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"ABSTRAKPenguatan Sistem PemantauanKesehatan Ibu Berbasis Wilayah Kerja untukPenurunan Risiko Kematian IbuAbstrakKasus kematian ibu di Kota Bogor menurut data profil kesehatan Kota Bogor tahun 2015 sebagian besardisebabkan oleh hipertensi 33 dan penyakit penyerta ibu 38 yang dapat terdeteksi sejak awal ibumelakukan pemeriksaan kehamilan. Hal ini menunjukkan jejak rekam kondisi ibu harus sudah terpantau sejak iakontak dengan layanan kesehatan yang tercatat dan terpantau melalui kohort ibu. Kohort ibu merupakan sumberdata pelayanan ibu hamil dan bersalin, serta keadaan dan resiko yang dimiliki ibu, Sehingga kohort merupakansumber data penting dalam deteksi dini ibu hamil sehingga dapat dilakukan penanggulangan sejak dini. Namunterkadang tidak semua ibu hamil di suatu wilayah kerja Puskesmas tercatat di kohort ibu, hal ini disebabkan masihlemahnya sistem registrasi populasi di wilayah kerja puskesmas. Berdasarkan data hasil Riskesdas 2013, fasilitaskesehatan yang banyak dimanfaatkan ibu hamil adalah praktek bidan 52,5 , sedangkan Puskesmas/Pustu 16,6 dan Posyandu 10,0 , sedangkan sisanya ibu hamil memeriksakan kehamilannya di RS, rumah bersalin,klinik/praktek dokter dan fasilitas lainnya, hal ini menunjukkan ada ibu hamil yang tidak teregistrasi olehpuskesmas.Penelitian ini bertujuan untuk mengembangkan suatu sistem informasi berupa prototype yang dapat mendukungmanajemen program KIA yang dapat menghasilkan informasi yang berkualitas untuk peningkatan pemantauankondisi kesehatan masyarakat di wilayah kerja Puskesmas khususnya kesehatan ibu dan menjadi data dasar dalamdeteksi dini resiko yang berkaitan dengan masalah kesehatan ibu selama kehamilan sehingga tidak terjadi resikodalam persalinannya. Aplikasi menghasilkan data jumlah ibu hamil beresiko, dan rekomendasi fasilitas kesehatanrujukan. Rekomendasi dimasa yang akan datang adalah menyederhanakan antara muka sistem informasi untukbisa digunakan di telepon pintar yang kemudian dapat diunggah kedalam server website aplikasiKata kunci: PWS-KIA; bumil beresiko; sistem rujukan.

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ABSTRACTCases of maternal mortality in the city of Bogor in Bogor City health profile data in 2015 mostly due tohypertension 33 and concomitant diseases of women 38 that can be detected early antenatal mothers. Itshowed footage mother 39 s condition must be monitored since he was in contact with health services recorded andmonitored through the cohorts of women. Cohorts of women is a data source expectant mothers and maternitycare, as well as the circumstances and the risks that the mother, so the cohort is an important data source for theearly detection of pregnant women in order to take countermeasures early. But sometimes, not all pregnant womenin a community health center work area recorded in cohorts of women, this is due to the weakness of a populationregistration system in the working area health centers. Based on data Riskesdas 2013, health facilities are widelyused pregnant women is the practice of midwives 52.5 , while the health center sub health 16.6 and IHC 10.0 , while the remaining checkups of pregnant women in hospital, maternity homes, clinics medicalpractices and other facilities, it indicates there are pregnant women who are not registered by the health center.This research aims to develop an information system is a prototype that can support the management of MCHprograms that can produce quality information for improved monitoring of community health in community healthcenter especially the health of mothers and into the data base in the early detection of risks related to the issue ofmaternal health during so there is no risk of pregnancy in childbirth. Applications generating data on the numberof pregnant women at risk, and on referral health facility. Recommendations in the future is to simplify theadvance of information systems to be used in smart phones which can then be uploaded into the website serverapplicationKeywords PWS KIA risk pregnant mother referral system"

