EVALUASI BESARAN PREMI TERHADAP KESESUAIAN PAKET PELAYANAN KESEHATAN PADA JAMINAN PEMELIHARAAN KESEHATAN DAERAH

Abstract

Background: The concept of community health care insurance
is presently being adopted by the local government of Sinjai
District known as Local Health Care Insurance of Sinjai managed
by an operating council. This program provides health service
packages for inpatient, outpatient and other particular
treatments at health centers and local hospitals of Sinjai. The
premi presently imposed is used to pay operational cost of
local health care insurance program and more than 80%-90%
of claims from health service providers have to be supported
by local government. If the amount of fund required to pay
claims is continuously increasing and not supported by relevant
amount of premi, the local government will consequently have
greater burden. Therefore some aspects related to real premi,
normative utilization of premi and benefit package have to be
evaluated by considering the ability and willingness to pay of
the community.
Objective: The objective of the study was to identify the
amount of real premi and normative utilization of standard premi,
assess the ability and willingness to pay premi of the participants
and analyze perception of the participants and stakeholders
about the relevance of benefit package, as well as identify the
perception of stakeholders about the existence and solution to
financial problems of Sinjai Local Health Care Insurance.
Method:  This descriptive study used both quantitative and
qualitative approaches. Data of claims and administration were
obtained from the operational council of local health care
insurance; ability and willingness to pay of the community and
perception about relevance of benefit package of local health
care insurance were obtained from questionnaires distributed
to 96 respondents of participants and in depth interview with
7 stakeholders from the government.
Result: Real premi in 2006 was Rp2,923.86/capita/month and
in 2007 was Rp2,453.59/capita/month; premi of normative
utilization in 2006 was Rp10,101.97/capita/month and in 2007
was Rp9,857.13/capita/month; ability to pay (ATP) 1 of each
participant was Rp11,246, ATP2 was Rp66,178/capita/month
and willingness to pay was Rp3,104/capita/month; 97.92% of
participants perceived benefit package relevant with their
expectation whereas stakeholders perceived that benefit
package greatly varied, the existence of local health care
insurance had to be sustained and financial problems could be
solved by increasing premi and optimizing premi billing, providing
subsidy for poor communities and generating other financial
sources.
Conclusion: In order to sustain the existence of local health
care insurance the real premi should be increased from
Rp10,000,00/family/month to Rp12.500,00 – Rp15.000,00 per
family/month as compensation for relevance of benefit package
of Sinjai Local Health Care Insurance.
Keywords: real premi, premi of normative utilization, perception
of stakeholders, benefit package, cost of claims, ability to pay,
willingness to pay