DAMPAK PELAKSANAAN PROGRAM JKN TERHADAP KUALITAS RUJUKAN RAWAT JALAN DI POLIKLINIK KEBIDANAN DAN KANDUNGAN RUMAH SAKIT CIPTO MANGUNKUSUMO JAKARTA

EKA RUSDIANTO G, Prof.Dr.Adi Utarini, MSc, MPH, PhD; dr.Hanevi Djasri, MARS

2017 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar belakang: Terdapat peningkatan jumlah pasien di Poliklinik Obstetri dan Ginekologi RSCM setelah dilaksanakannya program JKN. Kemungkinan disebabkan oleh sistem rujukan berjenjang yang belum berjalan dengan baik dan atau meningkatnya jumlah pasien JKN. Pelaksanaan sistem rujukan berjenjang ini dapat dilihat dengan menelaah pola dan kualitas rujukan tersebut. Tujuan: Mendeskripsikan dampak pelaksanaan program JKN terhadap pola dan kualitas rujukan di Poliklinik Obstetri dan Ginekologi RSCM, khususnya untuk mengukur ketepatan diagnosis, ketepatan asal Faskes dan kesesuaian diagnosis kasus rujukan BPJS Metode: Penelitian ini merupakan penelitian kuasi eksperimental dengan desain pre dan post, dengan melakukan analisis pola kasus dan kualitas rujukan, yang terdiri dari ketepatan diagnosis kasus rujukan, ketepatan asal Faskes perujuk, dan kesesuaian diagnosis kasus rujukan Hasil dan pembahasan: Terdapat peningkatan kunjungan rujukan BPJS di awal program JKN, namun mulai menurun dengan berjalannya waktu. Terjadi penurunan jumlah kasus Obstetri dan Ginekologi umum, sebaliknya kasus subspesialistik meningkat sesuai peran RSCM sebagai fasyankes rujukan ketiga. Kualitas rujukan BPJS membaik, terlihat sekitar 98% diagnosis rujukan merupakan kasus yang tepat untuk dirujuk, 82% kasus berasal dari fasyankes perujuk yang tepat, dan 98% diagnosis perujuk telah sesuai dengan diagnosis Kesimpulan dan saran: Kualitas rujukan kasus BPJS ke RSCM membaik setelah dimulainya pelaksanaan program JKN

Background: An increasing number of outpatient visits in Obstetrics and Gynecology Department, Cipto Mangunkusumo Hospital is observed after the implementation of National Health Insurance (JKN) program. This may be contributed by tiered referral system that is not yet well implemented and or the increasing number of nationally-insured patients (also called as BPJS patients). The tiered referral system implementation can be evaluated by analyzing the pattern and quality of these referrals. Objective: This study aims to describe the impact of National Health Insurance program implementation on the pattern and quality of referral in Obstetrics and Gynecology Outpatient Services, Cipto Mangunkusumo Hospital. Specifically, it aims to evaluate the accuracy of referred case diagnosis, accuracy of referring health facility, and consistency of referred case diagnosis. Method: The study is an kuasi experimental study that uses pre and post analysis. This is done by analyzing the pattern of cases and quality of referrals, which consist of accuracy of referred case diagnosis, accuracy of referring health facility, and consistency of referred case diagnosis. Result and discussion: There was an increasing number of referral visits in the early implementation of National Health Insurance program. However, the number declined over time. The number of general Obstetrics and Gynecology cases decreased. Conversely, the number of sub-specialistic cases increased. This is in line with the role of Cipto Mangunkusomo Hospital at the third level of referral system. Improved quality of BPJS referrals is seen from about 98% of referral diagnosis is suitable to be referred, 82% of cases are referred by the correct health facility, and 98% of referring diagnosis is consistent with Cipto Mangunkusumo Hospital diagnosis Conclusion and recommendation: Improved quality of BPJS referrals to Cipto Mangunkusumo Hospital is observed after the implementation of the National Health Insurance program.

Kata Kunci : kualitas rujukan, BPJS, Obstetri dan Ginekologi