"Latar belakang: Kematian ibu masih menjadi permasalahan besar di Indonesia, dimana perdarahan, infeksi, dan preeklampsia/eklampsia sebagai penyebab tersering. Sistem rujukan yang baik merupakan salah satu pendukung dalam penatalaksanaan kasus-kasus obstetri sehingga kasus komplikasi dapat terhindar. Saat ini sudah terdapat BPJS, dimana rujukan dilakukan secara berjenjang. Bidan yang berpraktik mandiri tidak termasuk dalam sistem BPJS, hanya menjadi jejaring BPJS bila tidak terdapat fasilitas persalinan pada pelayanan primer. Namun masih belum dijabarkan secara jelas kedudukan bidan pada sistem rujukan untuk kasus gawat darurat. Sehingga masih banyak yang merujuk langsung kasus obstetri dan kasus yang bermanifestasi menjadi komplikatif ke pelayanan tersier, yaitu RSCM. Karakteristik bidan ternyata dapat memberikan pengaruh terhadap keputusan seorang bidan dalam merujuk. Penelitian ini mengumpulkan informasi mengenai alasan rujuk melalui gambaran karakteristik bidan yang merujuk langsung kasus-kasus komplikatif ke RSCM. Tujuan: Mengetahui karakteristik bidan yang berpraktik di praktik mandiri bidan serta hubungannya dengan kasus komplikatif yang dirujuk langsung ke RSCM. Metode: Penelitian ini menggunakan desain deskriptif analitik kasus kontrol pada bidan yang berpraktik mandiri yang merujuk langsung kasus-kasus obstetri dan/atau kasus komplikatif pada bulan Januari 2016 hingga Juli 2017. Dilakukan pencatatan data bidan yang berpraktik mandiri, kasus obstetri, dan kasus yang bermanifestasi menjadi kasus komplikasi yang memenuhi kriteria inklusi. Kemudian dilakukan analisis terhadap enam karakteristik bidan yang merujuk, yaitu: usia, pendidikan, pelatihan yang pernah diikuti selama masa praktik, lama waktu berpraktik, jumlah pasien yang pernah ditangani selama masa kerja, serta jarak dan waktu tempuh proses merujuk.Hasil: Didapati 82 bidan yang berpraktik mandiri yang merujuk 29 kasus preeklampsia (35.3%), 40 kasus ketuban pecah dini (48.8%), dan 13 kasus perdarahan (15.9%). 28 kasus bermanifestasi menjadi kasus komplikatif (34.1%). Keseluruhan bidan merujuk karena fasilitas yang tidak memadai. Terdapat hubungan yang bermakna secara statistik antara lama waktu praktik dengan jumlah kasus komplikatif yang dirujuk langsung ke RSCM dengan p=0.001 (OR 7.036 CI95% 2.543-19.472). Terdapat pula hubungan yang bermakna antara jumlah pasien dengan perujukan langsung kasus komplikatif ke RSCM dengan p=0.001 (OR 6.032 CI95% 2.220-16.391). Tidak ada hubungan yang bermakna secara statistik antara usia, pendidikan, pelatihan yang sudah pernah diikuti selama masa praktik, serta jarak dan waktu tempuh fasilitas pelayanan kesehatan perujuk, dengan kasus-kasus komplikatif yang dirujuk langsung ke RSCM.Kesimpulan: Keseluruhan bidan merujuk langsung kasus obstetri karena fasilitas yang tidak memadai dan mereka merujuk langsung ke RSCM agar pasien dapat langsung ditangani. Karakteristik bidan yang mempengaruhi bidan yang berpraktik mandiri dalam mengirim langsung kasus-kasus komplikatif yaitu lama waktu praktik dan jumlah pasien yang pernah ditangani selama masa kerjanya. Sehingga perlu dilakukan evaluasi ulang mengenai kedudukan bidan yang berpraktik mandiri di sistem BPJS. Selain itu diperlukan program penyegaran untuk praktik mandiri bidan setiap tahun dan pemantauan serta evaluasi yang dilakukan oleh instansi terkait. Diperlukan pula penelitian lanjutan dengan jumlah sampel yang lebih banyak, dimana penelitian ini menggabungkan karakteristik bidan serta karakteristik pasien pada kasus-kasus rujukan. Namun faktor perancu dan faktor eksternal yang dapat mempengaruhi proses analisis perlu diidentifikasi terlebih dahulu, agar dapat dilakukan analisis yang menyeluruh.

