Pelaksanaan Sistem KBK (Kapitasi Berbasis Komitmen Pelayanan) Jaminan Kesehatan Nasional di Puskesmas Glugur Darat Medan Tahun 2017

Abstract

Capitation Based on Service Commitmen is a system of capitation payments from National Health Care Security (BPJS) to FKTP based on fulfillment or accomplishment of four indicators applied as an effort to improve service quality of JKN participants in FKTP. The four indicators are contact rate, ratio of non-specialist outpatient referral, ratio of prolanis participants routinely visited to FKTP, and ratio of home visit. Nationally, the indicator of contact rate and the ratio of prolanis participants routinely visited to FKTP is below the safe zone target in 2017; 82,77 permil contact rate and the ratio of prolanis participants routinely visited to FKTP 25,90%. This research aims to explain the achievement of indicators Capitation Based on Service Commitmen and the underlying factor in Puskesmas Glugur Darat. This research used a qualitative approach by using in-depth interview method, observation, and document review. There were six informants that consisted of the Head of Puskesmas Glugur Darat, Head of Administration, treasurer of BPJS, HIV-IMS, Prolanis, PTM staffs, and doctor in Puskesmas Glugur Darat. Data analysis in qualitative research consists of data reduction, data presentation, conclusion, and verification. The results showed that the implementation of Capitation Based on Service Commitment system in Puskesmas Glugur Darat had not done well. From four indicators of Capitation Based on Service Commitment, there were two indicators in unsafe zone target, including indicator of contact rate and ratio of home visit. Contact rates were caused by limited human resources and public perception of national health service, while ratio of home visit was due to inadequate transportation facilities. The conclusion of this research was that the implementation of Capitation Based on Service Commitment system at Puskesmas Glugur Darat had not been done maximally so that the indicator target was not in safe zone. It has recommended that Dinas Kesehatan Kota Medan can analyze human resource requirement in accordance with applicable rules and it has also recommanded that Puskesmas Glugur Darat can provide information to public about the function of puskesmas and referral service flow and can optimize the utilization of transportation facilities so that the implementation of Capitation Based on Service Commitment system at Puskesmas Glugur Darat can do maximally.

Kapitasi Berbasis Komitmen Pelayanan adalah sistem pembayaran kapitasi dari BPJS Kesehatan kepada FKTP berdasarkan pemenuhan atau pencapaian empat indikator yang diterapkan sebagai upaya peningkatan kualitas pelayanan peserta JKN di FKTP. Adapun keempat indikator tersebut adalah angka kontak, rasio rujukan rawat jalan kasus non spesialistik, rasio peserta prolanis rutin berkunjung ke FKTP, dan rasio kunjungan rumah. Secara nasional, indikator angka kontak dan rasio peserta prolanis rutin berkunjung ke FKTP berada di bawah target zona aman pada tahun 2017; angka kontak 82,77 permil dan rasio peserta prolanis rutin berkunjung ke FKTP 25,90%. Penelitian ini bertujuan untuk menjelaskan pencapaian indikator Kapitasi Berbasis Komitmen Pelayanan dan faktor yang melatarbelakangi di Puskesmas Glugur Darat. Penelitian ini menggunakan pendekatan kualitatif dengan menggunakan metode wawancara mendalam, observasi, dan telaah dokumen sebagai cara untuk mengumpulkan data. Informan penelitian ini berjumlah enam orang, yaitu Kepala Puskesmas Glugur Darat, Kepala Tata Usaha, bendahara BPJS, pelaksana program HIV-IMS, Prolanis, PTM, dan dokter umum di Puskesmas Glugur Darat. Analisis data dalam penelitian kualitatif terdiri dari tahap reduksi data, penyajian data, penarikan kesimpulan, dan verifikasi. Hasil penelitian menunjukkan bahwa pelaksanaan sistem Kapitasi Berbasis Komitmen Pelayanan di Puskesmas Glugur Darat belum terlaksana dengan baik. Berdasarkan empat indikator Kapitasi Berbasis Komitmen Pelayanan, ada dua indikator yang berada di bawah target zona aman, antara lain indikator angka kontak dan rasio kunjungan rumah. Angka kontak disebabkan oleh keterbatasan sumber daya manusia dan persepsi masyarakat mengenai puskesmas, sedangkan rasio kunjungan rumah disebabkan oleh sarana transportasi yang belum memadai. Pelaksanaan sistem Kapitasi Berbasis Komitmen Pelayanan di Puskesmas Glugur Darat belum terlaksana secara maksimal sehingga target indikator tidak berada di zona aman. Diharapkan Dinas Kesehatan Kota Medan dapat melakukan analisis kebutuhan sumber daya manusia sesuai dengan aturan yang berlaku dan diharapkan Puskesmas Glugur Darat dapat memberikan informasi kepada masyarakat mengenai fungsi puskesmas dan alur pelayanan rujukan serta dapat melakukan optimalisasi penggunaan sarana transportasi sehingga pelaksanaan sistem Kapitasi Berbasis Komitmen Pelayanan di Puskesmas Glugur Darat dapat berjalan secara maksimal.