The Analysis of JKN-KIS Hospital Outpatient Referral System Implementation Subsequent to Online Referral Application

Abstract

National Health Insurance Program (JKN) carried out in referral system mandatory for members and health care providers, that hadn’t optimum in the implementation caused mismatch in submit the selected specialist and input the diagnoses, online reference numbers are not found, lack in giving the explanations for referral agreements, and incomplete filling the referral letters. This research aims to studying the implementation of hospital outpatient referral system in order to recommend various improvements. This research used Qualitative-Quantitative approaches (Mixed Method) with primary and secondary data. Five informants were included in this research, 114 participants for Quantitative study, and observed some relevant documents. The results of the Qualitative research revealed that vertical referrals to hospital had been implemented according to policy, but back referral system is still not running optimal. From survey study showed that 91.2% participant had approved in referral services, but 94.7% had incomplete contents of referral letter. It’s suggested to arrange cooperation and coordination between insurance operator (BPJS), healthcare provider (Hospital Management, Specialist) and members (patients) to optimize referral system. It is expected that the results of this research could give the insight for the Hospital and related institutions in improving various aspects related to the optimized of referral system.