Implementasi Sistem Rujukan (Referral System) BPJS Kesehatan dalam Pelayanan Kesehatan di Era Jaminan Kesehatan Nasional (Studi Pelaksanaan Rujukan di RSUD Sleman Yogyakarta)

Nadinda Anisadewi, Dwi Haryati, S.H., M.H.

2026 | Skripsi | ILMU HUKUM

Penelitian ini dilatarbelakangi oleh permasalahan pelaksanaan pelayanan kesehatan di RSUD Sleman melalui sistem rujukan BPJS Kesehatan. Permasalahan implementasi sistem rujukan tersebut terdapat pada aspek kompetensi sumber daya manusia, pengadaan sarana prasarana dan obat-obatan, permasalahan pembiayaan serta proses administrasi dan keaktifan status kepesertaan pasien. 

Penelitian dilaksanakan dengan pendekatan normatif empiris dengan penyajian data secara deskriptif. Data primer diperoleh melalui wawancara dengan stakesholders dan pasien BPJS Kesehatan di RSUD Sleman. Kemudian data sekunder diperoleh melalui studi kepustakaan, dokumen, serta regulasi yang terkait. 

Hasil penelitian menunjukkan bahwa pelaksanaan rujukan di RSUD Sleman telah terlaksana sesuai dengan regulasi normatif, meskipun terdapat hambatan dalam aspek sumber daya manusia, sarana prasarana dan obat-obaan, dan pembiayaan, serta administrasi dan kepesertaan pasien sehingga pelaksananaan pelayanan kesehatan belum optimal. 

Namun demikian, RSUD Sleman telah melakukan upaya untuk mengatasi permasalahan yang ada, meskipun belum terselesaikan secara maksimal. Oleh karena itu, maka dibutuhkan upaya perbaikan seperti pemenuhan sumber daya manusia dan sarana prasarana serta obat-obatan yang sesuai dengan regulasi. 

This research is based on issues in the implementation of health services at RSUD Sleman through the BPJS Health referral system. Problems in the implementation of the referral system are identified in several aspects, namely the competence of human resources, the procurement of facilities, infrastructure, and medicines, financing constraints, as well as administrative procedures and the active status of patients BPJS Health membership.

This study applies a normative empirical legal research approach with descriptive data presentation. Primary data were obtained through interviews with stakeholders and BPJS Health patients at RSUD Sleman. Secondary data were collected through statutory, documentary, and literature-based research on relevant laws and regulations.

The results indicate that the implementation of the referral system at RSUD Sleman has generally been carried out in accordance with the applicable normative regulations. However, several obstacles remain, particularly in the aspects of human resources, facilities, infrastructure and medicines, as well as administrative processes and patient membership status, which have resulted in suboptimal health service.

However, RSUD Sleman has undertaken certain measures to address these constraints, although have not yet been fully effective. Therefore, further improvements are required, particularly in relation to the fulfillment of human resources and the provision of facilities, infrastructure, and medicines in accordance with prevailing regulations

Kata Kunci : Sistem Rujukan, Pelayanan Kesehatan, Jaminan Kesehatan Nasional