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Background: Maternal mortality is still a major problem in Indonesia, where bleeding, infection, and preeclampsia/eclampsia are the commonest causes. A good referral system is one of the supporters in the management of obstetric cases so the complications can be avoided. Currently there is BPJS, where referrals start from primary to tertiary care. Self-employed midwives are not included in the BPJS system, only as a BPJS network if there is no delivery facility in primary care. It is still not clearly defined the position of midwife at the referral system for emergency cases. So there are still many self-employed midwives that directly refer the obstetric cases and cases that manifest into complication to tertiary care, which is RSCM. Characteristics of the midwife turned out to have an effect on the decision of a midwife in referring. This research collects information about the reasons for referring a case through a description of the characteristics of midwives who directly refer the complicated cases to RSCM. Objective: To identify characteristics of self-employed midwives and its relation to complicative cases referred directly to RSCM. Method: This study used descriptive design with analytic case control on self-employed midwife who referred directly the obstetric cases and/or cases that have manifested into further complication in January 2016 until July 2017. Data of self-employed midwife, obstetric cases, and cases manifested into complications that meet inclusion criteria, were recorded. Then characteristic of referral midwife namely: age, education, training that had been performed during their practice, duration of practice, number of patients that had been handled during the work period, as well as distance and travel time of referring process, were analyzed.Results: There were 82 self-employed midwives referring 29 cases of preeclampsia (35.3%), 40 cases of premature rupture of membranes (48.8%), and 13 cases of bleeding (15.9%). 28 cases were manifest into complicated cases (34.1%). The entire midwife referred those cases due to inadequate facilities. There was statistically significant correlation between duration of practice and number of complicated cases referred directly to RSCM, with p=0.001 (OR 7.036 CI95% 2,543-19,472). There was also a significant correlation between the number of patients with direct referral of complicated cases to RSCM, where p=0.001 (OR 6,032 and CI95% 2,220-16,391). There were no statistically significant correlations between age, education, training that had been performed during practice, as well as the distance and travel time of referring process, with complicated cases that directly referred to RSCM.Conclusions: All self-employed midwives were referring the obstetric cases due to inadequate facilities and they referred directly to RSCM so that patients can be handled immediately. Characteristics that affect self-employed midwife to directly send complicative cases including duration of practice and number of patients that ever handled during their work period. So it is necessary to reevaluate the position of self-employed midwife in BPJS system. In addition, a refresher course is required for them every year and the need of monitoring and evaluation conducted by the relevant agencies. Further research is needed, with a larger number of samples, which combine the characteristics of midwives and the characteristics of patients in referral cases. However, confounding factors and external factors that may affect the analysis process need to be identified first, in order to be able to do a thorough analysis."

"ABSTRAKRumah sakit Umum Daerah Tipe C sebagai Pusat Rujukan di Kabupaten mempunyai peranan penting dalam program penurunan angka kematian ibu dan anak di daerahnya. Demikian juga Rumah Sakit Umum Subang di Jawa Barat yang berpenduduk 1,3 juta orang mempunyai dua dokter spesialis kebidanan dan dua spesialis anak dengan sepuluh orang bidan, melayani rujukan yang berasal dari dokter, Puskesmas, Bidan maupun dukun bayi.Sampai dengan saat ini kegiatan pelayanan rujukan tersebut belum pernah dievaluasi.Penelitian ini bertujuan untuk mengkaji aktivitas pelayanan kesehatan ibu dan anak di kabupaten Subang dengan berfokus pada aktivitas rujukan medis dalam serial waktu 1989-1996 dengan menilai proses yang terjadi selama delapan tahun dan hasil yang tercatat. Data dikumpulkan melalui catatan medis dalam sistem rujukan.Pada analisis terlihat perbedaan yang mencolok terjadi pada tahun 1993, dimana terjadi kenaikan sebanyak 33-43 % kasus-kasus rujukan maternal maupun perinatal. Sejalan dengan itu angka bedah Caesar meningkat 11% setiap tahunnya dan rujukan partus normal menurun. Angka kematian perinatal meningkat terutama pada kasus yang dirawat kurang dan 48 jam pertarna dengan sebab kematian asfiksia dan Berat Badan Lahir Rendah. Pada kasus ini dengan jumlah kasus yang meningkat tidak diimbangi dengan kelengkapan pelayanan intensif perinatal, sehingga banyak kasus yang tidak dapat ditolong. Rujukan kasus kehamilan resiko tinggi meningkat dan sebab kematian maternal ialah perdarahan dan eklamsi.Selama delapan tahun dilakukan sekitar 9 bentuk interfensi yang dilakukan oleh Rumah Sakit Umum Subang bersama Dinas Kesehatan Kabupaten Daerah Tingkat II Subang, antara lain pembentukan Puskesmas dengan perawatan, penempatan bidan desa, menyediakan ruang perinatologi di rumah sakit, membentuk Tim Rujukan rumah sakit, ceramah di organisasi IDI dan IBI, pelatihan tenaga kesehatan dan pelatihan dukun bayi.Banyak spesialis kebidanan maupun spesialis anak di daerah enggan terjun ke daerah, kami menyarankan kepada Departemen Kesehatan untuk membuat suatu posisi tertentu bagi para spesialis sehingga mereka mau tidak mau terjun dalam program kesehatan di daerah melalui suatu Surat Keputusan resmi. Penelitian ini juga mengusulkan kepada rumah sakit untuk melengkapi dengan unit pelayanan intensif perinatal/neonatal. Diperlukan juga peningkatan partisipasi dari lintas sektoral untuk mendukung kegiatan rujukan ini terutama bagi kaum yang tidak mampu.Daftar bacaan : 24 buah

