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Backgorund: The high of outpatient revisit in hospital from INA CBG Claims with grouping code Q-5-44-0 since 2014 can be a burden on health assurance (JKN) financing. Based on INA CBG system, grouping code: Q- 5-44-0 is set for follow up after treatment visit at secondary health facilities. This condition needs indepth analysis to find factor which is related with outpatient revisit rate. Methodology: This study used a cross-sectional study (quantitative methods) to observe relationship between independent variables of JKN participant (gender, age cluster, participant cluster) and hospital (ownership type, hospital referral class, specialist clinic) with outpatient revisit rate (dependent variable). Sample size were 2.947 participant identities as uniqely code which is presented every participant from nine branch offices of BPJS Kesehatan (Indonesia administration bodies of social health security). Results: the average number of 9.96 visits in 2017 was highest in Class B FKRTL (51.5%) and the highest specialist poly destination was internal medicine poly (27.5%). There is no average difference between the number of outpatient revisit for women and men, there is no difference in the average number of outpatient revisit between government and private ownership, and there is no difference in the number of outpatient revisit between age groups. There is an average difference in the number of outpatient revisit between subsidized participan and Non-subsidized participan, there are differences in the number of outpatient revisit between hospital classes, and there is a significant difference in the number of outpatient revisit between specialists clinic. Hospital class and specialist clinic have a positive influence on the number of return visits while the participation segment has a negative influence on the number of return visits. Non-subsidized participan, hospital class B, neurosurgical poly, gastrology poly, geriatric poly, kidney poly, emergency clinic, eye clinic, poly obgyn, and poly rheumatology had negative effect while subsidized participan, hospital class A, C, and with other specialist clinic had a positive effect on the number of outpatient revisit.
Kata kunci: Kasus rujukan, dokter, puskesmas, pasien JKN
This study aims to determine the factors associated with referral cases of National Health Insurance (JKN) Participants at Tanah Sareal health center and Cipaku health center in 2016. This study uses a mixed methods research with quantitative and qualitative approach, by using secondary data from primary care application of health centers and in-depth interviews. The results of this study found that referral cases are influenced by patient age, sex, type of membership, diagnosis, distance of health center to referral center, completeness of medical equipment, physician perception about the role of gatekeeper and capitation, physician experience and patient understanding of participants JKN about referral procedures. The researcher suggests improving the physician decision to reduce referral cases are not based on medical indications, and the coordination between health center, BPJS Kesehatan and the regional health office to provide medical equipment required in health center.
Key words: Referral cases, physician, health center and patient JKN
