PRIMIX: Evaluating Indonesia's Blended Primary-Care Payment

Executive summary

PRIMIX evaluates Indonesia's blended (mix) primary-care payment system, which combines non-capitation, a programmatic fund, and performance-based capitation, and asks how it shapes chronic-disease management at the front line. Using a staggered difference-in-differences design that exploits the roughly 4,000 Puskesmas transitioning to BLUD status between 2019 and 2024, the study links the payment framework to facility performance, service-standard compliance, efficiency, and utilisation, and compares incentives across BLUD, non-BLUD, and private organisations.

Questions this report answers

• How did Indonesia's blended primary-care payment emerge, and how was it designed?
• What enables or blocks its effect on chronic-disease management at the front line?
• Do BLUD, non-BLUD, and private facilities respond to the incentives differently?

Key findings

• The study evaluates Indonesia's blended primary-care payment: non-capitation, a programmatic fund, and performance-based capitation (KBK).
• It uses a staggered difference-in-differences design exploiting the roughly 4,000 Puskesmas that transitioned to BLUD status between 2019 and 2024.
• Callaway-Sant'Anna and Sun-Abraham estimators with facility fixed effects address staggered-adoption bias and heterogeneous treatment effects.
• Outcomes include the KBK performance score, SPM service-standard compliance, operational efficiency, and service utilisation, drawn from BPJS, SIRS, and BPS data.