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Effects of performance-based capitation payment on the use of public primary health care services in Indonesia

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  • Sambodo, Novat Pugo
  • Bonfrer, Igna
  • Sparrow, Robert
  • Pradhan, Menno
  • van Doorslaer, Eddy

Abstract

The Indonesian national health insurance agency BPJS Kesehatan, the largest single-payer system in the world, is among the first to combine capitation-based payments with performance-based financing. The Kapitasi Berbasis Komitmen (KBK) scheme for puskesmas (community health centres) was implemented in province capitals between August 2015 and May 2016. Its main goal was to incentivize the substitution of secondary by primary care use. We evaluate its effect on its three incentivized outcomes: the fraction of insured visiting the puskesmas, the fraction of chronically ill with a puskesmas visit and the hospital referral rate for insured with a non-specialistic condition. We use BPJS Kesehatan claims data from 2015 to 2016 from a stratified one percent sample of its members. Comparable control districts were identified using coarsened exact matching. We adopt a Difference-in-Differences (DID) study design and estimate a two-way fixed effects regression model to compare 27 intervention districts to 300 comparable non-capital control districts. We find that KBK payment increased the monthly percentage of enrolees contacting a puskesmas with 0.578 percentage points. This is a sizeable increase of 48 percent compared to the baseline rate of just 1.2% but it still leaves most puskesmas far below the “sufficient” KBK threshold of 15%. For chronically ill patients, a small increase of 1.15 percentage points was estimated, but it leaves the rate even further below the program's “sufficient” threshold of 50%. We find no statistically significant effect on referral rates to hospitals for conditions not requiring specialist care. While we find positive effects of KBK on two out of three outcomes, all estimated effect sizes leave the actual rates far below the program targets. Our findings suggest that the KBK performance-based capitation reform has not been very successful in substituting secondary care use by greater primary care use.

Suggested Citation

  • Sambodo, Novat Pugo & Bonfrer, Igna & Sparrow, Robert & Pradhan, Menno & van Doorslaer, Eddy, 2023. "Effects of performance-based capitation payment on the use of public primary health care services in Indonesia," Social Science & Medicine, Elsevier, vol. 327(C).
    • Handle: RePEc:eee:socmed:v:327:y:2023:i:c:s0277953623002782
    DOI: 10.1016/j.socscimed.2023.115921
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    References listed on IDEAS

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    1. Damian Clarke & Kathya Tapia-Schythe, 2021. "Implementing the panel event study," Stata Journal, StataCorp LP, vol. 21(4), pages 853-884, December.
    2. Martin Chalkley & Andrew J. Mirelman & Luigi Siciliani & Marc Suhrcke & Peter Berman, 2020. "Paying for Performance for Health Care in Low- and Middle-Income Countries: An Economic Perspective," World Scientific Book Chapters, in: Paul Revill & Marc Suhrcke & Rodrigo Moreno-Serra & Mark Sculpher (ed.), Global Health Economics Shaping Health Policy in Low- and Middle-Income Countries, chapter 6, pages 157-190, World Scientific Publishing Co. Pte. Ltd..
    3. Anis Fuad, 2019. "Indonesian Social Health Insurance Sample Data are Now Available and Accessible for Research," PharmacoEconomics - Open, Springer, vol. 3(4), pages 643-645, December.
    4. Rafael Cortez, 2009. "Argentina - Provincial Maternal and Child Health Insurance : A Results-Based Financing Project at Work," World Bank Publications - Reports 10218, The World Bank Group.
    5. Paula González & Gabriel Montes-Rojas & Sarmistha Pal, 2017. "Dual Practice by Health Workers: Theory and Evidence from Indonesia," Working Papers 17.12, Universidad Pablo de Olavide, Department of Economics.
    6. Wahyu Pudji Nugraheni & Rofingatul Mubasyiroh & Risky Kusuma Hartono, 2020. "The influence of Jaminan Kesehatan Nasional (JKN) on the cost of delivery services in Indonesia," PLOS ONE, Public Library of Science, vol. 15(7), pages 1-16, July.
    7. Damian Clarke & Kathya Tapia-Schythe, 2021. "Implementing the panel event study," Stata Journal, StataCorp LP, vol. 21(4), pages 853-884, December.
    8. Xiaojie Sun & Xiaoyun Liu & Qiang Sun & Winnie Yip & Adam Wagstaff & Qingyue Meng, 2016. "The Impact of a Pay‐for‐Performance Scheme on Prescription Quality in Rural China," Health Economics, John Wiley & Sons, Ltd., vol. 25(6), pages 706-722, June.
    9. Dimitrovová, Klára & Perelman, Julian & Serrano-Alarcón, Manuel, 2020. "Effect of a national primary care reform on avoidable hospital admissions (2000–2015): A difference-in-difference analysis," Social Science & Medicine, Elsevier, vol. 252(C).
    10. Iacus, Stefano M. & King, Gary & Porro, Giuseppe, 2012. "Causal Inference without Balance Checking: Coarsened Exact Matching," Political Analysis, Cambridge University Press, vol. 20(1), pages 1-24, January.
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