Incentive policies are often considered an effective way to improve the performance of public services, including those in the health sector. Through performance-based incentive schemes, the government expects primary health care facilities to enhance service quality, expand access, and reduce the burden on referral hospitals.
Lecturer at the Department of Economics, Faculty of Economics and Business Universitas Gadjah Mada (FEB UGM), Novat Pugo Sambodo, Ph.D., discussed the implementation of this policy in the Research Series 2.0 program titled Evaluating the Impact of the KBK Policy on the Performance of Public Health Centers in Indonesia. He presented findings from his study, Effects of Performance-Based Capitation Payment on the Use of Public Primary Health Care Services in Indonesia.
The research was conducted in collaboration with academics from Erasmus University Rotterdam, Wageningen University & Research, and the University of Amsterdam. This international collaboration enriched the empirical analysis in evaluating the impact of performance-based incentive policies in Indonesia’s health sector.
The Performance-Based Capitation (Kapitasi Berbasis Kinerja/KBK) policy was designed to encourage National Health Insurance (JKN) participants to visit public health centers (puskesmas) more often, strengthen the management of chronic diseases such as hypertension and diabetes, and reduce unnecessary hospital referrals. Through an incentive-based approach, public health centers are expected to be more proactive in providing services to the community.
To evaluate the policy’s effectiveness, the study analyzed claims data from approximately 800,000 JKN participants, aggregated to the district/city level during the 2015–2016 period. Using the Difference-in-Differences method, the research team compared provincial capital districts/cities as intervention areas with non-capital regions as control groups.
The analysis found significant increases in two key indicators: general visits and visits by patients with chronic diseases.
“The first finding shows that general visits to public health centers increased by 0.578 percentage points, or about 48 percent from the baseline before the policy was implemented. The second indicator, chronic disease patient visits (Prolanis), increased by 1.15 percentage points,” he explained.
These findings indicate that financial incentives can drive behavioral changes in the utilization of primary health care services, particularly among patients with chronic conditions.
Despite the positive response, the achievements remain below policy targets. The monthly visit targets and chronic disease management targets remain unmet, and there has been no significant reduction in non-specialist hospital referrals.
Responding to these findings, Pugo emphasized the importance of health facility readiness in supporting the effectiveness of incentive-based policies.
“These findings show that financial incentives can be an effective tool to encourage behavioral change, but only under certain conditions. The key requirement is that health facilities must have sufficient capacity,” Novat stated.
He further stressed that the success of health policies depends not only on well-designed incentive schemes but also on facility readiness, quality of management, and infrastructure support at the primary care level. More adaptive policy designs aligned with each health facility’s capacity are essential to optimally and sustainably strengthen primary health care services.
The full video of the Research Series 2.0 program, Evaluating the Impact of the KBK Policy on the Performance of Public Health Centers in Indonesia, is available at ugm.id/EvaluasiDampakKebijakanKBKpadaPerformaPuskesmas.
Reporter: Dwi Zhafirah Meiliani
Editor: Kurnia Ekaptiningrum
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