Financial resilience of Indonesiaʼs national health security program through capitation adjustment based on budget account surplus (SiLPA): a case study in West Kotawaringin and Sukamara Regencies

For several years, the main issue aff ecting the fi nancial resilience of BPJS Kesehatan, Indonesia’s Social Security Administering Body for Health Sector was funding defi cit. BPJS Kesehatan is deemed resilient when able to cover the estimated claim payment to health facilities for the subsequent 1.5 to 6 months. For primary care providers, payments are executed through the capitation scheme. However, not all capitation funds received were used by primary care providers for healthcare improvements.This condition led to a budget account surplus (Sisa Lebih Perhitungan Anggaran, formally known as SiLPA) in government-owned primary care providers (Puskesmas). In 2019, BPJS Kesehatan had to cover more than 10% of total healthcare service expenditures to pay for capitation to Puskesmas in West Kotawaringin and Sukamara Regencies, Central Kalimantan Province. Such is due to a gap between the premium revenue and the service payment to the healthcare facility in 2019. Aft er the Minister of Home Aff airs Regulation No. 28 Year 2021 was issued, the capitation paid to Puskesmas was adjusted according to the amount of SiLPA balance in each Puskesmas. The policy intended to create effi cient capitation payment, reducing the potential risks of fi nancial defi cit. Objective: This study aims to observe the eff ect of the capitation adjustment based on budget account surplus (SiLPA) of BPJS Kesehatan fi nancial resilience in West Kotawaringin and Sukamara regencies. Method: The study is a descriptive non-experimental study through data analysis. Result: A claim payment ratio of 45% of the premium revenue (from the Premium assistance program) was noticed from January to December 2019. A cost-effi ciency of 993,448,519 rupiahs was found between January and December 2021. Conclusion: The policy can improve the fi nancial soundness and resilience of BPJS Kesehatan social security funding in West Kotawaringin and Sukamara regencies.