Analysis of the Implementation of the Horizontal Referral System among Health Facilities in Serving BPJS Patients at UPTD Puskesmas Sumalata

Arman Sunge; Rukiah Nggilu; Lisda Van Gobel

doi:10.70742/arsos.v2i2.400

Authors

Arman Sunge Universitas Bina Taruna Gorontalo
Rukiah Nggilu Universitas Bina Taruna Gorontalo
Lisda Van Gobel Universitas Bina Taruna Gorontalo

DOI:

https://doi.org/10.70742/arsos.v2i2.400

Keywords:

horizontal referral system, BPJS, health facilities

Abstract

This study aims to analyze the implementation of the horizontal referral system among primary health care facilities in serving BPJS patients at Puskesmas Sumalata and to identify supporting factors for its success. The research applied a qualitative case study design, involving informants from the District Health Office, medical staff, administrative staff, and patients’ families. Data were collected through in-depth interviews, observations, and document reviews, then analyzed using thematic analysis. The results show that the implementation of the horizontal referral system has not been optimal. Coordination among Puskesmas remains limited, the referral information system is not integrated, and technical regulations are not fully understood by health workers. However, support from the Health Office in improving human resource capacity acts as a strengthening factor. This study emphasizes the importance of strengthening coordination, staff understanding, facilities, and clear SOPs so that the horizontal referral system can function more effectively.

Downloads

Download data is not yet available.

References

Cheng, Q., Fattah, R. A., Susilo, D., et al. (2025). Determinants of healthcare utilization under the Indonesian National Health Insurance system: A cross-sectional study. BMC Health Services Research, 25(48). https://doi.org/10.1186/s12913-024-11951-8

Darmasurya, A., Anindita, R., & Ikhda, M. C. (2021). Did the horizontal referral policy in Indonesia create cost savings? Jurnal Jaminan Kesehatan Nasional, 1(1), 15–32. https://doi.org/10.53756/jjkn.v1i1.14

Hermiyanty, H., Wandira, B. A., & Nelianti, F. (2024). Implementasi Rujukan Pasien Jaminan Kesehatan Nasional (JKN) BPJS di Puskesmas Singgani, Kecamatan Palu Timur Kota Palu. Healthy Tadulako Journal, 5(1), Article 110. https://doi.org/10.22487/htj.v5i1.110

Institution Kesehatan Indonesia. (2021). Laporan tahunan Jaminan Kesehatan Nasional 2021. Jakarta: BPJS Kesehatan.

Juwita, N. E., & Santoso, D. (2025). Analysis of factors affecting referral rates in community health centers: A scoping review. Jurnal Jaminan Kesehatan Nasional, 5(1), 35–48. https://doi.org/10.53756/jjkn.v5i1.300

Monitoring, Evaluation, and Analysis of BPJS Referral Implementation at Primary Healthcare Facilities: Literature Review. (2024). Formosa Journal of Science and Technology, 3(11), 2477–2488. https://doi.org/10.55927/fjst.v3i11.11780

Norman, F., Palloge, S. A., & Syamsu, R. F. (2024). Monitoring, evaluation, and analysis of BPJS referral implementation at primary healthcare facilities: Literature review. Formosa Journal of Science and Technology, 3(11), 2477–2488. https://doi.org/10.55927/fjst.v3i11.11780

Pressman, J. L., & Wildavsky, A. (1973). Implementation: How great expectations in Washington are dashed in Oakland. University of California Press.

Ridwan, R., & Ramadhan, S. (2025). Influencing factors in patient referrals: A doctor’s perspective on primary health care facilities. Jurnal Jaminan Kesehatan Nasional, 5(1), 89–100. https://doi.org/10.53756/jjkn.v5i1.255

Safari Ode Arli, R., Syamsu, R. F., & Makmun, A. (2023). Faktor penyebab tingginya angka rujukan di fasilitas kesehatan tingkat pertama pada era JKN: Literature review. Prepotif: Jurnal Kesehatan Masyarakat, 7(3). https://doi.org/10.31004/prepotif.v7i3.20704

Sabatier, P. A., & Mazmanian, D. (1980). The implementation of public policy: A framework of analysis. Policy Studies Journal, 8(4), 538–560. https://doi.org/10.1111/j.1541-0072.1980.tb01266.x

Suhardi, S., Hidayat, S., & Putra, R. (2020). Leadership commitment in implementing digital governance reform in public health services. Journal of Administrative Sciences, 12(3), 201–214.

Sutrisnawati, N. D., & Suandari, P. V. L. (2024). Analysis of factors influencing the implementation of an integrated referral system (SISRUTE) in an effort to improve the quality of health service facilities. Indonesian Journal of Global Health Research, 5(4). https://doi.org/10.37287/ijghr.v5i4.3341

Van Meter, D. S., & Van Horn, C. E. (1975). The policy implementation process: A conceptual framework. Administration & Society, 6(4), 445–488. https://doi.org/10.1177/009539977500600404

World Health Organization. (2022). Digital transformation and health system strengthening in Southeast Asia: Policy brief. WHO Regional Office for South-East Asia.

Yanthi, B., Hendratini, J., & Sulistyo, D. H. (2023). Determinants of non-specialist referrals with TACC criteria in FKTP, Batang Hari Regency, 2022. Jurnal Jaminan Kesehatan Nasional, 3(1). https://doi.org/10.53756/jjkn.v3i1.63