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ABSTRACT

Referral System of Maternal and Child Health Analysis. A Studi Case in General Hospital of Subang District in 1989-1996.

Set up as a medical referral for complicated maternal and child cases, a district hospital in Indonesia plays a huge role in its contribution to decrease infant and maternal death in its catchman area. Subang District Hospital is one of it. Lies in hilly Subang District in West Java province, serves 1,3 million population. It has run maternal and child health care since its establishment in 1984, given at the obgyn outpatient and inpatient service, which is staffed by 2 obgyn, 2 pediatrician and 10 clinical midwives. Complicated cases have been referred so far, either a self referral or sent by the traditional birth attendants, or by the health center doctors and midwives.

It is felt nowadays that Subang Hospital has made a sufficient contribution toward the improvement of MCH program in Subang district, however, these activities renders by the hospital has never been evaluated. Therefore, no empirical data could be shown sa far to evident the contribution, moreever, no lesson learned or successful stories could be disseminated. This study aimed to evaluate the maternal- and child health activities conducted by Subang Hospital, focusing on its activities related to the medical referral system, using a 8 years time series data from 1989 to 1996 , to assess the process accrued during those years in order to achieve outputs recorded. The data was collected through the medical records to this referral system activities.

The analysis showed that differences in output achievements started to occur after 1993,.where in that year high risk Maternal and Prenatal cases referred to the hospital increase sharply to 33-43% per year afterwards. Commensurating to that, number of sectio caesarians conducted in the hospital increases 11% every year, and normal deliveries decreased. Neonatal death after the first 48 hours of hospitalization increase since 1993, with main causes are neonatal asphyxia and low birth weight. In this case, number of cases increase, but the hospital is not equipped with a neonatal emergency room, which made the hospital failed in surviving those little souls. High risk pregnancy cases referred increases, and main cause of deaths are severe bleeding predisposed by heavy anemia and eclampsia.

During those 8 years 9 kind of interventions have been conducted in the hospital setting. Those were; the formal establishment of the AMP team, the deployment of new young fresh graduates midwives in each village in Subang district, intensive maternal and child care education to the community through the health eadres and community midwives, knowledge and eithiocal backup by midwives and physicians's proffesional organizations, continous trainning to the traditional birth attendants, and emergency obgyn care and treatment trainings for the community midwives.

The study recommends to the Department of Health to respect the obgyns and pediatrician who are also dedicate their work by serving community outside the hospital setting through issuing a legal acknowledgement (Letter of Decree). This is because most obgyns and pediatricians only focus their work and job at their station, hospital, and only a few of them are willing to serve in the community setting. The hospital also pleas for the provision of emergency prenatal care unit, since the need is obvious. Increase participation and contribution from other related sectors as well as from the community to back up transportation fee for those low socioeconomic high risk cases (mothers and or infants) which have to be referred to the hospital for survival is very much expected. The Medical trainings for community midwives are urged to be continued and training should be given in the hospital in an internship setting.

