Tuesday, December 19, 2023, the Faculty of Public Health (FPH) Universitas Indonesia (UI) held an open doctoral promotion session on behalf of Ari Dwi Aryani. Through performance indicators for First Level Health Facilities (KBK) and a framework developed to measure health service equity, Ari wrote a dissertation entitled “Development of a First Level Health Facility Performance Indicator Model in a Performance-Based Capitation Scheme to Measure National Health Insurance Health Service Equity”.
The persistence of inequity in health services after the National Health Insurance (JKN) was implemented is the background to Ari’s dissertation. The key strategy to overcome inequality is strengthening first level health services. Performance-Based Capitation Payments (KBK), which are implemented in JKN to strengthen the performance of First Level Health Facilities (FKTP), still need to be developed to increase equity in health services. It is also necessary to develop indicators for capacity, FKTP performance and health service equity as well as a primary care framework to monitor FKTP performance and health service equity.
The results of the entire research process carried out by Ari in stages one to three, which were aligned with the references used, came to the conclusion that three FKTP capacity indicators were obtained, namely human resources and infrastructure (recredentialing score), ratio of doctors per FKTP, and percent capitation payments based on performance. Nine indicators of FKTP performance were obtained, namely the contact rate, the ratio of controlled prolanis participants, the proportion of diabetes mellitus sufferers having their blood sugar checked, the proportion of hypertensive sufferers having their blood pressure checked, the ratio of non-specialist referrals, the proportion of patients referred back, the proportion of heart disease screening, the proportion of diabetes mellitus screening, and proportion of hypertension screening. Health service equity indicators were obtained, namely utilization based on socio-demographics (Gender and Age) per region, and utilization based on socio-economics (PBI/Non-PBI) per region. Based on these results, Ari succeeded in compiling the JKN Primary Care Performance Indicator (PCPI) Framework (JKN Primary Care Indicator Framework), with dimensions of capacity, performance and health service equity. The results of the structural model analysis show that FKTP capacity has a positive and significant influence on Health Service Equity, FKTP capacity has a positive and significant influence on performance.
The results of this dissertation were welcomed by the entire Board of Examiners consisting of Prof. Dr. Drg. Mardiati Nadjib, M.S.; Prof. Dr. Dr. Sabarinah Prasetyo, M.Sc.; Prof. Dr. Kemal N. Siregar, S.K.M., M.A., Ph.D; Prof. Dr. dra. Dumilah Ayuningtyas, M.A.R.S., and Prof. Dr. Dr. Rizanda Machmud, M. Kes. and as Promoter, Prof. Dr. Adang Bachtiar, M.P.H., D.Sc.; Copromoter, Prof. Dr. Ali Ghufron Mukti, M.Sc., Ph.D. and Prof. Dr. Dr. Fachmi Idris, M. Kes. The results of this research are recommended to the Ministry of Health, the National Planning and Development Agency and BPJS Health, to improve regulations and monitor the performance of FKTP to increase health service equity.
“This dissertation produces 11 recommended points, which must be followed up and coordinated with Ministries/Institutions, as input for improvements to increase equity in health services,” said Prof. Dr. Adang Bachtiar, M.P.H., D.Sc., in his congratulatory speech. The eleven points of policy recommendations in question are a performance-based capitation policy, fulfillment of the strategy for providing doctors and other health workers for the implementation of national priority programs and health transformation, especially the transformation of primary services, assessment of credentialing and recredentialing as FKTP criteria that can implement KBK, indicators for assessing credentialing or recredentialing. taken into consideration in determining FKTP performance targets, developing a performance-based payment system at FKTP for special capitation payments and also developing a performance-based payment system at FKRTL, mapping health service financing with funding sources originating from the APBN, APBD and JKN so that they can be utilized optimally so that the goal is achieved, the calculation formula uses an assessment of the achievement of regional promotive preventive performance indicators, the utilization value is one of the performance assessment indicators for BPJS Health from the perspective of service to participants, the utilization value is an indicator of success in implementing JKN as included in the RPJMN, development of capitation rates based on region, preparation of a primary service performance framework in the JKN scheme, digitization of the primary service performance framework in the JKN scheme, as well as preparation of a primary health service performance framework in Indonesia.
For the dissertation she defended in front of the examining team, Ari Dwi Aryani, who is the Deputy Director for Primary Health Financing Guarantee at BPJS Health, successfully graduated with a GPA of 3.89. Ari was declared a Doctor in the field of Public Health Sciences (IKM) and is the 296th Doctor of IKM and the 382nd Doctor at FPH UI.