Implementation Challenges of Performance-Based Capitation in Indonesia
A Scoping Review
DOI:
https://doi.org/10.22487/atjpe119Keywords:
Challenges, Contact rate, primary healthcare, RPPT, RRNSAbstract
Performance-Based Capitation (KBK) is a payment system implemented in Indonesia’s primary health care (PHC) to improve service quality through performance-based financing. Despite its potential, various challenges have limited its effectiveness. This study aimed to identify and synthesize evidence on the barriers to KBK implementation in Indonesia. A scoping review was conducted using studies published from 2019 to 2025 that meet the inclusion and exclusion criteria. Data from 14 included studies were extracted, charted, and thematically analyzed into five categories: human resources, systems and infrastructure, program management and governance, technical capacity, and patient participation and engagement. The study found that face interrelated challenges in implementing KBK, including shortages and unequal distribution of human resources, inadequate systems and infrastructure, weak governance, limited technical capacity, and low community participation. These factors collectively hinder the achievement of key performance indicators encompassing contact rate, the non-specialist referral ratio (RRNS), and the controlled condition of the Chronic Disease Management Program (RPPT), underscoring the need for comprehensive strategies that strengthen workforce capacity, infrastructure, governance, and community engagement.
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31. Sambodo NP, Bonfrer I, Sparrow R, Pradhan M, van Doorslaer E. Effects of performance-based capitation payment on the use of public primary health care services in Indonesia. Soc Sci Med [Internet]. 2023;327(April):115921. Available from: https://doi.org/10.1016/j.socscimed.2023.115921
32. Purnamasari AT, Ningrum HD, Ardhiasti A, Zahroh AH. Capitation Management Through Performance-Based Capitation Mechanism of Primary Health Care in Malang, Indonesia. Kesmas Natl Public Heal J. 2024;19(5):46–55.
33. Khoe LC, Id GW, Soewondo P, Tahapary DL, Widyahening IS. The implementation of community-based diabetes and hypertension management care program in Indonesia. PLoS One [Internet]. 2020;15(1):1–9. Available from: http://dx.doi.org/10.1371/journal.pone.0227806
34. Ogundeji YK, Quinn A, Lunney M, Chong C, Chew D, Danso G, et al. Factors that influence specialist physician preferences for fee-for-service and salary-based payment models: A qualitative study. Health Policy [Internet]. 2021;125(4 PG-442–449):442–9. Available from: NS -
35. Poel E Van De, Flores G, Ir P, Donnell OO. IMPACT OF PERFORMANCE-BASED FINANCING IN A LOW-RESOURCE SETTING : A DECADE OF EXPERIENCE IN CAMBODIA. Health Econ. 2016;705(July 2015):688–705.
36. Manongi R, Mushi D, Kessy J, Salome S, Njau B. Does training on performance based financing make a difference in performance and quality of health care delivery ? Health care provider ’ s perspective in Rungwe Tanzania. BMC Health Serv Res. 2014;14(154).
37. Gholipour K, Shokri A, Yarahmadi AA, Tabrizi JS, Iezadi S, Naghibi D. Barriers to community participation in primary health care of district health : a qualitative study. BMC Prim Care. 2023;24(117):1–12.
2. Kementerian Kesehatan RI. Jaminan Kesehatan Nasional harus Diperkuat dengan Dukungan Primary Health Care yang Sedekat Mungkin dengan Pasien [Internet]. 2013 [cited 2025 Apr 23]. Available from: https://sehatnegeriku.kemkes.go.id/baca/rilis-media/20130305/347388/jaminan-kesehatan-nasional-harus-diperkuat-dengan-dukungan-primary-health-care-yang-sedekat-mungkin-dengan-pasien/
3. Kementerian Kesehatan RI. Peraturan Menteri Kesehatan Republik Indonesia Nomor 19 taun 2024 tentang Penyelenggaraan Pusat Kesehatan Masyarakat. Kementerian Hukum Republik Indonesia; 2024.
4. Ratnasari D. Analisis Pelaksanaan Sistem Rujukan Berjenjang Bagi Peserta JKN di Puskesmas X Kota Surabaya Analysis of The Implementation of Tiered Referral System for Participant of National Health Security at Primary Health Center X of Surabaya. JAKI. 2017;5:145–54.
5. Kementerian Kesehatan RI. Peraturan Menteri Kesehatan No 6 Tahun 2022 tentang Penggunaan Jasa Pelayanan Kesehatan dan Dukungan Biaya Operasional Pelayanan Kesehatan Dalam Pemanfaatan Dana Kapitasi Jaminan Kesehatan Nasional Pada Fasilitas Kesehatan Milik Pemerintah. Indonesia; 2022.
6. Berenson RA, Upadhyay DK, Delbanco SF, Murray R. A Typology of Payment Methods: Payment Methods and Benefit Designs: How They Work and How They Work Together to Improve Health Care. Urban Institute; 2016.
