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"Kecenderungan biaya pelayanan kesehatan yang terus meningkat mendorong pemerintah untuk mencari alternatif pembiayaan yang dapat mengefisienkan dana tanpa mengurangi mutu pelayanan. Salah satu sistem tersebut adalah dengan dijalankannya konsekuensi kapitasi berbasis komitmen pelayanan dimana puskesmas dibayar berdasar jumlah peserta terdaftar yang menjadi tanggungannya dipantau efektifitasnya dengan melihat kecenderungan angka kontak (≥1500/00), rasio prolanis (≥50%), dan rasio rujukan kasus non spesialistik (<0.5%), sehingga diharapkan moral hazard dari sisi suplai dapat dicegah atau diminimalisir. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan pelaksanaan KBK. Penelitian ini dilakukan di wilayah DKI Jakarta dengan unit analisis Puskesmas, dengan mixed method dengan model sequential (quan -> QUAL), data kualitatif diambil dengan metode indeph interview kepada informan kunci terkait untuk memvalidasi data yang tidak bisa divalidasi dengan metode kuantitatif. Hasil penelitian Implementasi KBK selama 2 tahun telah cukup baik dan signifikan meningkatkan rata-rata angka kontak pada tahun 2017 sebesar 192.6 0/00 (target ≥150 0/00), dan rata-rata rasio prolanis sebesar 44.9% (≥50%), dan menurunkan rata-rata rasio rujukan kasus non spesialistik menjadi 0.3% (target <5%). Dari analisis multivariate, didapatkan pemodelan variable didapatkan variable nilai kapitasi, dan kecukupan SDM (dokter, perawat, bidan, tenaga kefarmasian) adalah yang signifikan berpengaruh dominan terhadap capaian indikator komitmen pelayanan (p value <0.05). Penerapan kompensasi pemotongan kapitasi berdampak positif cukup memberi efek jera bagi puskesmas untuk mengerahkan segala usaha untuk pencapaian indikator komitmen pelayanan, di sisi lain adanya indikasi moral hazard di lapangan, sehingga diperlukan monitoring dan evaluasi dari berbagai pihak tanpa terfragmentasi agar cita-cita implementasi KBK untuk mewujudkan pelayanan yang berkualitas bisa diwujudkan.

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The increasing trend of health care costs has prompted the government to seek financing alternatives that can streamline funds without reducing the quality of services. One such system is the implementation of the commitment-based capitation consequence where the puskesmas is paid based on the number of registered participants who are responsible for its effectiveness monitoring by looking at the tendency of contact numbers (≥1500/00), prolanis ratio (≥50%), and non-specialist case referral ratio (<0.5%), so it is expected that moral hazard from the supply side can be prevented or minimized.

This study aims to determine the factors associated with the implementation of Capitation Based on Service Commitment. This research was conducted in DKI Jakarta area with Puskesmas as analysis unit, with sequential model mixed method (quan -> QUAL), qualitative data was taken by indeph interview method to key informant related to validate data which can not be validated by quantitative method.

The results of two year implementation significantly increased the average contact rate in 2017 by 192.6 0/00 (target ≥150 0/00), and the average prolanis ratio of 44.9% (≥50%), and lowering the average non-specialist case referral ratio to 0.3% (target <5%). From multivariate analysis, variables modeling related to achievement of service commitment indicator were capitation value, human resources (adequacy of doctor, nurse, midwife, pharmacy) are significant influence dominanly to achievement indicator of service commitment (p value <0.05).

Implementation of capitation compensation is positive enough to give an effect for all puskesmas efforts to achieve the indicator of service commitment, on the other side of the indication of moral hazard, so monitoring and evaluation is needed to create the quality service."

