Faktor Faktor Yang Mempengaruhi Capaian Kapitasi Berbasis Kinerja (KBK) Fasilitas Kesehatan Tingkat Pertama Di Wilayah Kantor Cabang Yogyakarta Tahun 2023

Rika Gusva Yelli, Dr. drg. Julita Hendrartini, M.Kes., CHIP, CHIA, FISDPH, FISPD

2025 | Tesis | MAGISTER KEBIJAKAN DAN MANAJEMEN KESEHATAN

Latar Belakang : Capaian Kapitasi Berbasis Kinerja (KBK) merupakan indikator penting untuk menilai kualitas layanan kesehatan pada Fasilitas Kesehatan Tingkat Pertama (FKTP) yang bekerja sama dengan BPJS Kesehatan. Meskipun sistem KBK diterapkan untuk meningkatkan efisiensi layanan kesehatan, data evaluasi menunjukkan capaian indikator KBK masih belum optimal, dengan sebagian besar FKTP tidak mencapai pembayaran penuh.

Tujuan : Penelitian ini bertujuan menganalisis faktor-faktor yang memengaruhi capaian KBK pada FKTP, termasuk jenis fasilitas kesehatan, demografi, jumlah dokter, beban kerja, ketersediaan laboratorium, dan konsekuensi pembayaran serta mengidentifikasi hambatan dalam mencapai indikator KBK.

Metode : Penelitian ini menggunakan metode campuran (mixed method) dengan pendekatan Sequential Explanatory Design. Penelitian mengamati FKTP yang bekerja sama dengan BPJS Kesehatan KC Yogyakarta jenis Puskesmas dan Klinik Pratama berjumlah 151 FKTP. Analisis kuantitatif meliputi Jenis FKTP, Demografi, Jumlah Dokter, Beban Kerja, Konsekuensi Pembayaran dan Ketersediaan Laboratorium menggunakan data sekunder BPJS Kesehatan periode Januari-Desember 2023 menggunakan regresi logistik, sedangkan data kualitatif akan diperoleh melalui wawancara mendalam dengan perwakilan dari 10 FKTP.

Hasil : Hasil analisis menunjukkan bahwa jenis fasilitas kesehatan (OR: 8, p<0>

Kesimpulan : Jenis fasilitas kesehatan dan konsekuensi pembayaran merupakan faktor paling signifikan yang memengaruhi capaian kinerja KBK

Background: The achievement of the Capitation-Based Performance (KBK) is a crucial indicator for assessing the quality of healthcare services at Primary Health Care Facilities (FKTP) collaborating with BPJS Kesehatan. Although the KBK system is implemented to improve healthcare service efficiency, evaluation data indicate that KBK achievement is still suboptimal, with most FKTPs failing to achieve full payment.

Objective: This study aims to analyze the factors influencing KBK achievement at FKTPs, including the type of healthcare facility, demographics, human resources, laboratory availability, and payment consequences. Additionally, this study identifies barriers to achieving KBK indicators.

Methods: A mixed-methods approach was used in this study using Sequential Explanatory Design. Quantitative analysis was conducted on secondary data from BPJS Kesehatan for the period January-December 2023 using logistic regression, while qualitative data were obtained through in-depth interviews with PHC representatives. This research examines 151 PHC collaborating with BPJS Kesehatan Yogyakarta including Community Health Centers (Puskesmas) and Primary Clinics. Quantitative analysis covers facility types, demographics, the number of doctors, workload, payment consequences, and laboratory availability using secondary data from January to December 2023, analyzed through logistic regression. Qualitative data is gathered through in-depth interviews with representatives from 10 selected PHCs.

Results: The analysis shows that type of healthcare facility (OR: 8, p<0 name="_Hlk188713642">Additionally, financial impacts can influence motivation and performance. The main barriers include limited human resources, high doctor workloads,limited availability of laboratories and medications and administrative issues related to documentation and reporting systems.

Conclusion: The type of healthcare facility and payment consequences are the most significant factors influencing KBK performance achievement

Kata Kunci : BPJS Kesehatan; Fasilitas Kesehatan Tingkat Pertama; Indikator KBK; KBK; Kapitasi Berbasis Kinerja