Kecenderungan biaya pelayanan kesehatan yang terus meningkat mendorong PT. Askes untuk mencari altematif pembiayaan yang dapat mengeiisienkan dana tanpa mengurangi mutu pelayanan. Salah satu sistem tersebut adalah Sistem Kapitasi Total dimana provider dibayar berdasar jumlah peserta terdaftar yang menjadi tanggungnya. Penerapan sistim kapitasi total tersebut perlu dipantau efektifitasnya dengan melihat kecendelungan angka kunjungan, angka rujukan menurut pesena terdaiiar dan angka rujukan menumt kunjungan. Penelitian ini diharapkan dapat diketahui bagaimana keoenderungan tersebut dan faktor-faktor apa yang mempengaruhinya. Pcnelitian dilakukan di Jakarta Pusat dengan rancangan cross sectional, jumlah sampel 37 puskesmas, menggunakan wawancara terstruktur dan wawancara mendalam, menggunakan data sekmmdcr tahun 1999-2000 , analisis data menggunakan SPSS. Hasil penelitian menunjukkan bahwa setelah penerapan selamzr 2 tahun, angka kunjungan cendenmg menurun, begitu pula angka rujukan menurut jumlah peserta terdatiar sedangkan angka nrjukan menunrt kunjungan oendenmg meningkat. Tingkat puskesmas dan besamya jasa yang diterima dari PT. Askes ternyata berhubungan dengan angka kunjungan, sedangkan status kepegawaian kepala puskesmas dan pengetahuan kepala puskesmas teniang kapitasi total berhubungan dengan angka mjukan menurut kunj ungan Disarankan agar kapitasi total disosialisasikan kepada provider maupun kepada pwert; sistem pendataan pesqrta diyrerkuat., dilakukan pemantauan langsung oleh PT. Askes ke puskesmas dan kemungkinan agar PT.Askes dapat kontrak langsung dengan puskesmas,

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The increasing tendency of the health care cost had forced PT.Askes to seek an alternative in iinancing system , without decreasing the quality of services. One of the system used is the total capitation where the providers are paid based on the amount of members registered The effectiveness of the capitation system should be monitored through visit rates, referrals rates per member registered and refenal rates per visit. 'I'hc objective of the study is to describes the rates and factors influencing them. The study is conducted in Central Jakarta , using cross sectional design, involving 37 primary care facilities as unit amalysis. The Structured and in-depth interview were used as well as the 1999- 2000 secondary data, quantitative analysis has been done using SPSS.

The result of the study showed that after 2 yeais of implementation, the visit rates had a tendency to decrease, similar result can also be seen on the referral rates per member registered, while the number of referralrates per visit tended to increase. The referral rate is related to' the grade of primary health care facility and the amount of payment received from PT. Ashes The study revealed that the referral per visit rate is related to employment status and the knowledge of the total capitation of the head ofthe primary health care facilities. The study suggested that capitation system should be socialized to the providers and the members. The membership data base system should be improved, PT. Askes should conduct direct monitoring to primary health care facilities and finally to review the possibility of direct contract with the primary health C818 facilities.