The Structural Equation Modelling of First Level Health Facilities’ Performance-Based Capitation Payment in National Health Service

Abstract

The BPJS Healthcare Security implemented performance-based capitation/Kapitasi Berbasis Kinerja (KBK) payments to conduct structured and ongoing monitoring of the First Level Health Facilities/Fasilitas Kesehatan Tingkat Pertama (FKTP)'s performance throughout Indonesia. This study aimed to examine the direct and indirect effects of FKTP capacity on KBK and FKTP performance. This study was conducted in February 2023, and Structural Equation Modelling analysis was performed with secondary data from the BPJS Healthcare Security system database in 2021. Human resources were defined as the availability of doctors in FKTP, infrastructure as credentialing value, ownership and type of FKTP, and KBK, and performance as first contact, non-specialist outpatient referral ratios, and Chronic Disease Management Program/Program Pengelolaan Penyakit Kronis (Prolanis) participant ratio. The analytical results revealed that human resources directly and positively affected the KBK. The indirect effect analysis results suggested that only human resources impacted FKTP performance. In conclusion, human resources are critical in achieving the KBK and FKTP performance.