Calculation the effect of nominal limit to the need for additional facilities and paramedics with the system dynamics methodology

There are some problems faced by the Healthcare and Social Security Agency (Badan Penyelenggara Jaminan Sosial Kesehatan or “BPJS Health”) in managing community-based health insurance program. In fact, the number of patients has increased dramatically and this condition influences the available capacity of the bed in the public health care center (Pusat Kesehatan Masyarakat or Puskemas) and hospital, and the available capacity of the paramedics. In the end, this condition will affect the total cost to be covered by the by BPJS Health and also influences the degree of satisfaction of the participant of this program. Based on this condition, this study will give BPJS Health a suggestion to switch the current system with the indemnity insurance payment system. Indemnity plans referred to as "fee-for-service" plans which have a nominal limit restricted the cost of health care of each participant. Then, according to a nominal limit, this study want to develop the simulation that describes the interrelationships between the nominal limit and the various factors that affect the availability of facilities and paramedics needed (such as number of number of beds in hospital, number of physicians, specialist, and nurses). This simulation will be carried out by the system dynamics methodology. The result of the simulation showed that, when BJS Health set the nominal limits, the number of participants of BPJS health will decrease slightly compared to the current state. Based on this condition, the demand of bed of the hospital, the demand of physicians, specialist, and nurses will also decrease slightly compared to the current state. For the next year, if the nominal limit is assigned, 49 additional hospital beds, 11.694 additional physicians, and 14.566 additional nurses would be required for the Province of Central of Java. In the others hand, if the nominal limit didn´t assigned, for the next year, 966 additional hospital beds, 12.645 additional physicians, and 17.364 additional nurses would be required for the Province of Central of Java.