Bibliography : 24"

"Jaminan Kesehatan Nasional merupakan implementasi dari UU No. 40 tahun 2004 tentang Sistem Jaminan Sosial Nasional di bidang kesehatan dengan konsep Universal Health Coverage yang memaksa pesertanya mengikuti sistem rujukan berjenjang untuk mendapatkan pelayanan kesehatan yang komprehensif, murah dan terjangkau namun berkualitas. Belum effektifnya sistem rujukan yang ada di Indonesia, membawa berbagai permasalahan dalam dunia kesehatan dan berdampak pada penumpukan pasien di fasilitas kesehatan lanjutan yang berakibat pemanfaatan tenaga terampil dan peralatan canggih secara tidak tepat guna dan menurunnya kualitas pelayanan kesehatan. Penelitian ini menggunakan pendekatan kualitatif, dengan arah penelitian pada Sistem Rujukan Jaminan Kesehatan Nasional RSUD dr. Adjidarmo di kabupaten Lebak. Metode analisa yang digunakan adalah Content Analysis berdasarkan triangulasi metode, triangulasi sumber dan triangulasi teori. Dengan menganalisis aspek yang terdapat didalamnya, hasil penelitian dan pembahasan dibagi dalam 2 komponen, yaitu Karakteristik Sistem Rujukan Medis dan Sistem Rujukan Berjenjang. Dari hasil penelitian menunjukan bahwa pada Karakteristik Sistem Rujukan Medis implementasi Jaminan Kesehatan Nasional membawa perbaikan dalam sistem rujukan di RSUD dr. Adjidarmo Kabupaten Lebak walaupun belum signifikan dan dari komponen Sistem Rujukan Berjenjang, perbaikan baru nampak pada aspek kebijakan dan prosedur, sehingga masih diperlukan upaya yang keras untuk meningkatkan aspek lainnya untuk menciptakan sistem rujukan yang lebih baik.

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National Health Insurance is an implementation of the Law No. 40 of 2004 on National Social Security System in the field of healthcare with the concept of Universal Health Coverage that forced participants to follow a tiered referral system for health services are comprehensive, affordable, cheap and quality.

The ineffectiveness of the existing referral system in Indonesia, bringing a variety of health problems in the world and have an impact on the accumulation of patients in healthcare facilities resulting in continued utilization of skilled personnel and sophisticated equipment is not appropriate and the declining quality of health care.

By analyzing aspects contained therein, the results obtained and the discussion is divided into two components, namely the Medical Referral System Characteristics and Referral System Tiered,. From the results of the study showed that the implementation of the Medical Referral System Characteristics of National Health Insurance to bring improvements in the referral system in Public Hospital of dr. Adjidarmo Lebak although not significant and tiered referral system components improvements just occured in both policy and procedures, so that a strong effort is still needed to improve other aspects of creating a better referral system. It is expected that the results of this study may be one of the input for the management of hospitals and related institutions in improving various aspects related to the successful implementation of a tiered referral system in Lebak district in order to achieve Universal Health Coverage in Indonesia."

"Peningkatan jumlah kunjungan pasien ke rumah sakit pada awal masa pemberlakuan program Kartu Jakarta Sehat (KJS) disebabkan belum optimalnya sistem pelayanan kesehatan berjenjang. PT Asuransi Kesehatan (PT Askes) bersama Dinas Kesehatan DKI Jakarta melakukan berbagai upaya dalam bentuk paket intervensi untuk mengoptimalkan sistem tersebut. Penelitian ini bertujuan untuk mengevaluasi efektivitas paket intervensi PT Askes dan Dinas Kesehatan DKI Jakarta dalam meningkatkan optimilisasi sistem rujukan pelayanan kesehatan. Penelitian ini menggunakan survei potong lintang dengan metode pengambilan sampel acak pada puskesmas di DKI Jakarta terhadap hasil intervensi PT Askes. Hasil intervensi diukur melalui wawancara pada kepala puskesmas atau petugas yang mewakili. Data dianalisis menggunakan tes statistik nonparametrik, yaitu uji Wilcoxon dan regresi Generalized Linear Model. Penelitian dilakukan pada bulan Oktober 2013 hingga Februari 2014. Terdapat perbedaan bermakna pada keempat indikator, terjadinya peningkatan kunjungan peserta KJS dipengaruhi oleh ketersediaan tempat tidur, jumlah peserta KJS terdaftar, intervensi dalam bentuk regulasi, serta persentase pengangguran terbuka. Meskipun ada perbedaan signifikan setelah dikelola PT Askes, hal ini belum cukup membentuk persepsi puskesmas untuk berpendapat bahwa PT Askes memiliki andil dalam mengoptimalkan sistem elayanan kesehatan berjenjang pada program KJS.

