Latar Belakang: Indikator mutu pelayanan di rumah sakit dapat dilihat melalui angka kejadian pulang paksa, ketidakpuasan terhadap pelayanan dan masalah biaya selama ini menjadi penyebab utama kejadian pulang paksa, ketiadaan kartu jaminan kesehatan merupakan faktor resiko terjadinya pulang paksa. Kepemilikan kartu BPJS diharapkan mampu mengurangi kejadian pulang paksa di rumah sakit, namun kejadian pulang paksa di RSUD Tais pada tahun 2015 pada peserta BPJS Kesehatan cukup tinggi yakni sebesar 17% sehingga penting untuk mengetahui faktor penyebab tingginya angka tersebut langsung dari pasien yang pulang paksa. Tujuan: Menganalisis alasan mengapa pasien peserta BPJS yang dirawat inap memutuskan pulang paksa dari RSUD Tais. Metode Penelitian: Jenis penelitian ini adalah studi kasus tunggal holistik, Informan dalam penelitian ini adalah seluruh pasien peserta BPJS yang pulang paksa selama periode penelitian yakni pada bulan April sampai dengan Mei tahun 2016. Pengumpulan data dilakukan dengan wawancara mendalam, observasi dan studi dokumen. Hasil Penelitian: Terdapat 14 kejadian pulang paksa selama penelitian dilakukan, alasan pulang paksa karena merasa sudah sembuh, masalah biaya, karena tempat tinggal jauh, menganggap petugas kurang profesional, proses diagnosis yang lambat dan karena ketersediaan air bersih kurang memadai. Kesimpulan: Sebagian besar pasien pulang paksa menyatakan kurang puas dengan pelayanan di rumah sakit, alasan pasien pulang paksa disebabkan oleh 3 faktor yakni karena faktor internal pasien, faktor yang berhubungan dengan petugas dan faktor yang berhubungan dengan sarana yang kurang memadai.

Background: Indicators of quality of care in hospitals can be seen through the prevalence of Discharge Against Medical Advice (DAMA), based on standard of the minimum service of hospital this figure should be below 5% as a means of evaluating the incidence of health care quality in hospitals. Various studies have shown dissatisfaction with the services and cost issues have been the main cause of occurrence of DAMA, lack of health insurance cards as a risk factor of DAMA. BPJS card ownership is expected to reduce the incidence of DAMA in the hospital but the incidence of Tais Hospital in 2015 to participants BPJS high enough by 17% so it is important to know the determine factors causing the DAMA from the patient or his family. Objective: To analize the reasons of BPJS participants for discharge against medical advice (DAMA)in Tais public hospital. Methods: The study was a descriptive study, with case study design. Informants in this study were all BPJS participants were hospitalized and DAMA during the study period in April to May 2016. Data was collected through interviews, observation and document study. Results: There were 14 events DAMA during the research carried out, most of the patients expressed less satisfied with the service, while the reason for DAMA because it was already cured, the financial problem, the conflict with the officer, wanted to move to another health facility, for a place to stay away (not resident of Seluma District), think of family circumstances, means and facilities are inadequate and because the diagnostic process is slow. Conclusions: Most patients BPJS participants of DAMA expressed less satisfied with hospital services, patients of DAMA reasons caused by 3 categories include internal factors such as the feeling better, financial problem, and stay away from the hospital. The second factor is related to the hospital staff considers less professional and the third is a factor related to the hospital facilities including means for the diagnostic process is slow and clean water supplies are inadequate..

Kata Kunci : Discharge Against Medical Advice , DAMA, BPJS Participants, Tais Public hospital