Latar Belakang: Akses terhadap pelayanan kesehatan yang berkualitas oleh masyarakat miskin yang ada di daerah kepulauan masih rendah. Faktor geografis, finansial, sosio-kultural dan penyedia layanan kesehatan sangat mempengaruhi. Berbagai bentuk kegiatan dan pengelolaan speed boat oleh dinas kesehatan dan puskesmas belum mampu membuat masyarakat miskin menjangkaunya. Program Kartu Sosial dan Jamkesmas merupakan faktor kunci terselenggaranya layanan rujukan ini. Kombinasi antara manajemen layanan rujukan dan manajemen pembiayaan berhasil meningkatkan akses masyarakat terhadap layanan kesehatan lanjutan yang lebih berkualitas. Meskipun demikian, masih terdapat praktek kekurangadilan dalam penyelenggaraan jaminan kesehatan. Tujuan Penelitian: Untuk mendapatkan gambaran penyelenggaraan layanan rujukan masyarakat miskin di daerah perairan Kabupaten Pelalawan. Metode Penelitian: Penelitian ini menggunakan metode kualitatif dengan rancangan studi kasus yang bersifat deskriptif. Informan penelitian dipilih secara non-probability dengan menggunakan teknik purposive. Data dikumpulkan dengan cara wawancara mendalam, observasi dan studi dokumentasi. Hasil: Speed boat dipilih sebagai alat transportasi utama rujukan ke rumah sakit oleh masyarakat daerah perairan karena kecepatannya. Tetapi, biaya operasional yang mahal membuat masyarakat miskin sulit memanfaatkannya. Adanya Program Kartu Sosial dan Jamkesmas sangat membantu terlaksananya layanan rujukan ini. Tetapi, ada perbedaan pemanfaatan Program Kartu Sosial antara masyarakat miskin di Kecamatan Teluk Meranti dengan di Kecamatan Kuala Kampar. Adanya Jamkesmas juga belum bisa sepenuhnya membebaskan masyarakat miskin Kecamatan Kuala Kampar dari pengeluaran biaya tambahan. Kesimpulan: Layanan rujukan daerah perairan telah menjadi agenda dan perhatian pemerintah melalui kombinasi pengelolaan sarana transportasi rujukan dan implementasi Program Kartu Sosial. Tetapi, belum sepenuhnya memperhatikan prinsip-prinsip pemerataan dan keadilan sehingga masih ada masyarakat miskin yang belum bisa memanfaatkannya.

Background: Access to quality health service by poor communities in islandic/watery region is still relatively low. Geographical, distance, infrastructure and economic conditions greatly affect access. Various activities and the management of speed boat carried out by health office and health centers are unable poor community use the service. Programs of social and community health insurance are key factors for the management of referral service. Combination between management of referral service and finance enables to increase access of the community to better quality secondary health services. However, there is some injustice of health insurance that has become a homework of the local government and health office as well as across related sectors to do. Objective: To get an overview of the management of referral service for poor communities at the watery region of District of Pelalawan. Method: The study used qualitative method with descriptive case study design. Informen of the study were selected using non probability with purposive technique. Data were obtained through indepth interview, observation and documentation study. Result: Speed boat was chosen as the major transport for referral to hospitals by the community due to its speed. However, expensive operational cost made the poor community unable to use the service. The program of social and community health insurance greatly assisted in the implementation of referral service. However, there was difference in the utilization of social insurance program between poor communities at Subdistrict of Teluk Miranti and at Kuala Kampar. Community health insurance (Jamkesmas) still could not fully free poor communities at Subdistrict of Kuala Kampar from extra expenditure. Conclusion: Although referral service at watery region had become the government agenda and attention, through the combination of referral transport facility management and the implementation of social card program, the practice had not fully consider the principles of equal distribution and justice so that some poor community were still unable to utilize the service.

Kata Kunci : Layanan rujukan,Masyarakat miskin,Transportasi rujukan,Pembiayaan kesehatan,asuransi, Referral service, poor communities, referral transportation, speed boat, insurance based health finance