"Pelayanan Obstetri dan Neonatal Emergensi Dasar (PONED) merupakan salah satu pelayanan Puskesmas yang diharapkan dapat memberikan kontribusi untuk penurunan AKI dan AKB. Angka Kematian Ibu (AKI), Angka Kematian Bayi (AKB) dan Angka Kematian Balita (AKABA) di Indonesia tertinggi dibandingkan negara-negara ASEAN lainnya. Kabupaten Administrasi Kepulauan Seribu memiliki 2 Puskesmas Kecamatan yang memiliki rawat inap yang berfungsi PONED dan 4 Puskesmas Kelurahan yang mempunyai perawatan 24 jam. Namun demikian indikator pelayanan Program PONED masih belum mencapai target, salah satunya angka Kematian Bayi dan Rujukan Ibu Melahirkan yang masih sangat tinggi. Penelitian ini merupakan penelitian analitik kualitatif. Informan ditentukan dengan menggunakan purposive sampling. Informan penelitian antara lain masyarakat, Pemerintah Daerah, Tim PONED Puskesmas, Para Kepala Puskesmas PONED, penanggung jawab program PONED Sudinkes Pulau Seribu, dan Penanggung Jawab SDM Kesehatan Sudinkes Kepulauan Seribu. Data yang dikumpulkan berupa data primer dan data sekunder berupa hasil wawancara mendalam dan telaah dokumen. Hasil penelitian diperoleh data bahwa pada standar dan ukuran kebijakan telah dipahami oleh pelaksana kebijakan. Pemahaman ini didukung komunikasi yang jelas dan berkelanjutan antara Dinas Kesehatan, puskesmas dan stakeholder, kejelasan informasi dan konsistensi informasi. Ketersediaan anggaran, sarana dan prasarana sudah mencukupi tetapi terkendala masalah pemeliharaan alat karena faktor air asin yang menyebabkan peralatan mudah berkarat dan rusak. Struktur birokrasi sudah terdapat Keputusan Bupati mengenai tim PONED, namun belum ada struktur khusus PONED di Suku Dinas Kesehatan Kepulauan Seribu Disposisi ditunjukan dengan sikap positif berupa komitmen bersama Pemerintah Daerah dan Puskesmas dalam penanganan ibu hamil, penanganan kasus rujukan ibu melahirkan dengan penyulit. Peran serta masyarakat dalam pelaksanaan PONED sudah ditunjukan dengan pemanfaatan Puskesmas PONED dalam pemeriksaan kehamilan dan proses melahirkan, Output pelaksanaan program PONED sudah dilakukan pencatatan dan pelaporan capaian program kepada penanggung jawab di Sudinkes, belum ada format pelaporan khusus PONED dan belum dilakukan analisa pelaporan PONED serta feedbacak pelaporan belum dilaksanakan. Implementasi pelayanan PONED di Puskesmas Kepulauan Seribu Selatan dan Puskesmas Pulau Seribu Utara sudah berjalan tapi belum optimal dengan adanya hambatan dan kendala di komponen input, proses maupun output yang harus diatasi sehingga pelayana PONED di Kepulauan Seribu bisa berjalan dengan baik.

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Basic Emergency Obstetric and Neonatal Care (PONED) is one of the Primary Health Care services that is expected to contribute to the reduction of MMR and IMR. Maternal Mortality Rate (MMR), Infant Mortality Rate (IMR) and Toddler Mortality Rate in Indonesia are the highest compared to other ASEAN countries. The Seribu Islands Administrative Regency has 2 sub-district health centers that have PONED inpatient care and 4 sub-district health centers that have 24-hour care. However, the service indicators of the PONED program have not yet reached the target, one of which is the very high infant mortality rate and maternal referral. This study was a qualitative analytic study. Informants were determined using purposive sampling. The research informants included the community, local government, Primary Health Care PONED team, Heads of Primary Health Care PONED, the person in charge of the Thousand Island sub-district PONED program, and the person in charge of the Thousand Islands sub-district health human resources. The research results show that the policy standards and measures have been understood by implementers. This understanding is supported by clear and continuous communication between the Health Service, community health centers and stakeholders, clarity of information and consistency of information. The availability of budget, facilities and infrastructure is sufficient but is hampered by equipment maintenance problems due to the salt water factor which causes the equipment to rust easily and cause damage. The bureaucratic structure already has a Regent's Decree regarding the poned team, but there is no special PONED structure in the Seribu Islands Health Sub-Department. The disposition is shown by a positive attitude in the form of a joint commitment between the Regional Government and the Community Health Center in handling pregnant women, handling referral cases of mothers giving birth with complications. Community participation in the implementation of PONED has been demonstrated by the use of PONED Community Health Centers in pregnancy checks and the birthing process. The output of the implementation of the PONED program has been recorded and reported on program achievements to the person in charge at the Health Sub-Department. reporting has not been implemented. The implementation of PONED services at the South Seribu Islands Community Health Center and North Thousand Islands Health Center is already underway but is not yet optimal due to the existence of barriers and obstacles in the input, process and output components that must be overcome so that PONED services in the Thousand Islands can run well."