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Increasing the number of patient visits to the hospital at the beginning of the implementation Healthy Jakarta Card (KJS) program was claimed to be associated with optimization of health care referral system. PT Asuransi Kesehatan (PT Askes) with the DKI Jakarta Department of Health Service made efforts to improve the optimalization that system. This study aimed to evaluate the effectiveness of intervention PT Askes?s and DKI Jakarta Departement Of Health?s packages in improving the optimization of health care referral system. This study used a cross sectional survey with a random sampling method in primary health centers in Jakarta related with the result of PT Askes?s intervention package. The result of intervention were conducted by interview to the head of the primary health center or officer representing. Data were analyzed with nonparametric statistical tests, using the Wilcoxon test and Generalized Linear Regression Model. The study was conducted in October 2013 until February 2014. There were significant differences between the four indicators, an increase in visits KJS participants are influenced by the availability of beds, number of participants registered KJS, intervention in the regulation, and the percentage of open unemployment. Although there were significant differences after managed by PT Askes, these efforts were not enough to make primary health centers perception that PT Askes has contributed to the optimization of health care referral system in KJS program."

"Pandemi COVID-19 di Indonesia berdampak pada implementasi Sisrute RSUD Siti Aisyah sehingga memengaruhi morbiditas dan mortalitas pasien. Penelitian ini bertujuan untuk menganalisis implementasi Sisrute yang meliputi kebijakan, kapasitas petugas, sistem jaringan, komunikasi dan pelayanan rujukan. Penelitian ini merupakan studi kasus dengan pendekatan kualitatif melalui observasi lapangan, telaah dokumen dan wawancara mendalam 13 informan RSUD Siti Aisyah. Penolakan rujukan lebih dari 80%. Response time kurang dari 60 menit terbanyak pada rujukan keluar non-COVID-19 (64%). Alasan penolakan meliputi ketidaktersediaan ruangan isolasi COVID-19-19, ketidaklengkapan berkas, kendala sistem jaringan, petugas lambat merespons dan lainnya. Informan mengatakan tidak terdapat kebijakan Sisrute dan dokumentasi sosialisasi; kapasitas petugas rujukan cukup adekuat.; Sistem Jaringan pada komputer dan konektifitas internet, SIMRS dan infrastruktur penunjang belum adekuat; Komunikasi rujukan melalui aplikasi Sisrute dan dibantu telepon dan Whatsapp; RSUD tidak memiliki SOP Sisrute, akan tetapi mengikuti prosedur klinis, administratif, dan operasional. Kendala pada implementasi Sisrute yaitu komitmen petugas, kecepatan penyampaian informasi, rangkap tugas, situasi faskes penerima, penerimaan keluarga, permasalahan biaya dan ketersediaan infrastruktur. Monitoring dan evaluasi tidak dilakukan pada implementasi Sisrute. Dengan demikian, implementasi Sisrute di RSUD Siti Aisyah Lubuklinggau perlu perbaikan dan peningkatan pada variabel diatas dapat mempercepat proses rujukan.

