THE DETERMINANT OF FINANCIAL ACCOUNTABILITY OF CAPITATION FUND OF NATIONAL HELATH ASSURANCE IN CENTRAL LOMBOK REGENCY
Asih Trisnawati 1, Budi Santoso 1, Busaini 1 Faculty of Economics, University of Mataram Email:
Abstract. This research aims to know the influence of human resource competence and utilization of information technology toward the financial accountability of capitation funding of National Health Assurance in central Lombok regency. The type of this research used explanatory interpretation sampling method "purposive sampling" and gotten 54 respondents from financial management and program holders at Local Government Clinic. Analysis instrument used SmartPLS 3.0. The result of research shows that human resource competence influences positively and effectiveness toward the financial accountability of capability fund of National Health Assurance and its utilization of capability fund of National Health Assurance. The significant contribution of theoretically supported agency theory while the contribution is as the consideration instrument to improve human resource competence and report arrangement training with computerizing system. Then policy contribution from this research is as the implementation evaluation of ministry regulation of health number 21 by 2016 about using of capitation data of National Health Assurance for services and operational funding support of FKTP/Local Government Clinic as revision from president regulation number 32 by 2014 about management and utilization of capitation fund.
Keywords: Financial Accounting, Human Resource Competence, Information Technology Utilization
1. INTRODUCTION
Act No. 36 of 2009 on health stated everyone has the same rights in obtaining the access or resources health and obtain healthcare services that are safe, of good quality and affordable. Health care is a form of government accountability to the public by way of providing any form of organized health efforts through the development of health. The Government can do because of the health sector development efforts has been enshrined in article 171 of the Act Number 36 in 2009 that the Government health budget quantity is allocated a minimum of 5% (Five Percent) of the total State Budget (APBN) outside salaries, including also in the budget is the budget for the first-level health facilities/clinic. The clinic is Implementing Technical district/city health Office, in accordance with the provisions of the legislation.
In an attempt to improve the poor health degrees (can't afford), since 2005 the Ministry of health through the assignment to PT Askes (Persero) based on decree No.124/Menkes/SK/XI/2004 implementing the policy of health care Assurance Program of the poor (JPKMM). Later in development, the program was renamed public health Guarantee (JAMKESMAS) with no change in the number of targets. In order to realize the objectives of the national social security System (SJSN), namely to guarantee the basic needs of life be worth for each participant and/or members of his family and carry out the mandate of the provisions of article 5 paragraph (1) of Act No. 40 of 2004, then formed a legal entity the Organizer i.e. social security social security governing body (BPJS). Since January 1, 2014, the Government set a national health coverage (JKN) implemented by the BPJS Health as contained in Act No. 40 of 2004 on SJSN. SJSN law article 19 formulated Health Assurance Program with basic principles namely, based on the principle of social insurance and the principle of equity.
In order to improve the quality of health services in an era-JKN, needed financial support based on kapitasi by the BPJS Health Clinic services provided to participants effectively and efficiently. Dana Kapitasi is the magnitude of the payments monthly paid in advance to the Clinics based on the number of participants who are registered regardless of the type and quantity of medical services provided. These funds support already includes medical services, maintenance costs, ancillary costs, and cost medicines that use of details is governed by the clinic. To support the management of financial Funds Kapitasi, head of the regional finance manager appoints Heads of clinics, namely the head of Administrative or financial, and administering a Fund Treasurer JKN Kapitasi (www.okezone.com). The management and utilization of Funds Kapitasi JKN at first-level health facilities belonging to the local Government initially arranged in a presidential Regulation No. 32 by 2014. The President rules regulating the management and utilization of Funds Kapitasi ranging from budgeting to accountability. However in practice this rule is confusing and does not provide legal certainty for the person who manages the Fund. In his KPK (corruption eradication Commission) find the 4 aspects of a weakness in fund management Kapitasi (www.kpk.go.id), namely:
1. Regulatory Aspects. KPK find medical services division rules and operating costs could potentially give rise to moral hazard and ketidakwajaran.
2. Aspects of financing. KPK finding potential fraud (perversion) of that displacement participants Recipient Dues (PBI) from clinics to private FKTP.
