Implementasi Kebijakan Rujukan Non Spesialistik Era Jaminan Kesehatan Nasional Di Puskesmas Kabupaten Ngawi

Maria Yeny Eskawati. S021602027.2017. TESIS. Implementation of the Referral System Policy in the National Health Insurance Scheme at Community Health Centers, Ngawi District, East Java. Supervisor: Didik Gunawan Tamtomo, Co Supervisor: Bhisma Murti. Masters Program in Public Health, Sebelas Maret University ABSTRACT Background: It has been reported that there are some obstacles in the implementation of the National Health Insurance, one of which is its referral system. Community Health Center is expected to serve as a gatekeeper, such that most of the health problems can be tackled at the Community Health Center. However, anecdotal evidences had shown that the referral system did not run as expected. This study aimed to examine the implementation of the referral system in the National Health Insurance scheme with special attention on the policy context, resources availability, process and product (CIPP models) at Community Health Centers in Ngawi, East Java. Subjects and Method: This was a qualitative study conducted in Ngawi, East Java. The institutions under study included 3 Community Health Centers of different strata Geminggar Community Health Center (highest strata), Ngawi Community Health Center (medium strata), Kasreman Community Health center (lowest strata). The other institution under study was Ngawi District Health Office. The informants for this study included 24 patients of various categories at Community Health Center: subsidy recipients, class I, class II, and class III. The other informants included 1 staff from District Health Office and 6 staff from Community Health Center. The data were collected by in-depth interview, observation, and document review. Results: Policies or regulation about unspecialist referral is not yet relevant if applied on this time where availability of human resources and medical equipment is still minimum and obstacles on the fact from availability resources, allocation of policy, the understanding of patient is less and socialization only from Community Health Center, then the easier referral scheme of ASKES so exposure high specialist patient and there is no effort for renewing competence by a training so the number of referral is still high. Conclusion: It is nedded optimalization of using capitation fund for fixing source, socialization from BPJS by media also placing verification staff in Community Health Center and expected there are extence transparency about 10% of capitation and giving reward for achievement CHC. Keywords: Referral System Policy, National Health Insurance, CH