What is the Best Method for Review Utilization Dental health Care at Primary Health Care Cooperation with Indonesian National Health Insurance (INHI)?

Abstract

The Indonesian National Health Insurance (INHI), initiated in 2014, encompasses dental healthcare services delivered by dentists in primary healthcare facilities. The remuneration model for healthcare practitioners is based on capitation, which involves payment per registered patient without consideration of the number of patient visits. INHI's monitoring has revealed a significant number of patients referred to advanced healthcare services. This study aims to explore and propose effective strategies for reducing the number of dental referrals, such as improving dental skills, enhancing IT-related capabilities, and providing government guidance. The research methodology employed a Focus Group Discussion (FGD) involving INHI facilitators and 30 dentists selected based on referral ratio data, focusing on instances where the number of referrals did not align with patient visits over the past three months. The INHI facilitators, who played a crucial role in guiding the discussions and providing insights, were instrumental in the success of the study. The dentists were categorized into three groups: those working in community health centers (Group A), family dentists (Group B), and primary clinics (Group C). A follow-up FGD occurred two months later to assess changes in the referral ratio. The findings highlighted specific challenges within each group. Group A exhibited a relatively low referral ratio, likely due to government guidance. Group B comprised senior dentists with limited IT-related capabilities, while Group C consisted of fresh graduates needing more experience in dental skills. Following discussions, facilitators guided Groups B and C, resulting in reduced referral ratios across all groups in the subsequent two months. The study concludes that routine monitoring of selected dentists is the most effective method for evaluating dental care delivery and addressing referral concerns.