Adequacy of dental capitation payment at community health centers in the implementation of Indonesian National Health Insurance

Aim: Managed care is considered a cost-control measure to prevent skyrocketing health-care expenditure. The Indonesian government launched National Health Insurance (NHI) at the beginning of 2014, with financial management for dental services that differs based on whether a fee-for-service or capitation scheme is used. This difference in financial schemes may financially affect community health centers (CHCs) that implement NHI. The aim was to compare the adequacy of funds for CHCs based on fee-for-service and capitation revenue in the implementation of Indonesian NHI for dental services. Materials and Methods: This is an observational study with a retrospective research design. Fee-for-service and capitation revenue data were obtained from NHI participants' dental records at selected CHCs in Yogyakarta Province. The unit analysis included dental services data from January 2014 until December 2014 collected from 30 CHCs selected from rural, suburban, and urban areas. Purposive sampling was used to define the CHC included in the research. Results: The utilization rate and the number of participants affected the adequacy of financial revenue at each CHC sampled. Rural and urban areas had statistically significant differences (independent t-test, P < 0.05) between their fee-for-service and capitation revenues. Only the CHCs in suburban areas exhibited no significant difference in their fee-for-service and capitation revenues (P > 0.05). Conclusions: The capitation funding scheme for dental treatments in the Indonesian NHI can sufficiently provide a benefit package of eight dental treatments in rural and suburban areas, but not in urban areas.