Kajian Implementasi Program Rujuk Balik Di BPJS Kesehatan Cabang Jakarta Selatan Tahun 2021

Study on the Implementation of Referback Programs at BPJS Kesehatan South Jakarta Branch in 2021

Abstract

Introduction: The realization of payment of claims for the National Health Insurance (JKN) every year continues to increase. This is due to the increasing prevalence of chronic diseases. Facing this phenomenon, BPJS Kesehatan makes case management efforts to maintain the effectiveness and cost-efficiency of health services through a Back Referral Program (BRP). The purpose of this study is to examine the implementation of the Back Referral Program at BPJS Kesehatan South Jakarta Branch in 2021.

Methods: This type of research was qualitative research with a descriptive approach. Sampling using a purposive sampling method. The time of research was carried out from July to August 2021. The data collection technique was through in-depth interviews. In-depth interviews were conducted with key informants (PIC BRP and management at government and private hospitals specialist doctors at government and private hospitals) and key informants (Head of Benefit Guarantee for BPJS Kesehatan South Jakarta Branch) and supporting informants (BRP pharmacy officers and BRP participants). 

Results: Implementation of the Back Referral Program in hospitals has not been running according to the set targets, seen from the availability of supporting infrastructure facilities (information media and BRP corner facilities) not yet available and problems with the V-Claim application. The factors of knowledge and understanding of officers in private hospitals were still low related to BRP as well as differences in the perception of specialist doctors on the competence of doctors in First Level Health Facilities. In addition, the problem of drugs that are not included in the National Formulary for Referback and the long distance from BRP pharmacies causes patients to refuse BRP.

Discussion: For hospitals provide supporting infrastructure in the implementation of BRP carry out routine socialization of BRP and make policies that require specialist doctors to make referrals.