3. The aspects of governance and resources. KPK found a number of problems including weak understanding and competencies of health workers in clinics in carrying out regulation.
4. Aspects of supervision. KPK noted the absence of budgetary oversight of Fund Kapitasi in the area. Coupled with the absence of supervision and control of Funds by the BPJS Kapitasi health.
Puskesmas that actually carry out the operational duties of public service are required to be able to prepare their own activities / budget plan according to the needs of puskesmas based on the amount of National Health Insurance Capacity Fund (JKN) they have. Mardiasmo (2002) suggests a form of local governance is the use of resources is done economically, effectively and efficiently, fairly and equitably to achieve public accountability. Budgets are needed in the management of these resources well to achieve the performance expected by the community and to create accountability. A budget is a tool for preventing information asymmetry and dysfunctional behavior of the agent or local governments and the public accountability process. The dimensions of public accountability include legal accountability and honesty, program accountability, managerial accountability, policy accountability, and financial (financial) accountability. With regard to financial accountability particularly in the regions, the government should publish its regional financial statements. Although the demand for accountability of public institutions both at the central and regional levels is strengthening, there are still many inappropriate data and deviations found by BPK in the audit of government financial statements, whereas many parties rely on financial statement information to be published as Basic decision-making.
BPKP Representative of NTB has conducted Performance Audit in Central Lombok Regency in April 2016. Audit This performance raises many records of deficiencies both in terms of facilities and infrastructure, buildings and equipment, the availability of human resources both health and non-health workers. Management of National Health Insurance Capitation Fund (JKN) which is based on Presidential Regulation No. 32 of 2014 causes the absorption of the budget is not maximal. BPKP performance audit results noted that Balance of FKTP Health Services Operational Support Fund Support as of December 31, 2015 is still quite large which amounted to Rp.11.779.989.239,00 where the balance per-puskesmas vary between Rp.265.644.520,00 up to Rp.824.097 .272.00. This is because the leaders of the puskesmas are more careful in utilizing the capitation funds that are still relatively new in the puskesmas. With the existence of the condition, then was born Regulation of Minister of Health Number 21 Year 2016 about Use of JKN Capitation Fund at FKTP owned by Local Government. Yuliyanto (2016) concluded that the Minister of Health Regulation No. 21 of 2016 was issued as a solution to the shortcomings / weaknesses of the previous regulation, which is expected to meet the needs in terms of implementation FKTP JKN in local government-owned.
Undap, et al (2017) showed budgeting Capitation Fund JKN Bitung by FKTP done centralized in the Department of Health while the implementation of the capitation fund management JKN not follow regulations governing, so it has implications not maximal FKTP services in the community. Another consequence that occurs because of this condition is very low budget absorption due to the program activities derived from the JKN Capitation Fund is not implemented maximally.
Anggraeni, et al (2016) concluded that PHC Chief Purbalingga need to monitor and control tool in the calculation of points of presence and dissemination of apportionment of healthcare services. While for operational costs, all puskesmas in Purbalingga do not allocate the same type of shopping items in accordance with the rules set, for example in promotive and preventive activities that are only done in 3 (three) puskesmas from 7 (seven) puskesmas in Purbalingga Regency. Sholihin, et al (2015) concluded Watubangga health center has done Capitation Fund Management JKN ranging from budgeting to accountability. Budgeting is done by making RKA in the fourth month of the current year. In terms of implementation and utilization of capitation funds used to pay for services 80%, BHP and medicines 14%, and outdoor activities and maintenance ambulance by 6%. In relation to accountability, Head of Watubangga Health Center is responsible formally and materially to the Management (income and expenditure) of JKN Capitation Fund of Watubangga Community Health Center (Puskesmas). Based SP2B FKTP, head SKPD Health Department prepared a report on revenue and expenditure JKN Capitation Fund as well as in the Financial Statements SKPD menyajikanya Health Department will be consolidated into Local Government Financial Statements in accordance with the provisions of the legislation in the field of financial management (SE Ministers No. 900/2280 / SJ).
