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Theory-practice gap of capitation payment in the Indonesian national health insurance: toward universal health coverage

Nuzulul Kusuma Putri (Department of Health Policy and Administration, Faculty of Public Health, Airlangga University, Surabaya, Indonesia)
Farah Purwaningrum (School of Social and Political Sciences, The University of Sydney, Sydney, Australia)
Hasbullah Thabrany (ThinkWell, Jakarta, Indonesia)
Eva Husnul Khotimah (ThinkWell, Jakarta, Indonesia)

International Journal of Health Governance

ISSN: 2059-4631

Article publication date: 8 February 2024

Issue publication date: 23 April 2024

76

Abstract

Purpose

This study aims to present a comprehensive integrative review of capitation payment for primary healthcare (PHC) in the Indonesian national health insurance (Jaminan Kesehatan Nasional,JKN).

Design/methodology/approach

Whittemore and Knafl’s integrative review method is used within this review and analysis framework. Multiple types of academic literature were included in this review, including all studies related to capitation payment in the JKN from 2014 until 2022.

Findings

This review found that several practices of capitation payments in the JKN in Indonesia deviate from basic economic concept of capitation. It does not yet incentivize PHC to create a competitive environment in attracting members and it does not incentivize health promotion and prevention. Moreover, the capitation model uses the same scope of primary care services for all PHC throughout the country – which in fact has disparities in providing 155 medical conditions as required competencies for PHC. The authors recommend that the JKN apply bottom-up costing and pricing methods to set market prices of capitation rates.

Originality/value

This is the first study that reviews theory-practice gap of the capitation payment model using an integrative review that covers academic literature, journal articles and regulations in Indonesia.

Keywords

Acknowledgements

This study is made possible by the support of the American people through the United States Agency for International Development (USAID) through USAID Health Financing Activity (USAID HFA). The contents of this journal article are the responsibility of the authors and do not necessarily reflect the views of the United States Agency for International Development (USAID) or the United States Government.

The authors are grateful to the Ministry of Health for their support and to ThinkWell for the support provided via the Samya Stumo Memorial Fellowship to the lead author.

Since submission of this article, the following author have updated their affiliation: Farah Purwaningrum is at Kalta Bina Insani, Jakarta, Indonesia.

Citation

Putri, N.K., Purwaningrum, F., Thabrany, H. and Khotimah, E.H. (2024), "Theory-practice gap of capitation payment in the Indonesian national health insurance: toward universal health coverage", International Journal of Health Governance, Vol. 29 No. 1, pp. 5-20. https://doi.org/10.1108/IJHG-08-2023-0081

Publisher

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Emerald Publishing Limited

Copyright © 2024, Emerald Publishing Limited

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