Jurnal Manajemen Pelayanan Kesehatan
Vol 13, No 02 (2010)

PERAN PENYELENGGARA PELAYANAN KESEHATAN PRIMER SWASTA DALAM JAMINAN KESEHATAN DI KABUPATEN BANDUNG

Gondodiputro, Sharon (Unknown)



Article Info

Publish Date
11 Dec 2013

Abstract

Background: Apart from funding, the role of health careproviders on the health insurance scheme should be takeninto account, because they are one of the components ofhealth insurance scheme and could play as gate keepers.They include private and public health providers. 92.14% ofthe total primary health providers in Bandung District are privatehealth providers, consisted of 561 doctors, 392 midwives and154 private clinics. The objective of the study was to assessthe involvement, mechanism of payment and willingness toparticipate of the private health providers in the health insuranceschemeMethod: A survey with a simple random sampling wasconducted using questionnaire for 207 respondents (153doctors and 54 clinics).Result: Only 23% doctors and 21% clinics that already hadcontracts with 14-20 third payers. The mechanisms of paymentfrom the third payer to the providers were capitation (43%doctors, 50% clinics) and claims (39% doctors, 43% clinics).Among private providers who had not yet contracts with thirdpayer, only 55% doctors and 56% clinics wanted to havecontract. Factors contributed to the refusal were humanresource and facilities, finance, administration and health caredeliveryConclusion: Private health providers should be involved, aspart of the health insurance scheme in Bandung District withdeveloping efforts to gain trust between the providers andthird payers and considering a proper benefit for all.Keywords: Private Health Providers (PPK I), gate keeper,health insurance

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