Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore.
East Asian Institute, National University of Singapore, Singapore.
Int J Health Plann Manage. 2019 Oct;34(4):e1688-e1710. doi: 10.1002/hpm.2883. Epub 2019 Aug 18.
One of the most important components of the ambitious 2014 National Health Insurance reform in Indonesia is the implementation of prospective payment system known as capitation grants, paid monthly to the primary health providers based on the enrolment rate. This has ushered in additional financial resources for the health managers in resource allocations, especially in the hiring of manpower. Drawing data from the Indonesia Family Life Survey (1993-2015), this paper uses difference-in-differences method to evaluate the effects of the payment method reform on the allocation of human resources for health among the primary health providers. To our surprise, there was no statistically significant change in the total number of full-time staff among the capitated facilities after the reform. However, capitation grants caused an increase in the number of full-time equivalent and part-time equivalent contract staff, but a significant decline in the number of full-time permanent staff among the urban capitated facilities. It is likely that more contract health workers were hired at the expense of full-time permanent staff among the capitated facilities in the urban regions. This unintended consequence shed light on the need to develop nuanced and contextual understanding of payment reforms in developing countries.
印度尼西亚雄心勃勃的 2014 年国家医疗保险改革的最重要组成部分之一是实施预付制系统，即根据注册率按月向初级卫生提供者支付人头费。这为卫生管理者在资源分配方面带来了额外的财政资源，特别是在人力招聘方面。本文利用印度尼西亚家庭生活调查（1993-2015 年）的数据，采用差异法评估了支付方式改革对初级卫生提供者人力资源配置的影响。令我们惊讶的是，改革后，人头付费机构的全职员工总数没有统计学意义上的变化。然而，人头费拨款导致全职当量和兼职当量合同工人数增加，但城市人头付费机构的全职永久员工人数显著下降。在城市地区，人头付费机构可能以牺牲全职永久员工为代价，雇佣了更多的合同卫生工作者。这一意外后果表明，有必要对发展中国家的支付改革进行细致和有背景的理解。
