lancet Regional Health - Southeast Asia, 28. https://doi.org/10.1016/j.lansea.2024.100462

Robbins, S. (1990). Organization Theory Structure, Design, and Applications Third Edition (3rd ed.). Prentice-Hall.

Robbins, S., Judge, T., & Breward, K. (1994). Essentials Of Organizational Behaviour. Pearson.

Steers, R. (1977). Organizational Effectiveness: A Behavioral View. Goodyear Publishing Company.

Supartiningsih, S. (2017). Kualitas Pelayanan an Kepuasan Pasien Rumah Sakit: Kasus Pada Pasien Rawat Jalan. Jurnal Medicoeticolegal Dan Manajemen Rumah Sakit 10.18196/Jmmr.2016, 6(1), 9–15. https://doi.org/10.18196/jmmr.6122

Yan, J., Shi, Y., Zhang, J., Chen, S., Huo, X., Shen, Y., & Zhang, N. (2023). Impact of capitation prepayment on the medical expenses and health service utilization of patients with coronary heart disease: a community policy intervention program in a county in China. BMC Public Health, 23(1). https://doi.org/10.1186/s12889-023-17161-x

Yuliardi, A. (2015). Analisis pola pemanfaatan pelayanan kesehatan yang di danai oleh kapitasi dan non kapitasi pada fktp milik pemerintah di kabupaten Pandeglang.