Analisis Rujukan Berjenjang Peserta BPJS Kesehatan di UPT Puskesmas Sawit Seberang Kabupaten Langkat Tahun 2023

Abstract

The referral system is the implementation of health services which regulates the reciprocal delegation of duties and responsibilities for health services, both vertically and horizontally, which must be implemented by participants in health insurance or social health insurance, and all health facilities. Puskesmas as FKTP plays a role in implementing gate keeper functions as a referral filter that regulates access to advanced health services through a referral system. The RRNS of the Sawit Seberang Health Center increased from 2022 by 4.5% to 7.5% in 2023 and exceeded the set standard limits. This makes the Sawit Seberang Health Center the health center with the sixth largest RRNS in 2022 and the third largest in 2023 in Langkat Regency. This research aims to determine the implementation of tiered referrals for BPJS Kesehatan participants at the Sawit Seberang Health Center, Langkat Regency. This research is qualitative research with research subjects as many as 7 informants. Data collection was carried out using in-depth interviews, observation and document review. The results of the research show that the implementation of tiered referrals for BPJS Kesehatan participants at the Sawit Seberang Health Center does not meet standards. The high referral rate is due to frequent vacancies of doctors, incomplete availability of medicines when compared with Kepmenkes HK.01.07/MENKES/6485/2021, incomplete health equipment when compared with Kepmenkes 118/MENKES/SK/IV/2014. This resulted in the Seberang Sawit Health Center not being able to meet its KBK payment milestones and only receiving 85% of the total KBK payments. From the research, it is hoped that the Sawit Seberang Health Center can evaluate the vacancies of doctors during health service times, incomplete medicines, and incomplete health equipment