Abstrak: Latar Belakang Rujukan merupakan suatu sistem penyelenggaraan pelayanan kesehatan yang melahirkan pelimpahan tanggung jawab timbal balik terhadap satu kasus penyakit atau masalah kesehatan secara vertikal atau secara horizontal, dengan tujuan untuk meningkatkan derajat kesehatan melalui pelayanan kesehatan paripurna berdasarkan pendekatan peningkatan, pencegahan , penyembuhan, dan pemulihan Rumah Sakit Umum Pusat Fatmawati sejak tahun 2000 memiliki status sebagai rumah sakit perusahaan jawatan, tetapi untuk kedepan status rumah sakit akan berubah lagi menjadi Badan Layanan Umum (BLU) . Perubahan status rumah sakit ini mengarah pada kegiatan organisasi sebagai badan usaha, sehingga rumah sakit harus mulai berubah dalam melakukan manajemennya, lebih berorientasi ke manajemen bisnis. Tujuan Tujuan penelitian ini untuk mengetahui mekanisme prosedur rujukan yang diterapkan oleh RSUP Fatmawati Jakarta mengingat telah ditetapkan sebagai pusat rujukan pelayanan Bedah Orthopaedi. Metode Penelitian ini merupakan penelitian observasional dengan menggunakan metode kualitatif dan kuantitatif, lokasi penelitian di RSUP Fatmawati Jakarta. informan adalah rujukan pasien rawat jalan, rawat inap, yang dilaksanakan pada bulan Juli 2005. Alat ukur penelitian dengan kuesioner, panduan wawancara, check list. Variabel penelitian meliputi input, proses, output. Hasil penelitian Hasil penelitian yang telah dilakukan menunjukkan bahwa kebijakan kurang dipahami, SOP kurang sosialisasi oleh RSUP Fatmawati Jakarta sebagai pemberi pelayanan, SDM dari segi kualitas & kuantitas dokter spesialis sesuai standar, perawat mahir masih kurang, sarana dan fasilitas lokasi ruang ter pencar-pencar, alat kesehatan kurang tersedia lengkap, ruang rawat inap kelas 1 tidak ada. Dalam observasi dan cek dokumen diketemukan bahwa rujukan balik ke RS pengirim belum pernah diberikan. Prosedur rujukan pasien di RSUP Fatmawati Jakarta tidak sesuai dengan pedoman yang ada. Kesimpulan dan Saran Kesimpulan, RSUP Fatmawati sebagai RS unggulan nasional sekaligus sebagai RS Pusat Rujukan pelayanan Bedah Orthopaedi, pelaksanaannya masih belum optimal, SDM Medis cukup tapi perawat masih kurang, sarana dan fasilitas belum memadai, sosialisasi kepada masyarakat kurang. Saran, RSUP Fatmawati dapat lebih meningkatkan komitmen untuk melaksanakan sistem rujukan, mengupayakan kelancaran komunikasi dengan semua jenjang rujukan. Kata kunci : Prosedur Rujukan, Rumah Sakit

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Back Ground Reference is a system of health service implementation, which results a delegation of responsibility on both sides toward a disease case or health problem vertically or horizontally, with an aim to increase any health level through a complete heath service based on the approach of improvement, prevention, curing and recovery. Rumah Sakit Umum Fatmawati since year 2000 has had a status as a service company hospital, however for the next future the status will be changed into Public Service Division (BLU). The status change of this hospital refers to an organization program as a business so this hospital has to start to change its management and be more oriented toward business management. Objective The aim of this research is to find out a mechanism Reference procedure which has been applied by RSUP Fatmawati Jakarta considering it has been pointed as a Reference Center of Orthopedics Surgery Service Methods The informants are referrals of on going patients and on stay patients that were conducted in July 2005. The measuring tools of the results were questionnaire, interview guidelines and check list. The variable of the research includes input, process and output. Results The result of the finished research shows that the policy is not really understandable, the Standard Operational Procedure (SOP) is not socialized well by RSUP Fatmawati Jakarta as the giver of the service, Human Resource in qualitatively and quantitatively of medical specialists is on the proper standard, skilled nurses are lacking, media and facilitation of room location are dispersed, health equipments are still uncompleted, and there is no first class room for a stay service. In some observation and document check, there is found something that the return reference to the hospital sender has not been given. The procedure of the patient reference is not suitable with its available guidelines. Conclusions Conclusion, the service of RSUP as a National Superior Hospital and Reference Center for Orthopedics Surgery Service, is not optimum yet in applying its system. There are enough medical Human Resources but lacking of skilled nurses, media and medical facilitation and socialization to the public. Suggestion, RSUP Fatmawati could improve its commitment more to carry out the reference system, and make a serious effort for the smoothness of communication with the whole reference levels. Keywords : Reference procedure, Hospital

