Analysis of Cost per Capita and Premium of Jembrana Health Insurance (JHI) based on Claim Cost and Service Utilization Year 2006

Abstract

Program of Jembrana Health Insurance (JHI) is intended to provide health insurance at first level for inhabitants of Jembrana District. Up till now, financing of JHI depends on subsidy in which it is growing up and has a trend to be out of the target. Therefore, it needs to manage cost by implementing the concepts of managed care. Aim of this research was to analyze cost per kapita and premium of JHI comprehensively and to identify perception of JHI stakeholders towards capitation and premium system. Type of this research was case study through analyzing secondary data and performing in-depth interview. Result of this research shows that visit number of PPK I is 404.9 % per month with amount of the claim cost for public is RP 14.040.878.776. Result of cost calculation per total capital based on real utilization of PPK I namely Rp 10.479 per month per member is 31.61 % higher than cost per total capital based on normal utilization of PPK I namely Rp 7.166 per month per member. Amount of JHI operational cost is Rp 1.751 per member per year. Amount of crude premium based on real utilization of PPK I namely Rp 140.069 per member per year is 31% higher than amount of crude premium based on normal utilization of PPK I namely Rp 96.341 per year per member. Subsidy of PPK I premium of JHI, Rp 8 billions per year, can be used to subsidize premium of PPK I, II, and III of JHI for 40 % inhabitants who have lowest income. Furthermore, result of in-depth interview shows that the respondents have a wrong perceptions towards policy makers concerning basic needs of health and egalitarian aspects, have a bad perception towards capitation system, and reject premium payment to PPK I of JHI. Beside that, they have a bad perception towards results of calculating cost per capita. Sumber Utama : www.mikm.undip.ac.id