e-ISSN 2598-3849       print ISSN 2527-8878

Vol 3, No 1 (2018)

Risk Adjustment of Capitation Payment System: What Can Indonesia Adopt from other Countries?

Asri Hikmatuz Zahroh, Rizki Asriani Putri, Latanza Shima, Erdayani Erdayani, Rira Martaliza, Tri Priyo Anggoro, Wulansari Wulansari

Abstract


Abstract

Capitation calculation in Indonesia is not adjusted by individual and aggregate risk. Without risk adjustment, capitation rates are likely to overpay or underpay primary care. This study aimed to review risk-adjusted capitation payment in other countries for evaluation of capitation payment system in Indonesia. The conduct and reporting of this systematic review followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). This study used comprehensive electronic search in five databases: Pubmed, Proquest, Scopus, PMC, and EBSCOHost. Search results from five databases in April 2018, yielded a total 19 titles that will continue to review the full article and at the end, 4 articles included for systematic review. Based on risk adjustment of capitation payment system in UK, USA, Canada and Sweden, Indonesia may initiate the use of risk adjustment based on the distribution of age and sex. Then Indonesia can develop risk adjustment based on diagnosis and socioeconomic factors to create more fair and accurate capitation rates for primary care.

 

Abstrak

Perhitungan kapitasi di Indonesia belum disesuaikan berdasarkan risiko individu dan agregat. Tanpa penyesuaian risiko, rate kapitasi cenderung untuk membayar lebih atau kurang fasilitas kesehatan tingkat pertama. Studi ini bertujuan untuk meninjau sistem pembayaran kapitasi di negara lain sebagai dasar evaluasi untuk sistem pembayaran kapitasi di Indonesia Penyusunan systematic review ini menggunakan rekomendasi dari Preferred Reporting Items for Systematic Reviews and  Meta-Analyses (PRISMA). Studi ini mengumpulkan artikel dari lima database yaitu: Pubmed, Proquest, Scopus, PMC, and EBSCOHost. Hasil pencarian dari lima database pada bulan April 2018, didapatkan 19 judul artikel yang akan dilanjutkan untuk ditinjau secara menyuluruh, dan akhirnya didapatkan 4 artikel yang akan diikutsertakan dalam systematic review. Berdasarkan penyesuaian risiko sistem pembayaran kapitasi di UK, USA, Canada dan Swedia, Indonesia dapat memulai sistem pembayaran kapitasi berdasarkan penyesuiaan distribusi umur dan jenis kelamin. Selanjutnya Indonesia dapat mengembangkan sistem pembayaran kapitasi berdasarkan diagnosis dan sosioekonomi untuk menciptakan rate kapitasi yang lebih adil dan akurat untuk fasilitas kesehatan tingkat pertama.


Keywords


Risk adjustment; Capitation; Primary Care

References


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Full Text: PDF

DOI: 10.7454/eki.v3i1.2408

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