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Latar belakang: Program Jaminan Kesehatan Nasional (JKN) meningkatkan utilisasi dan pendapatan pasien dari prosedur operasi rawat inap di RS Jakarta. Namun, peningkatan ini justru menurunkan laba rumah sakit akibat tarif JKN yang relatif rendah. Prosedur operasi bedah umum merupakan prosedur terbanyak yang dilakukan, tetapi memiliki utilitas kamar operasi terendah. Untuk itu, perlu dilakukan analisis efisiensi biaya prosedur ini sebagai dasar strategi pengembangan layanan untuk kesinambungan bisnis rumah sakit ke depan. Tujuan: Diketahui perbandingan tingkat efisiensi biaya prosedur operasi agar dapat memberikan rekomendasi strategi efisiensi dan pengembangan prosedur operasi bedah umum JKN di RS Jakarta agar tercapai kesinambungan bisnis rumah sakit yang baik. Metode: Penelitian menggunakan data prosedur operasi bedah umum pasien JKN tahun 2023. Biaya satuan dihitung menggunakan metode activity-based costing, mencakup biaya langsung dan tidak langsung. Efisiensi dinilai dengan membandingkan biaya aktual dengan biaya normatif berdasarkan clinical pathway. Total biaya diperoleh dari penjumlahan biaya prosedur dan akomodasi rawat inap. Skor efisiensi teknis dan skala dihitung dengan pendekatan Data Envelopment Analysis (DEA). Hasil: Rata-rata biaya satuan prosedur aktual di kamar operasi sebesar Rp3.515.894,65 dengan skor efisiensi 103,0%, yang idealnya ada di bawah 100%. Komponen biaya jasa medis dan obat serta bahan medis habis pakai (BMHP), menjadi pemicu utama inefisiensi. Rata-rata biaya total aktual, yaitu biaya satuan prosedur aktual di kamar operasi ditambah biaya akomodasi adalah Rp4.678.032,01 dengan skor efisiensi 108,4%. Biaya akomodasi menyumbang 24,8% dari biaya total dan berkontribusi besar pada inefisiensi. Prosedur paling efisien adalah hemoroidektomi kelas 3 dan insisi abses perianal (satu kelas). Kesimpulan: Biaya satuan prosedur operasi bedah umum di kamar operasi untuk pasien JKN tahun 2023 belum efisien karena penggunaan obat, BMHP, dan lama rawat inap yang tidak sesuai clinical pathway. Diperlukan penerapan clinical pathway yang ketat, perubahan sistem pembayaran jasa medis berbasis kinerja, serta optimalisasi metode dan jenis anestesi. Rumah sakit juga perlu meningkatkan kompetensi, khususnya di bidang bedah digestif, untuk menghadapi kebijakan kelas standar dan klasifikasi rumah sakit berbasis kompetensi.

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Background: The National Health Insurance (JKN) program has led to increased inpatient utilization and revenue at RS Jakarta, particularly through surgical procedures. However, this increase has paradoxically reduced hospital profit margins due to the relatively low reimbursement rates under JKN. General surgery accounts for the highest number of procedures but demonstrates the lowest operating room utilization. Therefore, a cost-efficiency analysis of these procedures is essential to inform service development strategies that ensure long-term hospital sustainability.  Objective: This study aims to compare the cost efficiency of general surgical procedures for JKN patients, providing strategic recommendations to improve efficiency and develop general surgery services to support sustainable hospital operations.  Methods: The study used data on general surgical procedures performed on JKN patients in 2023. Unit costs were calculated using an activity-based costing method, incorporating both direct and indirect costs. Efficiency was assessed by comparing actual costs to normative costs based on clinical pathways. Total costs included both procedural and inpatient accommodation expenses. Technical and scale efficiency scores were calculated using the Data Envelopment Analysis (DEA) approach.  Results: The average unit cost for actual surgical procedures in the operating room was IDR 3,515,894.65, with an efficiency score of 103.0%, indicating inefficiency as ideal scores should be below 100%. Direct operating costs—particularly medical services, medications, and consumables—were the main contributors to inefficiency. The average total actual cost, including accommodation, was IDR 4,678,032.01, with an efficiency score of 108.4%. Accommodation costs accounted for 24.8% of the total and were a significant source of inefficiency. The most efficient procedures were Grade 3 hemorrhoidectomy and perianal abscess incision (single class).  Conclusion: The unit costs for general surgical procedures under JKN in 2023 remain inefficient relative to clinical pathway standards, primarily due to inappropriate use of medications, consumables, and extended length of stay. Improvements are needed through stricter clinical pathway implementation, performance-based physician remuneration, and optimization of anesthetic techniques. The hospital must also enhance competencies, particularly in digestive surgery, in anticipation of standard class policies and competency-based hospital classifications.

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