Abstract
AbstractCapitation calculation in Indonesia is not adjusted by individual and aggregate risk. Without risk adjustment, capitation ratesare likely to overpay or underpay primary care. This study aimed to review risk-adjusted capitation payment in other countriesfor evaluation of capitation payment system in Indonesia. The conduct and reporting of this systematic review followedthe recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). This studyused comprehensive electronic search in five databases: Pubmed, Proquest, Scopus, PMC, and EBSCOHost. Search resultsfrom five databases in April 2018, yielded a total 19 titles that will continue to review the full article and at the end, 4 articlesincluded 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 riskadjustment based on diagnosis and socioeconomic factors to create more fair and accurate capitation rates for primary care.AbstrakPerhitungan kapitasi di Indonesia belum disesuaikan berdasarkan risiko individu dan agregat. Tanpa penyesuaian risiko, rate kapitasicenderung untuk membayar lebih atau kurang fasilitas kesehatan tingkat pertama. Studi ini bertujuan untuk meninjau sistem pembayarankapitasi di negara lain sebagai dasar evaluasi untuk sistem pembayaran kapitasi di Indonesia Penyusunan systematic review inimenggunakan rekomendasi dari Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studi ini mengumpulkanartikel dari lima database yaitu: Pubmed, Proquest, Scopus, PMC, and EBSCOHost. Hasil pencarian dari lima database padabulan April 2018, didapatkan 19 judul artikel yang akan dilanjutkan untuk ditinjau secara menyuluruh, dan akhirnya didapatkan 4artikel 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 untukmenciptakan rate kapitasi yang lebih adil dan akurat untuk fasilitas kesehatan tingkat pertama.
Highlights
Capitation is a prospective unit of payment per patient, per month or year, in which a payer makes a fixed payment for a defined set of services, regardless of the quantity of services provided (Telykov, 2001)
This paper aims to explore available risk adjustment methods and their determining factors which can be potentially applied to the capitation payment system in Indonesia
Capitation Payment System in Indonesia One of the problems that has recently been highlighted is the issue of deposition of the capitation funds in primary care
Summary
Capitation is a prospective unit of payment per patient, per month or year, in which a payer makes a fixed payment for a defined set of services, regardless of the quantity of services provided (Telykov, 2001). With this payment system, service providers will be aware of the risks and consequences as they perform services beyond what has been agreed. The many variations of health risks there need to be a risk grouping to determine the value of capitation.
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