THE BACK-REFERRAL PROGRAM IN THE ERA OF NATIONAL HEALTH INSURANCE AT DISTRICT GENERAL HOSPITAL OF BALUNG JEMBER DISTRICT 2017

Abstract

Background: In 2014, Social Security Agency for Health through National Health Insurance Programme or BPJS Kesehatan implementing a back-referral program or Program Rujuk Balik (PRB) to facilitate access to health care for patients with chronic diseases in stable conditions. However, it was still not optimal at District General Hospital of Balung which had the lowest back-referral program (6 participants) in 2015-2016. Aim: The study aimed to examine the back-referral program at District General Hospital of Balung, Jember in 2017. Methods: This study used qualitative methods with a case study design. The informants consisted of Head of verification treasury and secretary controlling JKN service and local government’s free care scheme, coordinator of internal and neurological disease, specialists in internal and neurological diseases, and officers of Social Security Agency for Health and patient eligibility verification, and participants of back-referral program. The study was conducted from October to December 2017. Results: The results showed that there was no contribution of officers’ attendance of BPJS Kesehatan in the Centre of Social Secuirty Agency for Health, and the participants did not have trouble to implement recalling flow due to drug stock-out in the first-level primary healthcare facilities. The neurologists did not write referral letters since 2016, so patient registration no longer existed. Conclusion s : The PRB did not achieve its target (<5 cases/week). Contrastly, the average number of patients referred was 86 patients/week. District General Hospital of Balung should implement Standard Operating Procedure for the letter signed by responsible physician for patients and evaluate the back-referral program. Keywords: Universal Health Coverage, Back-referral program, Hospital.