IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v327y2023ics0277953623002782.html

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

Author

Listed:
  • 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
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953623002782
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2023.115921?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to

    for a different version of it.

    References listed on IDEAS

    as
    1. Damian Clarke & Kathya Tapia-Schythe, 2021. "Implementing the panel event study," Stata Journal, StataCorp LP, vol. 21(4), pages 853-884, December.
    2. 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.
    3. Gonzalez, Paula & Montes-Rojas, Gabriel V. & Pal, Sarmistha, 2017. "Dual Practice by Health Workers: Theory and Evidence from Indonesia," IZA Discussion Papers 11038, IZA Network @ LISER.
    4. 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..
    5. 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.
    6. Damian Clarke & Kathya Tapia-Schythe, 2021. "Implementing the panel event study," Stata Journal, StataCorp LLC, vol. 21(4), pages 853-884, December.
    7. 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.
    8. 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.
    9. 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.
    10. 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).
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Haddou, Samira, 2024. "Determinants of CDS in core and peripheral European countries: A comparative study during crisis and calm periods," The North American Journal of Economics and Finance, Elsevier, vol. 71(C).
    2. Rik Chakraborti & Gavin Roberts, 2023. "How price-gouging regulation undermined COVID-19 mitigation: county-level evidence of unintended consequences," Public Choice, Springer, vol. 196(1), pages 51-83, July.
    3. Matthias Florian Sahli & Alexander Cuntz, 2026. "Is there a premium for legacy artists? The death effect in exhibition shows and auction transactions," Journal of Cultural Economics, Springer;The Association for Cultural Economics International, vol. 50(1), pages 1-34, March.
    4. Wadjidou Boukari & Fenjie Long & Imorou Abdou-Latif, 2025. "Can affordable housing supply exclusively stop urban sprawl?," Environment, Development and Sustainability: A Multidisciplinary Approach to the Theory and Practice of Sustainable Development, Springer, vol. 27(4), pages 8317-8355, April.
    5. David Boto-García & José Francisco Baños-Pino & Eduardo Del Valle & Inés Sustacha, 2023. "Vacation rental market regulation and accommodation supply growth," Tourism Economics, , vol. 29(6), pages 1551-1576, September.
    6. Musayir, Arlan & Arabsheibani, Reza, 2025. "Motherhood and Informality: Empirical Evidence from Russia," IZA Discussion Papers 17916, IZA Network @ LISER.
    7. Escamilla-Guerrero, David & Kosack, Edward & Ward, Zachary, 2023. "The Impact of Violence during the Mexican Revolution on Migration to the United States," IZA Discussion Papers 16359, IZA Network @ LISER.
    8. repec:ags:aaea22:343590 is not listed on IDEAS
    9. Damian Clarke & Daniel Paila~nir & Susan Athey & Guido Imbens, 2023. "Synthetic Difference In Differences Estimation," Papers 2301.11859, arXiv.org, revised Feb 2023.
    10. Di Matteo, Dante & Mariotti, Ilaria & Rossi, Federica, 2023. "Transport infrastructure and economic performance: An evaluation of the Milan-Bologna high-speed rail corridor," Socio-Economic Planning Sciences, Elsevier, vol. 85(C).
    11. Paolo Castelnuovo & Stefano Clo & Massimo Florio, 2021. "Space policy drives innovation through technological procurement: evidence from Italy," Working Papers - Economics wp2021_08.rdf, Universita' degli Studi di Firenze, Dipartimento di Scienze per l'Economia e l'Impresa.
    12. Hirvonen, Kalle & Machado, Elia Axinia & Simons, Andrew M., 2024. "Do social protection programs reduce conflict risk? Evidence from a large-scale safety net program in rural Ethiopia," 2024 Annual Meeting, July 28-30, New Orleans, LA 343590, Agricultural and Applied Economics Association.
    13. Kai Barron & Charles D. H. Parry & Debbie Bradshaw & Rob Dorrington & Pam Groenewald & Ria Laubscher & Richard Matzopoulos, 2024. "Alcohol, Violence, and Injury-Induced Mortality: Evidence from a Modern-Day Prohibition," The Review of Economics and Statistics, MIT Press, vol. 106(4), pages 938-955, July.
    14. Adrien Fabre & Thomas Douenne & Linus Mattauch, 2023. "International Attitudes Toward Global Policies," Working Papers 2023.01, FAERE - French Association of Environmental and Resource Economists.
    15. Durevall, Dick & Isaksson, Ann-Sofie, 2024. "Aid and child health: A disaggregated analysis of the effects of aid on impaired growth," World Development, Elsevier, vol. 182(C).
    16. Zhu, Junjie & Guo, Hongfeng, 2025. "Does the development of high-speed rail benefit carbon emissions reduction?," Transport Policy, Elsevier, vol. 172(C).
    17. Gabriele Letta & Mario Cesare Nurchis & Luca Salmasi & Gilberto Turati, 2026. "Do vaccination-based access restriction policies curb hesitancy? A comparison between Italy and Spain," DISCE - Working Papers del Dipartimento di Economia e Finanza def153, Università Cattolica del Sacro Cuore, Dipartimenti e Istituti di Scienze Economiche (DISCE).
    18. Wang, Menghan & Zhang, Yinglin & Gong, Xiaoxiao, 2025. "The impacts of social credit environment improvement on corporate ESG greenwashing: Evidence from China," International Review of Economics & Finance, Elsevier, vol. 102(C).
    19. Huang, Yujie & Zhang, Guoqing & Chen, Xiaofeng & Du, Kerui, 2025. "From awareness to action: The role of ESG committees in driving corporate ambidextrous green innovation," Energy Economics, Elsevier, vol. 150(C).
    20. Vincent Jerald Ramos, 2024. "Extreme Lockdowns and the Gendered Informalization of Employment: Evidence from the Philippines," Work, Employment & Society, British Sociological Association, vol. 38(5), pages 1197-1222, October.
    21. Anubhav Gupta & Thomas Luke Spreen, 2024. "Do tax credits benefit charities? Evidence from two states," Contemporary Economic Policy, Western Economic Association International, vol. 42(1), pages 94-109, January.

    More about this item

    Keywords

    ;
    ;
    ;
    ;
    ;

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:327:y:2023:i:c:s0277953623002782. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.