Paper Title
The Effectivity of Special Capitation Payment System for Remote Community Health Centers in Indonesia

Background Indonesia that consists of diverse geographical areas has been struggling to provide health services for its remote areas. In dealing with this problem, the National Health Insurance program offer special capitation payment system for community health centres in remote areas, in addition to the general capitation prevails for the rest of community health centres. With special capitation each community health centrereceives higher tariff to increase utilisation and quality of service. This study aims to examine the effectiveness of the special capitation in remote community health centres. Methods Special capitation payment has been implemented in 98 community health centres, however only 59 community health centres have sufficient data to be analysed. As no performance indicators were in place, we use proportion of utilisation to population and average number of physicians per community health centre as performance indicators.Difference-in-difference is used to analyse the impact of the policywith 2017 as the dividing line. Fifty eight community health centres from the same areas but did not receive special capitation were used as control group. Also, in order to understand the implementation of special capitation more thoroughly, we interviewed 63 community health centres and 21 local governments. Results This study shows that both theutilisation (proportion to community health centre membership)of community health centres and number of physicians has increased after the implementation of special capitation. However, compared to other community health centres without special capitation in the same remote areas, the increasewas much lower. Most community health centres claimed there was an increase on utilisation during the interviews, nevertheless, the increase seems to be confined to limited numbers of community health centres and not widespread. In term of number of physicians, there was a miniscule increase, however, it was not significant. The special capitation did not persuademore physicians to work in remote community health centres as the allowance allocated by the scheme was not large enough to attract physicians. In addition, the increase of physicians was more to do with central government ongoing program that was already planned beforehand than to special capitation. With a larger amount of money,our qualitative study shows that a number of community health services have actually developed local-specific innovation such as the installation of waste management and home visit, however, the impact remains localised.In order for special capitation to be implemented effectively, the central government should develop performance indicator similar to that of non-remote community health centres. Without one in place, community health centres tend to be less motivated to improve their health services. Conclusion In contrast to its initial intention, special capitation neither effectively increase utilisation of community health centres nor did it increase the number of physicians in community health centres in remote areas. Although there were some local-specific innovations, unfortunately it wasonly confined to a number of health community health centres. Keywords - Special Capitation, Remote Community Health Centres, Payment System