Evaluasi pembiayaan program jaminan pemeliharaan kesehatan masyarakat (JPKM) di Kotamadya Medan = Evaluating the financing of JPKM in Medan municipality

Background: Medan municipality in Sumatcra Utara has implemented Jarninan Pcmcliharaan Kesehatan Masyarakat (JPKM = Health Maintenance Organization) since 1996. However, it did not run as desired. To subsidize comprehensive health care, the municipality collected fund from electricity bill paid by subscribers of the State Electricity Enterprise (PLN). It was questioned if the current premium of Rp. 1.000,- was sufficient to finance comprehensive health carc.This retrospective study evaluated the appropriateness of financing of health care for members of JPKM-KPUM (JPKM of Medan Public Transport Cooperative), enrolling 4000 families. Methods: Secondary data were collected from Badan Penyelenggara (the managing organization) of the JPKM-KPUM from 1996 to 1998. Utilization of health care by members was recapitulated. Also collected were data on unit tariff used by Badan Penyelenggara to finance health care providers, i.e. i he unit tariff of Dr. Pirngadi Public Hospital and of Adam Malik Public Hospital. Results: This evaluation study showed that JPKM-KPUM lost Rp. 40.947.000,- over the past three-year operation. Because the municipality could no longer provide subsidy. members of JPKM-KPUM were expected to finance their own health care. Using utilization review and unit tariff prevailing at referral hospitals in Medan, it was calculated that the current premium of Rp. I.000.- was insufficient to finance comprehensive health care. Conclusion: Projected premium that can cover comprehensive health care should he Rp.4.822,- . It is also shown that the top-down policy of tariffing was not appropriate. Ke ywords: JPKM, premium, managed care, utilization revie