7. Barber SL, Mathauer I, Rosenberg M, Larrain N, Liu Y, Long Q, et al. Purchasing Primary Care Services for Quality Chronic Care: Capitation With Performance Payments in Four Countries. Int J Health Plann Manage [Internet]. 2025 Apr 8;n/a(n/a). Available from: https://doi.org/10.1002/hpm.3929
8. BPJS Kesehatan. Peraturan Badan Penyelenggara Jaminan Sosial Kesehatan Nomor 7 Tahun 2019 tentang Petunjuk Pelaksanaan Pembayaran Kapitasi Berbasis Kinerja. Jakarta; 2019.
9. Aryani AD. Factors Affecting the Achievements of Performance-Based Capitation: A Scoping Review. J Jaminan Kesehat Nas. 2022;2(1):53–65.
10. Umakaapa M, Sjaaf AC. Evaluation of the Implementation of the Performance-Based Capitation Policy (KBK) at the Merial Health Clinic of DKI Jakarta City in 2020. J Indones Heal Policy Adm. 2021;6(2):141–5.
11. Arksey H, Malley LO. Scoping Studies : Towards a Methodological Framework. Int J Soc Res Methodol ISSN. 2005;8(1):19–32.
12. BPJS Kesehatan. Peraturan Badan Penyelenggara Jaminan Sosial Kesehatan Nomor 7 Tahun 2019 tentang Petunjuk Pelaksanaan Pembayaran Kapitasi Berbasis Kinerja [Internet]. Jakarta: BPJS Kesehatan; 2019. p. 1–26. Available from: https://jdih.djsn.go.id/assets/file/07-bpjsk-2019.pdf
13. Astuti J, Solida A, Mekarisce AA, Noerjoedianto D, Wardiah R. Analysis of Efforts to Achieve Performance-Based Capitation Indicators Talang Banjar Public Health Center. KESANS Int J Heal Sci Sci. 2023;3(3):268–87.
14. Augustian R, Ayuningtyas D. Analisis capaian kapitasi berbasis kinerja fasilitas kesehatan tingkat pertama di wilayah Jakarta Timur pada masa pandemi COVID-19. Syntax Lit J Ilm Indones. 2023;8(7).
15. Cahyati ST, Sandra C, Herawati YT. Implementasi kebijakan pembayaran kapitasi berbasis kinerja (KBK) di Puskesmas Kabupaten Nganjuk. J Kebijak Kesehat Indones JKKI [Internet]. 2023;12(3):168–77. Available from: https://journal.ugm.ac.id/jkki/article/view/87474https://journal.ugm.ac.id/jkki/article/download/87474/37532 NS -
16. Lestari AD, Witcahyo E, Sandra C. Sumber Daya Manusia dan Manajemen Puskesmas dalam Mencapai Indikator Rasio Peserta Prolanis Terkendali (RPPT) di Kabupaten Situbondo. J Penelit Kesehat Suara Forikes. 2022;13(4):983–9.
17. Fadila R, Purnomo AF. Analisis Faktor Penyebab Tingginya Rasio Rujukan Non Spesialistik Puskesmas Rawat Inap. J Kesehat komunitas (Journal community …. 2021;7(2):144–9.
18. Aryani AD, Bachtiar A, Candi C. The Structural Equation Modelling of First Level Health Facilities ’ Performance-Based Capitation Payment in National Health Service The Structural Equation Modelling of First Level Health Facilities ’ Performance-Based Capitation Payment in National. Kesmas Natl Public Heal J. 2024;19(1):35–41.
19. Rosita S, Rahmayani, Za RN, Asnimar. Implementasi Kapitasi Berbasis Kinerja ( KBK ) di Puskesmas Meuraxa Kota Banda Aceh Implementation of Performance Based Capitation ( KBK ) at the Meuraxa Community Health Center , Banda Aceh City. J Heal Technol Med. 2024;10(1):15–21.
20. Trisno Z, Raihan W, Zahroh Q. Relationship of Doctor Ratio with Non-Specialistic Referrals Status in Social Security Agency on Health, Pamekasan. J-Kesmas J Fak Kesehat … [Internet]. 2024;11(2):16–26. Available from: http://jurnal.utu.ac.id/jkesmas/article/view/10565http://jurnal.utu.ac.id/jkesmas/article/download/10565/pdf NS -
21. Febrianti E, Razak A, Haerani S. Basic Study on the Implementation of Outpatient Referral of BPJS Health Members in the First Health Facility at Makassar. Int J Multicult Multireligious Underst. 2019;6(5):694–704.