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The Pandemy of COVID-19 in Indonesia has a major impact in integrated referral system (IRS) implementation of Siti Aisyah (SA) General Hospital Lubuklinggau influencing patient morbidity and mortality. This study was conducted to analyse policy, officer capacity, network system, referral communication, and referral services resulting in referral system implementation. It was a case study with qualitative approach through observation, documents research, in-depth interview with 13 informants working at Siti Aisyah General Hospital. The study suggested that Sisrute referral rejection was more than 80%. Referral response time suggest less than 60 minutes only occurring in outward non-COVID-19 referral (64%). Reasons for rejection were unavailability of COVID-19 Isolation room, incomplete referral documents, network system issue, late response, etc. Informants stated that there was no referral policy and dissemination documents; officer capacity was considered adequate enough; Network system in computer and internet connectivity, hospital management information system and supporting infrastructures remained inadequate; referral communication through IRS and assistance of phone calling and Whatsapp were performed; SA General Hospital had no standard operating procedures, but it follows clinical, administrative and operational procedures. Challenges in IRS implementation were commitment, information delivery speed, multi-tasking, current situation in referred facility, family reception, extra fee and infrastructures issue. Monitoring and evaluation had not been performed in IRS implementation. Thus, SA General Hospital needs to improve and increase IRS implementation in aforementioned variable to accelerate referral process."

"Salah satu permasalahan sistem rujukan kesehatan yang mengatur pelimpahan tugas dan tanggung jawab secara timbal balik, maupun struktural dan fungsional terhadap kasus penyakit dalam permasalahan kesehatan hal ini juga terjadi juga di kota Batam. Untuk mengatasi hal tersebut sistem pelayanan kesehatan di era BPJS Kesehatan mengutamakan optimalisasi di fasilitas kesehatan tingkat pertama (FKTP), seperti Puskesmas, klinik pratama, maupun dokter praktek perorangan yang bekerjasama dengan BPJS Kesehatan dalam menyediakan layanan kesehatan bagi masyarakat. Namun masih sering kita temui masalah rujukan pelayanan rumah sakit yang terjadia ketidak tepatan dalam rujukan yang dialami oleh IGD Rumah Sakit dan Klinik-klinik di Batam. Tujuan dari penelitian ini adalah Mengetahuai penyebab ketidak tepatan atau penyimpangan dalam rujukan FKTP yang terjadi di kota Batam.Hasil penelitian mendapatkan bahwa BPJS selalu menghimbau pimpinan dan dokter klinik untuk menahan laju rujukan yang relatif tinggi (berdasarkan asumsi yang banyak beredar di kalangan klinik dan tenaga medis baik di rumah sakit dan klinik). Dan rujukan non spesialistik yang rationya tidak lebih boleh lebih dari 15% agar tidak berdampak pada turunnya jumlah kapitasi (pasien kepesertaan BPJS kesehatan dalam tiap bulannya) yang dimiliki klinik. Disarankan Saran yang dapat disampaikan sehubungan dengan hasil penelitian merupakan peningkatkan kualitas atau mutu tenaga kesehatan dalam pelayanan kesehatan, mengadakan sosialisasi terhadap aturan-aturan kebijakan secara berkesinambungan mengingat agar terhindari dari konflik dalam pelayanan, peningkatan kompetensi tenaga kesehatan. Dan perlu adanya edukasi akan sebuah sistem dan aturan pelayanan untuk mengatasi masalah rujukan dan mengembalikan peran dokter umum sebagai ujung tombak pelayanan kesehatan tingkat primer.

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One of the problems of the health referral system that regulates the delegation of tasks and responsibilities on a reciprocal basis, as well as the structural and functional aspects of illness in health problems is also happening in the city of Batam. To overcome this the health care system in the era of BPJS Health prioritizes the optimization in first-rate health facilities (FKTP), such as health centers, clinics, and individual practice physicians in collaboration with BPJS Health in providing health services for the community. But still we often encounter the problem of hospital service referral that happened inaccurate in the references experienced by IGD Hospital and Clinics in Batam. The purpose of this research is to know the cause of inaccuracy or deviation in FKTP reference that occurred in Batam city.The results found that BPJS always appealed to clinical leaders and clinicians to withhold relatively high referral rates (based on widely circulated assumptions among clinics and medical personnel in hospitals and clinics). And non-specialist referrals whose ration is no more than 15% in order not to affect the decrease in the number of capitals (monthly health membership BPJS patients) owned by the clinic. Suggested suggestions that can be submitted in relation to the results of the study is to improve the quality or quality of health personnel in health services, socialization of policy rules continuously in order to avoid the conflict in service, increasing the competence of health workers. And there is need for education of a system and rules of service to overcome the problem of referrals and return the role of general practitioners as the spearhead of primary health care."