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An unintended consequence of provider payment reform: The case of capitation grants in the National Health Insurance reform of Indonesia
Author(s) -
Tan Si Ying,
Qian Jiwei
Publication year - 2019
Publication title -
the international journal of health planning and management
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.672
H-Index - 41
eISSN - 1099-1751
pISSN - 0749-6753
DOI - 10.1002/hpm.2883
Subject(s) - capitation , payment , business , capitation fee , actuarial science , health care reform , health care , finance , health policy , economic growth , economics
Summary One of the most important components of the ambitious 2014 National Health Insurance reform in Indonesia is the implementation of prospective payment system known as capitation grants, paid monthly to the primary health providers based on the enrolment rate. This has ushered in additional financial resources for the health managers in resource allocations, especially in the hiring of manpower. Drawing data from the Indonesia Family Life Survey (1993‐2015), this paper uses difference‐in‐differences method to evaluate the effects of the payment method reform on the allocation of human resources for health among the primary health providers. To our surprise, there was no statistically significant change in the total number of full‐time staff among the capitated facilities after the reform. However, capitation grants caused an increase in the number of full‐time equivalent and part‐time equivalent contract staff, but a significant decline in the number of full‐time permanent staff among the urban capitated facilities. It is likely that more contract health workers were hired at the expense of full‐time permanent staff among the capitated facilities in the urban regions. This unintended consequence shed light on the need to develop nuanced and contextual understanding of payment reforms in developing countries.