Determinan Capaian Kapitasi Berbasis Kinerja (KBK) di Puskesmas Kabupaten Kubu Raya Kalimantan Barat

YAYA WIDYATMOKO, dr. Firdaus Hafidz As Shidieq, M.P.H., AAK., Ph.D

2025 | Tesis | MAGISTER KEBIJAKAN DAN MANAJEMEN KESEHATAN

Latar belakang: Skema pembayaran berdasarkan kinerja (Pay for Performance) memberikan insentif finansial kepada pekerja atau fasilitas layanan kesehatan berdasarkan pencapaian target kinerja yang telah ditentukan sebelumnya dan diterapkan dalam sistem kesehatan di negara-negara berpendapatan rendah dan menengah. Indonesia dalam pelaksanaan Jaminan Kesehatan Nasional (JKN) juga telah memperkenalkan pay for performance (P4P) yang dinamakan Kapitasi Berbasis Kinerja (KBK) yang diterapkan di Fasilitas Kesehatan Tingkat Pertama (FKTP) dimana metode ini merupakan salah satu konsep strategis yang paling banyak dibahas, bahkan berbagai kalangan telah mendorong agar pembayaran berbasis kinerja menjadi prioritas utama nasional. 

Tujuan: Penelitian ini bertujuan untuk mengeksplorasi capaian indikator Kapitasi Berbasis Kinerja (KBK) di puskesmas Kabupaten Kubu Raya.

Metode: Jenis penelitian yang digunakan adalah penelitian kualitatif dengan pendekatan studi kasus. Penelitian dilakukan di 7 puskesmas dipilih secara purposive sampling dengan kriteria yaitu berdasarkan karakteristik wilayah kerja puskesmas dan besaran kapitasi yang diterima. Wawancara dilakukan pada bulan Maret-Mei 2025 menggunakan pedoman wawancara semi-terstruktur dengan melibatkan 34 responden. Data yang diperoleh dianalisis menggunakan analisis tematik deduktif.

Hasil: Capaian indikator angka kontak menunjukan peningkatan pada proporsi kunjungan sehat. Hampir semua puskesmas mengalami penurunan yang signifikan pada rasio rujukan non spesialistik pada tahun 2022 hingga 2024. Semakin kecil proporsi peserta prolanis dari peserta JKN maka puskesmas akan semakin mudah dalam mencapai target prolanis. Determinan capaian KBK yaitu determinan sistem kesehatan dan determinan individu.

Kesimpulan: Determinan sistem kesehatan dan determinan individu merupakan faktor yang paling signifikan yang mempengaruhi capaian KBK.

Background: Pay for performance schemes provides financial incentives to healthcare workers or facilities based on the achievement of pre-determined performance targets and are applied in health systems in low- and middle-income countries. Indonesia in the implementation of the National Health Insurance (JKN) has also introduced pay for performance (P4P) called Performance-Based Capitation (KBK) applied at the Primary Health Care (PHC) where this method is one of the most discussed strategic concepts, and various groups have encouraged that performance-based payments become a top national priority.

Objective: This study aims to explore the achievement of Performance-Based Capitation (KBK) indicator in Kubu Raya district health centres.

Methods: The type of research used was qualitative research with a case study approach. The research was conducted in 7 community health centers selected using purposive sampling based on the criteria of the characteristics of the community health center's working area and the amount of capitation received. Interviews were conducted from March to May 2025 using semi-structured interview guidelines involving 34 respondents. The data obtained were analyzed using deductive thematic analysis.

Result: The achievement of the contact rate indicator shows an increase in the proportion of healthy visits. Almost all community health centers experienced a significant decrease in the ratio of non-specialist referrals from 2022 to 2024. The smaller the proportion of Prolanis participants from JKN participants, the easier it will be for community health centers to achieve Prolanis targets. The determinants of KBK achievement are health system determinants and individual determinants.

Conclusion: The achievement of KBK (Performance-Based Capitation) indicators is influenced by determinants from both healthcare providers and patients. Key barriers include limited facilities and infrastructure, a shortage of medical personnel, high workloads, lack of managerial support, and suboptimal data management and health information systems. From the patient's perspective, low awareness of the importance of regular visits, limited availability of medicines, and irregular service delivery impact their perception of service quality and participation in programs such as Prolanis.

Kata Kunci : Performance-based Capitation, Health Systems Determinants, Individual Determinant and Primary Health Care