Understanding BPJS Health Patients On Referral Systems In The JKN Era At Kampung Baru Puskesmas Medan City In 2019

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Understanding BPJS Health Patients on Referral Systems in the JKN Era at Kampung Baru Puskesmas Medan City in 2019

Introduction

The referral system is a crucial mechanism in the healthcare industry that regulates the transfer of duties and responsibilities between health facilities, both vertically and horizontally. This system starts from first-level health facilities, such as the Public Health Center (Puskesmas). In the context of the National Health Insurance (JKN) era, the referral system plays a vital role in ensuring that patients receive the necessary medical attention in a timely and efficient manner. However, the understanding of BPJS Health patients regarding the applicable referral system is still a significant concern.

The Importance of Referral Systems in the JKN Era

The referral system is designed to facilitate the transfer of patients from one health facility to another, ensuring that they receive the necessary medical attention. In the JKN era, the referral system is more complex, with multiple levels of healthcare facilities involved. The system starts from the primary healthcare level, which includes Puskesmas, and then moves to secondary and tertiary healthcare levels. The referral system is essential in ensuring that patients receive the necessary medical attention, and it also helps to prevent unnecessary hospitalizations and reduce healthcare costs.

The Understanding of BPJS Health Patients Regarding Referral Systems

The understanding of BPJS Health patients regarding the referral system is still a significant concern. Many patients assume that the Puskesmas only functions as a place to publish a referral letter, without understanding the actual procedures and referral flow. This lack of understanding can lead to unnecessary referrals, which can put a strain on the healthcare system. In addition, many patients do not know about the rayonization system, where they can refer to any hospital just because they have paid contributions. This lack of understanding can lead to confusion and frustration among patients, which can ultimately affect the quality of healthcare services.

Methodology

This study aims to explore the understanding of BPJS Health patients about the referral system in the JKN era. The method used is qualitative with the phenomenological approach, involving 12 informants chosen purposive sampling. Data collection was carried out through in-depth interviews, and data analysis using the phenomenological method with the results presented in the form of narration.

Results

The results showed that the understanding of BPJS Health patients at the Kampung Baru Health Center about the tiered referral system was still very minimal. Many patients assume that the Puskesmas only functions as a place to publish a referral letter, without understanding the actual procedures and referral flow. The informant also did not know about the rayonization system, where as many as four non-PBI patients felt they were free to refer to any hospital just because they had paid contributions. In addition, an understanding of the flow of referral services, including procedures that must be met and the types of diseases that can be handled at the Puskesmas, are also still lacking.

Discussion

The results of this study highlight the need for better understanding of the referral system among BPJS Health patients. The lack of understanding can lead to unnecessary referrals, which can put a strain on the healthcare system. In addition, the lack of understanding can lead to confusion and frustration among patients, which can ultimately affect the quality of healthcare services. Therefore, it is essential to strengthen the role of the Medan City Health Office in fostering and overseeing the implementation of referrals at the level of primary health services. BPJS Health needs to support the Puskesmas in conducting socialization regarding the referral system that applies in the JKN era. Puskesmas should also carry out regular socialization to the public to increase awareness and understanding of the referral system, as well as equipped with adequate information media in the building for better access.

Conclusion

In conclusion, the understanding of BPJS Health patients regarding the referral system is still a significant concern. The lack of understanding can lead to unnecessary referrals, which can put a strain on the healthcare system. Therefore, it is essential to strengthen the role of the Medan City Health Office in fostering and overseeing the implementation of referrals at the level of primary health services. BPJS Health needs to support the Puskesmas in conducting socialization regarding the referral system that applies in the JKN era. Puskesmas should also carry out regular socialization to the public to increase awareness and understanding of the referral system, as well as equipped with adequate information media in the building for better access.

Recommendations

Based on the findings of this study, the following recommendations are made:

  1. Strengthen the role of the Medan City Health Office: The Medan City Health Office should be able to foster and oversee the implementation of referrals at the level of primary health services.
  2. Conduct socialization regarding the referral system: BPJS Health needs to support the Puskesmas in conducting socialization regarding the referral system that applies in the JKN era.
  3. Regular socialization to the public: Puskesmas should carry out regular socialization to the public to increase awareness and understanding of the referral system.
  4. Equipped with adequate information media: Puskesmas should be equipped with adequate information media in the building for better access.

Limitations of the Study

This study has several limitations. Firstly, the study only focused on the understanding of BPJS Health patients regarding the referral system in the JKN era. Secondly, the study only involved 12 informants, which may not be representative of the entire population. Finally, the study only used qualitative methods, which may not provide a comprehensive understanding of the referral system.

Future Research Directions

Future research should focus on exploring the referral system in more depth, including the procedures and referral flow. In addition, future research should involve a larger sample size and use both qualitative and quantitative methods to provide a more comprehensive understanding of the referral system.
Understanding BPJS Health Patients on Referral Systems in the JKN Era at Kampung Baru Puskesmas Medan City in 2019: Q&A

Q: What is the referral system in the JKN era?

A: The referral system in the JKN era is a mechanism that regulates the transfer of duties and responsibilities between health facilities, both vertically and horizontally. This system starts from first-level health facilities, such as the Public Health Center (Puskesmas), and then moves to secondary and tertiary healthcare levels.

Q: Why is the understanding of BPJS Health patients regarding the referral system important?

A: The understanding of BPJS Health patients regarding the referral system is important because it can affect the quality of healthcare services. If patients do not understand the referral system, they may make unnecessary referrals, which can put a strain on the healthcare system.

Q: What are the main challenges faced by BPJS Health patients regarding the referral system?

A: The main challenges faced by BPJS Health patients regarding the referral system include:

  • Lack of understanding of the referral system
  • Difficulty in navigating the referral process
  • Limited access to information about the referral system
  • Inadequate communication between healthcare providers and patients

Q: What are the benefits of a well-understood referral system?

A: The benefits of a well-understood referral system include:

  • Improved quality of healthcare services
  • Reduced unnecessary referrals
  • Increased patient satisfaction
  • Better use of healthcare resources

Q: What can be done to improve the understanding of BPJS Health patients regarding the referral system?

A: To improve the understanding of BPJS Health patients regarding the referral system, the following can be done:

  • Conduct regular socialization and education programs for patients
  • Provide clear and concise information about the referral system
  • Use multiple channels to communicate with patients, such as phone, email, and text messaging
  • Involve patients in the decision-making process regarding their care

Q: What is the role of the Medan City Health Office in improving the referral system?

A: The Medan City Health Office plays a crucial role in improving the referral system by:

  • Fostering and overseeing the implementation of referrals at the level of primary health services
  • Providing guidance and support to healthcare providers
  • Monitoring and evaluating the referral system to identify areas for improvement

Q: What is the role of BPJS Health in improving the referral system?

A: BPJS Health plays a crucial role in improving the referral system by:

  • Providing support and resources to healthcare providers
  • Conducting socialization and education programs for patients
  • Monitoring and evaluating the referral system to identify areas for improvement

Q: What can be done to improve the referral system in the JKN era?

A: To improve the referral system in the JKN era, the following can be done:

  • Implement a more efficient and effective referral process
  • Use technology to streamline the referral process
  • Improve communication between healthcare providers and patients
  • Increase patient involvement in the decision-making process regarding their care

Q: What are the future directions for research on the referral system in the JKN era?

A: Future research on the referral system in the JKN era should focus on:

  • Exploring the referral system in more depth, including the procedures and referral flow
  • Using both qualitative and quantitative methods to provide a more comprehensive understanding of the referral system
  • Investigating the impact of the referral system on patient outcomes and healthcare costs.