National health coverage programs and the quality of referral cases to the obstetrics and gynaecology clinic at top referral hospital in Jakarta
| Main Authors: | Suastika, Arresta Vitasatria, Gunardi, Eka Rusdianto, Djasri, Hanevi, Utarini, Adi |
|---|---|
| Format: | Article info Journal |
| Bahasa: | eng |
| Terbitan: |
Fakultas Kedokteran Universitas Gadjah Mada
, 2018
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| Subjects: | |
| Online Access: |
https://journal.ugm.ac.id/bkm/article/view/38067 |
Daftar Isi:
- Purpose: Implementation of national health coverage contributes to the increasing number of outpatient visits in Obstetrics and Gynecology Department of the Cipto Mangunkusumo Hospital. It may be caused by improper referral system or number of government insurance patients called as BPJS patients. Therefore, this study aims to analyze the pattern and quality of referral system in the implementation of universal health coverage Methods: The quasi-experimental study was conducted using pre and post analysis of the cases pattern and referral quality. A total of 400 referral cases who meet the inclusion and exclusion criteria were used for analysis. Quality of cases include accuracy of referred case diagnosis, the accuracy of referring health facility, and consistency of referred case diagnosisResults: There was an increasing number of referral visits in the early implementation of the national health program; however, it declined over time. There was a reduction of general obstetrics and gynecology cases and an increase of sub-specialistic cases. It was inappropriate to the role of center referral hospital in Indonesia. Around 98% referral diagnoses were correct to be referred, 82% of cases came from correct health facilities, and 98% referral diagnosis was consistent to the Cipto Mangunkusumo Hospital.Conclusion: There is an improvement in the quality of cases referred to Dr. Cipto Mangunkusumo hospital after the implementation of national health coverage program. Latar belakang: Jumlah pasien di Poliklinik Obstetri dan Ginekologi RSCM setelah dilaksanakannya program JKN mengalami peningkatan. Hal itu dapat disebabkan oleh sistem rujukan berjenjang yang belum berjalan dengan baik dan atau peningkatan jumlah pasien BPJS. Pelaksanaan sistem rujukan berjenjang ini dapat dilihat dengan menelaah pola dan kualitas rujukan tersebut.Tujuan: Studi ini mengkaji 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 rujukanHasil: Kunjungan rujukan BPJS mengalami peningkatan di awal program JKN tetapi mengalami penurunan dengan berjalannya waktu. Sejalan dengan peran RSCM sebagai fasyankes rujukan tersier. jumlah kasus obstetri dan ginekologi umum menurun, sebaliknya kasus subspesialistik meningkat. Kualitas rujukan BPJS membaik, terlihat sekitar 98% diagnosis rujukan merupakan kasus yang tepat untuk dirujuk, 82% kasus berasal dari fasilitas layanan perujuk yang tepat, dan 98% diagnosis perujuk telah sesuai dengan diagnosis.Simpulan: Kualitas rujukan kasus BPJS ke RSCM membaik sejalan dengan pelaksanaan program JKN.