GAMBARAN KECUKUPAN PENDAPATAN DARI KAPITASI PELAYANAN KESEHATAN GIGI DAN MULUT DI KLINIK PRATAMA FIRDAUS BERDASARKAN UTILIZATION REVIEW
Abstract
Background. Dental health services in the National Health Insurance (NHI) system are placed in the primary and secondary service level. Primary services are carried out by primary health care provider. The financing system used for primary health care provider in the NHI system is capitation. Some previous studies showed that income from capitation at the pratama clinic was not enough to finance NHI participants' health services. This inadequacy will increase the risk of loss for providers.
Objective. To find out the adequacy of income from capitation of dental and oral health services at Pratama Firdaus Clinic based on the utilization review.
Method. This research was an observational descriptive study, with a cross sectional research design. This research used quantitative data obtained from information system applications. The sample of this research was Klinik Pratama Firdaus Yogyakarta which was selected using non probability sampling techniques.
Result. The highest income is obtained from capitation funds, the most spending is used to pay for dentist salaries. The results of the calculation of adequacy based on real data, unit cost assumptions and actual cost values indicate that income from capitation is not enough to finance dental and oral health services in NHI system, while the results of calculation of variable cost assumptions indicate that the remaining margin of capitation income is sufficient to finance dental and oral health services.
Conclusion. The income obtained by the clinic from capitation is not yet sufficient to finance the costs of dental and oral health services.