Determinant Performance Of Puskesmas Doctors Paid Capitation In Gunungsitoli City In 2016
Background and Context
In the city of Gunungsitoli, the Puskesmas functions as the front guard in health services in the National Health Insurance Era (JKN). The Puskesmas is responsible for providing primary health care services to the community, including preventive, promotive, curative, and rehabilitative services. However, the reality shows that the performance of the Puskesmas has not reached the desired expectations. This can be seen from the high referral rate which reached 27.3% in 2015 and the level of utilization of puskesmas which is still low, which is less than 10% per month. The performance of doctors at the Puskesmas also contributes to this problem, where their knowledge, satisfaction, and perception of the capitation system, doctor's ethics, and the availability of facilities and infrastructure are still not optimal. In addition, the patient's desire to carry out direct referrals and inadequate supervision is also an inhibiting factor.
Research Objectives and Methodology
This study aims to identify the factors that influence the performance of doctors in the Puskesmas that receive payments through the capitation system in Gunungsitoli City. By using a qualitative approach, this research involves stakeholders related to the performance of doctors at the Puskesmas as informants. The data obtained are analyzed through three stages: data reduction, data presentation, and drawing conclusions. The qualitative approach used in this study is suitable for exploring the complex and multifaceted issues related to the performance of doctors in the Puskesmas.
Results and Discussion
The results showed that there were several main determinants that affected the performance of the Puskesmas doctor. Among these are doctors' knowledge and perception of the capitation system, the availability of supporting facilities and infrastructure, the patient's desire to get referrals directly, as well as the level of supervision that is not optimal. Doctors' knowledge about the capitation system is very important because it can affect their way of providing health services. In addition, a good understanding of professional ethics is also needed so that doctors can carry out their duties well and professionally.
The availability of supporting facilities and infrastructure is also a crucial factor in determining the performance of doctors in the Puskesmas. The lack of adequate facilities and infrastructure can hinder the provision of quality health services, leading to a decrease in patient satisfaction and an increase in referral rates. Furthermore, the patient's desire to get referrals directly is also a significant factor that affects the performance of doctors in the Puskesmas. Patients who are not satisfied with the services provided by the Puskesmas may choose to seek medical attention elsewhere, leading to a decrease in the utilization of puskesmas services.
Conclusion and Recommendations
Based on these findings, this study recommended the Gunungsitoli City Health Office and BPJS Gunungsitoli City Branch to conduct more effective socialization about the capitation service system to doctors at the Puskesmas and the community. Revision of the system of distributing medical services from capitation funds also needs to be done to be more fair and transparent. In addition, it is important to establish a clear regulation regarding the use of capitation funds in the Puskesmas so that its management can be carried out effectively.
A more stringent supervision of the health service system in the JKN era is also very necessary so that doctors and other health workers can work optimally. Doctors are expected to carry out comprehensive efforts in providing services to BPJS participating patients so that access and quality of health services can be improved.
Implications and Future Directions
With these steps, it is expected that the performance of Puskesmas doctors in Gunungsitoli City can be improved, which in turn will contribute to improving public health and achieving JKN goals. This will also provide more confidence to the public for the health services provided, as well as reducing unnecessary referral rates. Furthermore, this study highlights the importance of effective socialization and supervision in improving the performance of doctors in the Puskesmas. Future studies can build on this research by exploring the impact of these interventions on the performance of doctors in the Puskesmas and the overall quality of health services provided.
Limitations and Future Research Directions
This study has several limitations that need to be addressed in future research. Firstly, the study only focused on the Puskesmas in Gunungsitoli City, and the findings may not be generalizable to other areas. Secondly, the study used a qualitative approach, which may not provide a comprehensive understanding of the factors that influence the performance of doctors in the Puskesmas. Future studies can use a mixed-methods approach to provide a more comprehensive understanding of the factors that influence the performance of doctors in the Puskesmas.
Conclusion
In conclusion, this study highlights the importance of effective socialization and supervision in improving the performance of doctors in the Puskesmas. The findings of this study have implications for the Gunungsitoli City Health Office and BPJS Gunungsitoli City Branch in terms of improving the performance of doctors in the Puskesmas and the overall quality of health services provided. Future studies can build on this research by exploring the impact of these interventions on the performance of doctors in the Puskesmas and the overall quality of health services provided.
Q: What is the main objective of this study?
A: The main objective of this study is to identify the factors that influence the performance of doctors in the Puskesmas that receive payments through the capitation system in Gunungsitoli City.
Q: What is the capitation system?
A: The capitation system is a payment system where a fixed amount of money is paid to healthcare providers for each patient they serve, regardless of the actual cost of care.
Q: What are the main determinants that affect the performance of Puskesmas doctors?
A: The main determinants that affect the performance of Puskesmas doctors include doctors' knowledge and perception of the capitation system, the availability of supporting facilities and infrastructure, the patient's desire to get referrals directly, and the level of supervision that is not optimal.
Q: Why is doctors' knowledge about the capitation system important?
A: Doctors' knowledge about the capitation system is important because it can affect their way of providing health services. A good understanding of the capitation system can help doctors to provide more efficient and effective care.
Q: What is the role of the patient in determining the performance of Puskesmas doctors?
A: The patient plays a significant role in determining the performance of Puskesmas doctors. Patients who are satisfied with the services provided by the Puskesmas are more likely to continue using the services, while patients who are dissatisfied may choose to seek medical attention elsewhere.
Q: What are the implications of this study for the Gunungsitoli City Health Office and BPJS Gunungsitoli City Branch?
A: The findings of this study have implications for the Gunungsitoli City Health Office and BPJS Gunungsitoli City Branch in terms of improving the performance of doctors in the Puskesmas and the overall quality of health services provided. The study recommends that the Gunungsitoli City Health Office and BPJS Gunungsitoli City Branch conduct more effective socialization about the capitation service system to doctors at the Puskesmas and the community.
Q: What are the limitations of this study?
A: This study has several limitations that need to be addressed in future research. Firstly, the study only focused on the Puskesmas in Gunungsitoli City, and the findings may not be generalizable to other areas. Secondly, the study used a qualitative approach, which may not provide a comprehensive understanding of the factors that influence the performance of doctors in the Puskesmas.
Q: What are the future research directions based on this study?
A: Future studies can build on this research by exploring the impact of the interventions recommended in this study on the performance of doctors in the Puskesmas and the overall quality of health services provided. Additionally, future studies can use a mixed-methods approach to provide a more comprehensive understanding of the factors that influence the performance of doctors in the Puskesmas.
Q: What are the implications of this study for public health and the achievement of JKN goals?
A: The findings of this study have implications for public health and the achievement of JKN goals. By improving the performance of doctors in the Puskesmas, the study aims to contribute to improving public health and achieving JKN goals. This will also provide more confidence to the public for the health services provided, as well as reducing unnecessary referral rates.