22. Purnamasari AT, Ningrum HD. Implementasi program pengelolaan penyakit kronis (Prolanis) di masa pandemi COVID-19 pada FKTP di Kota Malang. J Kebijak Kesehat Indones … [Internet]. 2023;(Query date: 2025-07-31 06:19:4011 cites: https://scholar.google.com/scholar?cites=14996206140154687413&as_sdt=2005&sciodt=2007&hl=en PG-). Available from: https://core.ac.uk/download/pdf/572862116.pdfhttps://core.ac.uk/download/pdf/572862116.pdf NS -
23. Rosida A, Nopiyani NMS, Januraga PP. Implementation of performance-based capitation payment at public health centers in Denpasar, Bali, Indonesia. Public Heal Prev … [Internet]. 2024;12(2):94–109. Available from: http://phpmarchive.org/index.php/phpma/article/view/367http://phpmarchive.org/index.php/phpma/article/view/367 NS -
24. Susanti Y. Performance Based Capitation Settings in the National Health Insurance Program for Primary Healthcare Facilities. J Law, Polit Humanit [Internet]. 2025;5(3):2271–81. Available from: https://dinastires.org/JLPH/article/view/1545https://dinastires.org/JLPH/article/download/1545/1199 NS -
25. Kasim AM. Potret Implementasi Program Pengelolaan Penyakit Kronis (Prolanis) Di Puskesmas Perkotaan Kabupaten Flores Timur Nusa Tenggara Timur. Media Inf [Internet]. 2024;20(2):176–84. Available from: https://ejurnal2.poltekkestasikmalaya.ac.id/index.php/bmi/article/view/608https://ejurnal2.poltekkestasikmalaya.ac.id/index.php/bmi/article/download/608/352 NS -
26. Geodesi M, Wardani R. Performance of Health Facilities in Relation to Capitation Payments. KnE Life Sci. 2022;766–78.
27. Purnamasari AT, Ningrum HD. Implementasi Program Pengelolaan Penyakit Kronis ( Prolanis ) di Masa Pandemi COVID-19 pada FKTP di Kota Malang. J Kebijak Kesehat Indones JKKI. 2023;12(02):84–96.
28. Pholpark A, Mon HM, Lim LT, Tsilaajav T, ... Challenging inadequate and fragmented primary health care financing: findings from Bangladesh, Indonesia, Maldives, and Nepal. Lancet Reg … [Internet]. 2025;38:1–6. Available from: https://www.thelancet.com/journals/lansea/article/PIIS2772-3682(25)00084-8/fulltexthttps://www.thelancet.com/journals/lansea/article/PIIS2772-3682(25)00084-8/fulltext NS -
29. Bonenberger M, Aikins M, Akweongo P, Wyss K. The effects of health worker motivation and job satisfaction on turnover intention in Ghana: a cross-sectional study. Hum Resour Health. 2014;12(43):1–12.
30. Fanda RB, Probandari A, Yuniar Y, Hendarwan H, Trisnantoro L, Jongeneel N. Articles The availability of essential medicines in primary health centres in Indonesia : achievements and challenges across the archipelago. Lancet Reg Heal - Southeast Asia [Internet]. 2024;22:1–13. Available from: https://doi.org/10.1016/j.lansea.2023.100345
31. Sambodo NP, Bonfrer I, Sparrow R, Pradhan M, van Doorslaer E. Effects of performance-based capitation payment on the use of public primary health care services in Indonesia. Soc Sci Med [Internet]. 2023;327(April):115921. Available from: https://doi.org/10.1016/j.socscimed.2023.115921
32. Purnamasari AT, Ningrum HD, Ardhiasti A, Zahroh AH. Capitation Management Through Performance-Based Capitation Mechanism of Primary Health Care in Malang, Indonesia. Kesmas Natl Public Heal J. 2024;19(5):46–55.
33. Khoe LC, Id GW, Soewondo P, Tahapary DL, Widyahening IS. The implementation of community-based diabetes and hypertension management care program in Indonesia. PLoS One [Internet]. 2020;15(1):1–9. Available from: http://dx.doi.org/10.1371/journal.pone.0227806
34. Ogundeji YK, Quinn A, Lunney M, Chong C, Chew D, Danso G, et al. Factors that influence specialist physician preferences for fee-for-service and salary-based payment models: A qualitative study. Health Policy [Internet]. 2021;125(4 PG-442–449):442–9. Available from: NS -
35. Poel E Van De, Flores G, Ir P, Donnell OO. IMPACT OF PERFORMANCE-BASED FINANCING IN A LOW-RESOURCE SETTING : A DECADE OF EXPERIENCE IN CAMBODIA. Health Econ. 2016;705(July 2015):688–705.
36. Manongi R, Mushi D, Kessy J, Salome S, Njau B. Does training on performance based financing make a difference in performance and quality of health care delivery ? Health care provider ’ s perspective in Rungwe Tanzania. BMC Health Serv Res. 2014;14(154).
37. Gholipour K, Shokri A, Yarahmadi AA, Tabrizi JS, Iezadi S, Naghibi D. Barriers to community participation in primary health care of district health : a qualitative study. BMC Prim Care. 2023;24(117):1–12.
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Implementation Challenges of Performance-Based Capitation in Indonesia: A Scoping Review. (2025). Preventif : Jurnal Kesehatan Masyarakat, 16(3). https://doi.org/10.22487/atjpe119