This research tries to contribute knowledge by explaining the influence of Information Technology Utilization and Human Resource Competence on Financial Accountability of JKN Capitation Fund in Central Lombok Regency. JKN Capitation Fund of Central Lombok Regency is implemented based on Regulation of the Minister of Health No. 21 of 2016 on the Use of JKN Capitation Fund at FKTP owned by Local Government. The purpose of this research is to prove the influence of Information Technology Utilization and Human Resource Competence on Financial Accountability of JKN Capitation Fund. Theoretical research contributions support the theory Agency (Agency Theory), while the contribution of thumb is for consideration to enhance the Human Resource Competency training and preparation of reports with the computerized system. Furthermore, policy contribution from this research is to evaluate the implementation of Regulation of the Minister of Health Number 21 of 2016 on the Use of JKN Capitation Fund for Service and Support of Operational Cost of FKTP / Puskesmas belonging to Local Government as an update from Presidential Regulation no. 32 by 2014 on the management and utilization of the Capitation Fund.
2. LITERATURE STUDY AND HYPOTHESES DEVELOPMENT
JKN capitation funds coming from the government (principal) is one of the resources managed by the health center (agent). Puskesmas are required to provide facilities that can support quality health services to the community by realizing the JKN Capacity Fund expenditure. JKN Capacity Fund as stipulated in the Work Plan and Budget SKPD (RKA-SKPD) prepared by the Head of SKPD Dinas Kesehatan. RKA-SKPD can be composed by the Head of SKPD because previously the puskesmas has compiled and submitted the plan of income and expenditure of JKN Capitation Fund to SKPD Dinas Kesehatan. The revenue and expenditure plan of the JKN Capacity Fund refers to the number of participants enrolled in the puskesmas and the amount of capitation of JKN in accordance with the prevailing laws and regulations. Besides principal also developed technical guidelines (guidelines) the use and accountability of Capitation Fund JKN regulated through the Ministry of Health Regulation No. 21 of 2016. For the purpose of aligning agent and principal, then the principal requires the agent to account JKN Capitation Fund management through periodic financial reporting mechanisms . In realizing it is necessary that adequate facilities and infrastructure of information technology and supported also with the existence of competent human resources who are able to manage JKN Capacity Fund accountably and transparently.
2.1 Effect of Information Technology Utilization on Financial Accountability of JKN Capitation Fund
The use of agency theory is in accordance with the concept of accountability. Accountability is an obligation to provide the information (including financial information) required for a given public service. Accountability in the context of public organizations is the provision of information and disclosure (disclosure) on the activities and financial performance to the parties concerned either to the higher institutional, public, media, and other stakeholders. Mardiasmo (2002) mentions the concept of accountability can be understood as the obligation of a fiduciary (agent) to provide accountability, serving, reporting, and disclose all activities and activities that are its responsibility to the grantor trustee (principal) who has the right and authority to hold accountable those . Accountability is intended to seek answers to questions relating to what services, who, to whom, whom, and where. Financial accountability is an accountability of financial integrity, disclosure, and compliance with laws and regulations. The objectives of accountability are the financial statements presented and the prevailing laws and regulations covering receipts, storage, and expenditures by government agencies. Accountability can be achieved if there is a commitment of the leadership and the entire staff of government agencies concerned to ensure proper use of resources consistent with the laws and regulations (Santoso, 2016). In order to facilitate the preparation and presentation of financial statements, the government needs to optimize the utilization of information technology to build a network of management information systems and work processes that allow the government to work in an integrated and planned by simplifying access between units.
Information technology can be defined as a technology used to process data, including processing, obtaining, compiling, storing, manipulating data in various ways to produce quality information, ie relevant, accurate, and timely information used for personal, business purposes , And governance and is a strategic information for decision-making. This technology is a set of computers to process data, equipped with a network system that can connect one computer to another computer, and use communication technology so that data can be spread and accessed globally. (http://www.informatika.lipi.go.id/perkembangan-teknologi-informasi-di-indonesia ). Momuat (2016), examines the effect of the use of information technology to the timeliness of financial reporting in order to bring transparency and accountability demonstrate that the use of information technology a significant effect on the timeliness of financial reporting. Pratama (2015), showed the better pemanfaaan information technology, the better the value of financial reporting information generated by each local government agencies to meet the demands of accountability in the public sector. Based on these studies can be drawn hypothesis: