DETERMINAN KINERJA DOKTER KELUARGA YANG DIBAYAR KAPITASI

Abstract

Background: In the last two decades, the payment system in
health insurance scheme in Indonesia for GPs (family doctors)
has been changed from fee for service to capitation. The
capitation payment used by managed care organizations to
influence the practice of primary care physician is still
controversial. The purpose of this study was to describe the
estimation of a causal model of GP’s performance on capitation
payment.
Methods: This study used cross sectional survey design.
Total subjects were 290 GPs who had contract with managed
care organization’s at least 6 months and 580 patients who
were member of managed care organization which choose
by simple random sampling. The data were collected by using
questionnaires to asses knowledge, satisfaction, attitude and
patient’s satisfaction. The dependent laten variable was GP’s
performance with observed variable were utilization’s rate,
refferal’s rate and patient’s satisfaction. The data was
analyzed with Structural Equation Model with AMOS 6 to
estimate the statistical model of capitation and associations
between variables on capitation, doctor’s satisfaction, attitude
and GP’s performance.
Result: The results of this study confirmed that the important
variables in the prediction of GP’s performance were
knowledge, attitude and length of contract. Income ratio of
capitation and GP’s satisfaction had indirect effect on GP’s
performance, but influence GP’s attitudes as mediating variables
toward GP’s performance to control the cost. Almost half of
the GPs (45,2%) had ratio income of capitation lower than
10% from the total income, therefore it couldn’t be expected
as main income. This situation caused that GPs still fee for
services oriented.
Conclusion: The capitation payment is not effective to change
the GP’s performance, because the income ratio is still low.
The implication of these findings is important to improve the
contract of payment capitation and it needs a strategy to maintain
good relationship between managed-care organization and
provider in addition to improve GP’s performance.
Keywords: capitation, contract, GP’s satisfaction, GP’s attitude,
GP’s performance.