Theory-practice gap of capitation payment in the Indonesian national health insurance: toward universal health coverage
International Journal of Health Governance
ISSN: 2059-4631
Article publication date: 8 February 2024
Issue publication date: 23 April 2024
Abstract
Purpose
This study aims to present a comprehensive integrative review of capitation payment for primary healthcare (PHC) in the Indonesian national health insurance (Jaminan Kesehatan Nasional,JKN).
Design/methodology/approach
Whittemore and Knafl’s integrative review method is used within this review and analysis framework. Multiple types of academic literature were included in this review, including all studies related to capitation payment in the JKN from 2014 until 2022.
Findings
This review found that several practices of capitation payments in the JKN in Indonesia deviate from basic economic concept of capitation. It does not yet incentivize PHC to create a competitive environment in attracting members and it does not incentivize health promotion and prevention. Moreover, the capitation model uses the same scope of primary care services for all PHC throughout the country – which in fact has disparities in providing 155 medical conditions as required competencies for PHC. The authors recommend that the JKN apply bottom-up costing and pricing methods to set market prices of capitation rates.
Originality/value
This is the first study that reviews theory-practice gap of the capitation payment model using an integrative review that covers academic literature, journal articles and regulations in Indonesia.
Keywords
Acknowledgements
This study is made possible by the support of the American people through the United States Agency for International Development (USAID) through USAID Health Financing Activity (USAID HFA). The contents of this journal article are the responsibility of the authors and do not necessarily reflect the views of the United States Agency for International Development (USAID) or the United States Government.
The authors are grateful to the Ministry of Health for their support and to ThinkWell for the support provided via the Samya Stumo Memorial Fellowship to the lead author.
Since submission of this article, the following author have updated their affiliation: Farah Purwaningrum is at Kalta Bina Insani, Jakarta, Indonesia.
Citation
Putri, N.K., Purwaningrum, F., Thabrany, H. and Khotimah, E.H. (2024), "Theory-practice gap of capitation payment in the Indonesian national health insurance: toward universal health coverage", International Journal of Health Governance, Vol. 29 No. 1, pp. 5-20. https://doi.org/10.1108/IJHG-08-2023-0081
Publisher
:Emerald Publishing Limited
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