BPJS Health Capitation Rates Rise, Minister Of Health Claims Can Improve Service Quality

PHOTO VIA ANTARA

JAKARTA - The Minister of Health has increased the capitation amount for health services at basic and referral health facilities paid by the Health Social Security Administering Body (BPJS) this year.

This is stated in the Regulation of the Minister of Health (Permenkes) Number 3 of 2023 concerning Standard Health Service Tariffs in the Implementation of the Health Insurance Program.

The Minister of Health (Menkes) Budi Gunadi Sadikin claims that the increase in the amount of monthly payments paid in advance by BPJS Health can improve the quality of health services, both those received by JKN participants, doctors, and health service facilities.

"This is the first time that there has been an increase in capitation service rates that will be received by puskesmas/clinics/practicing doctors from BPJS Health since 2016. For JKN Participants, the change in service rates will have an impact on improving the quality of services obtained according to medical indications," said Budi in his statement. , quoted on Monday, January 16.

Budi explained, for health service facilities, there was an adjustment in the financing received so that it was hoped that the quality of the health services provided would be better and in accordance with competence. Meanwhile, for doctors and medical personnel, the revision of this regulation has an impact on increasing income.

The standard capitation rates are set as follows:

a. Community Health Center Rp. 3,600 to Rp. 9,000 per participant per month;

b. Primary Class D hospitals, pratama clinics, or equivalent health facilities of IDR 9,000 to IDR 16,000 per participant per month;

c. Doctor's independent practice or primary service doctor's practice of IDR 8,300 to IDR 15,000 per participant per month; and

d. Independent dentist practice of IDR 3,000 to IDR 4,000 per participant per month.

However, one of the calculations for the amount paid to first-level health facilities is based on the availability of doctors or the ratio of doctors to the number of registered participants and/or the availability of dentists.

Calculation of tariffs at the health center:

1. Doctors are available with a ratio of 1:≤5000 participants and dentists are available at IDR 7,000 per participant;

2. Doctors are available with a ratio of 1:≤5000 participants and dentists are not available IDR 6,300 per participant;

3. Doctors are available with a ratio of 1:> 5000 participants and dentists are available for IDR 6,000 per participant;

4. Doctors are available with a ratio of 1:> 5000 participants and dentists are not available for IDR 5,300 per participant;

5. Doctors and dentists are not available, so the tariff is IDR 4,300 per participant; and

6. Doctors and dentists are not available, so the tariff is IDR 3,600 per participant.

At the pratama clinic, class D pratama hospital or equivalent health facility:

1. Doctors are available with a ratio of 1:≤5000 participants and dentists are available at IDR 12,000 per participant;

2. Availability of doctors with a ratio of 1:≤5000 participants and no dentists available IDR 10,000 per participant;

3. Doctors are available with a ratio of 1:> 5000 participants and dentists are available for IDR 11,000 per participant;

4. Doctors are available with a ratio of 1:> 5000 participants and no dentists are available for IDR 9,000 per participant.

In a doctor's or primary care doctor's independent practice:

1. Doctors are available with a ratio of 1:≤5000 participants, IDR 8,800 per participant; and

2. Doctors are available with a ratio of 1:> 5000 participants at IDR 8,300 per participant.

Meanwhile, for dentists' independent practice, the rate is set at IDR 3,500 per participant per month.

"The rate based on this ratio will then be multiplied by the participant's morbidity risk coefficient assessed by age and gender as well as the percentage of health facility performance achievements each month," said Budi.

In addition to capitation rates, there are increases in non-capitation rates for delivery services, maternal and child health, family planning, and first-level hospitalization as well as additional non-capitation rates for certain health screening services.

Meanwhile, for health services at referral service facilities or in hospitals, there have been changes in the scope of services. Among them are changes to the scope of services included in the standard INA-CBG rates such as types of family planning services, blood bags, chronic drug services.