Regulation Amendment Needed to Ensure Transparency
At least 60 percent of the capitation fund is allocated for healthcare services. The Supreme Audit Agency (BPK) highlighted the absence of direct control by BPJS Kesehatan on the use of capitation funds at Puskesmas.
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JAKARTA, KOMPAS – The transparent management of capitation funds is necessary. Apart from the huge amounts of idle capitation fund in community health centers (Puskesmas), which reached Rp 3.02 trillion (US$220.46 million) at the end of 2016, the fund is also prone to corruption by bureaucrats mandated to manage and monitor the use of the fund.
Capitation funds are a down payment paid monthly by the Healthcare and Social Security Agency (BPJS Kesehatan) to first-level healthcare facilities, including Puskesmas. The amount is based on the number of BPJS Kesehatan participants registered at the Puskesmas and in consideration of the type and amount of healthcare services provided by the Puskesmas. The capitation fund is used to pay for healthcare services and healthcare operational support. At least 60 percent of the capitation fund is allocated for healthcare services.
The Supreme Audit Agency (BPK) highlighted the absence of direct control by BPJS Kesehatan on the use of capitation funds at Puskesmas. BPK commissioner Harry Azhar Azis said his side had only observed capitation fund distribution to Puskemas and not the actual spending of the capitation fund. “In the second half of 2018, we plan to audit healthcare services thoroughly, including at Puskesmas. We will also audit the capitation fund,” Harry said.
KPK deputy chair of corruption prevention Pahala Nainggolan said there was potential corruption in relation to capitation funds due to a lack of monitoring. Regulations stipulate that monitoring is limited within the government. “Even if people have no plan [to misuse fund], they can still [misuse capitation fund],” he said.
Therefore, Pahala said, the government should call for transparency in capitation fund management in all regencies and cities. This way, the public can be involved in monitoring. “Transparency first, as it is a prerequisite of a clean government. Next, we can talk about accountability,” he said.
In its investigation in Bekasi, Karawang and Bogor regencies in West Java last week, Kompas found that capitation fund use plans had been initiated by Puskesmas heads and treasurers. In line with Home Ministerial Circular No. 900/2280/SJ, the use of funds must follow regional heads’ regulations and is proposed in stages by the Puskesmas to the local health agency head. The monitoring is also done in stages, from Puskesmas, local health agency head and regional head.
However, reflecting on the corruption related to capitation funds in Jombang regency, East Java, the alleged perpetrators were the bureaucrats tasked with managing and monitoring the fund use, including the regional head and the health agency head.
Bekasi regency health agency acting secretary Alamsyah said that, every time medical service funds are withdrawn, a Puskesmas head and treasurer will submit a fund withdrawal note to the head of the local health agency. The note is to be accompanied by a number of documents related to accountability reports. In Bogor regency, capitation fund management at Puskesmas involves the local health agency head. Bogor regency health agency head Tri Wahyu said technical procedures should be followed by Puskesmas in using capitation fund.
National Social Security Council (DJSN) expert staff Hasbullah Thabrany said different policies across regions due to regional autonomy resulted in the ineffective disbursement of capitation funds. “Puskesmas are owned by regional administrations and their management depends on the owner. This makes fund disbursement to Puskesmas ineffective,” he said.
BPJS Kesehatan spokesperson Nopi Hidayat said that, in line with regulations, BPJS Kesehatan did not have the authority to audit capitation fund financial reports at Puskesmas.
However, in order to control capitation fund use in line with medical professionals’ performance, Nopi said BPJS Kesehatan had begun to implement a Commitment-Based Capitation (KBK) mechanism. KBK assessments serve as a basis for capitation fund disbursement for medical care for doctors, nurses and other Puskesmas officers.
DJSN member Ahmad Ansyori said the DJSN had invited the Health Ministry, Home Ministry and Finance Ministry to talk about the huge amount of idle capitation funds. The Home Ministry is urged to be involved in providing solutions as the idle funds are included in regional budgets. “We have asked the ministries to find a solution. The Health Ministry must think about the policy that should be implemented to optimize capitation fund use,” he said.