Factors Related to the Achievement of Service Commitment-based Capitation Indicators at Community Health Centers in Aceh Province

Abstract

The increasing trend of health care costs has prompted the government to seek financing alternatives that can streamline funds without reducing the quality of services. One such system is the implementation of the commitment-based capitation consequence where the puskesmas is paid based on the number of registered participants who are responsible for its effectiveness monitoring by looking at the tendency of contact numbers (≥1500/00), prolanis ratio (≥50%), and non-specialist case referral ratio (<0.5%), so it is expected that moral hazard from the supply side can be prevented or minimized. This study aims to determine the factors associated with the implementation of Capitation Based on Service Commitment. This research was conducted in Propinsi Aceh area with Puskesmas as analysis unit, with sequential model mixed method (quan à QUAL), qualitative data was taken by indeph interview method to key informant related to validate data which can not be validated by quantitative method. The results of two year implementation significantly increased the average contact rate in 2020 by 192.6 0/00 (target ≥150 0/00), and the average prolanis ratio of 44.9% (≥50%), and lowering the average non-specialist case referral ratio to 0.3% (target <5%). From multivariate analysis, variables modeling related to achievement of service commitment indicator were capitation value, human resources (adequacy of doctor, nurse, midwife, pharmacy) are significant influence dominanly to achievement indicator of service commitment (p value <0.05). mplementation of capitation compensation is positive enough to give an effect for all puskesmas efforts to achieve the indicator of service commitment, on the other side of the indication of moral hazard, so monitoring and evaluation is needed to create the quality service.