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Abstrak: Dalam menghadapi Bonus Demografi, Indonesia masih menghadapi tantanganbesar di berbagai bidang, salah satunya bidang kesehatan. Tantangan tersebutsalah satunya ialah terus meningkatkanya angka penyakit tidak menular dimanamenjadi beban ganda dalam pelayanan kesehatan. BPJS Kesehatan dalamProgram Rujuk Balik (PRB) menawarkan sistem pelayanan efektif untuk pasienpenyakit kronis yang sudah mendapat perawatan di RS dan kondisi telah stabilagar dapat berobat jalan di Faskes Primer. Tujuan penelitian ini adalah untukmengetahui efektivitas implementasi PRB peserta JKN di RSUD Kota Depok.Penelitian ini menggunakan metode kualitatif dengan pendekatan studi kasus diRSUD Kota Depok. Hasil penelitan menunjukkan bahwa implementasi PRB diRSUD Kota Depok belum efektif. Masih seringnya terjadi kekosongan obat diapotek rekanan BPJS dan perbedaan obat yang antara obat yang diberikan selamaberobat jalan di rumah sakit dan obat rujuk balik menjadi faktor penghambatefektivitas implementasi PRB di RSUD Kota Depok. Perlunya perhatian untukmemenuhi persediaan obat agar implementasi PRB dapat berjalan efektif.Kata Kunci: Implementasi; efektivitas; PRB; JKN

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In the face of demographic bonus, Indonesia still faces a major challenge in manyareas, one of which the health sector. The one challenge is the increasing numberof non-communicable disease in which a double burden on the health service.BPJS Kesehatan in their refferal back program offer an effective service systemfor chronic disease patients who have received treatment in hospital and thecondition has stabilized in order to outpatient treatment in primary health care.The aim of this study was to examine the effectiveness of implementation refferalback program on JKN member in RSUD Depok. This study used a qualitativemethod with case study approach. The results showed that the implementation ofthe refferal back program in RSUD Depok not yet effective. The emptiness ofdrugs and the difference between drugs given during hospital treatment and drugsgiven by the pharmacy made the implementation not effective. The necessity ofattention to drug supply in order to make implementation more effective.Keyword: implementation; effectiveness; refferal back program; JKN

Abstrak: Penelitian ini membahas tentang gambaran utilisasi kunjungan rawat jalan tingkatpertama dan rujukan berdasarkan karakteristik peserta JKN di Puskesmas Tabanan IIIdan Puskesmas Pupuan I Periode Januari-Maret tahun 2016. Penelitian ini merupakanpenelitian kuantitatif dengan desain studi cross sectional. Berdasarkan hasil penelitian,diketahui bahwa angka kunjungan (9,32%) dan angka rujukan (9,67%) di PuskesmasTabanan III (perkotaan) lebih tinggi dibandingkan angka kunjungan (5,04%) danangka rujukan (3,81%) di Puskesmas Pupuan I (perdesaan). Kondisi tersebut dapatdisebabkan oleh akses ke pelayanan kesehatan yang lebih mudah di wilayah kerjaPuskesmas Tabanan III dibandingkan Puskesmas Pupuan I.
Kata kunci: Utilisasi, Angka Rujukan, Jaminan Kesehatan Nasional.

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This study discusses the overview of outpatient utilization and referrals based on thecharacteristics of National Health Insurance (JKN) participants in Puskesmas TabananIII and Puskesmas Pupuan I from January until March 2016. This is a quantitativeresearch with cross sectional study design. Based on this research, it is known that thenumber of outpatient visits (9,32%) and referral rates (9,67%) in Tabanan III PHC(urban area) was higher than the number of visits (5,04%) and referral rates (3,81%)in Pupuan I PHC (rural area). It can be caused by the Puskesmas Tabanan III is moreaccessible than Puskesmas Pupuan I.
Keywords: Utilization, Referral Rate, National Health Insurance.

Abstrak: Fenomena tingginya angka rujukan pasien yang diterima oleh rumah sakit di eraJaminan Kesehatan Nasional mengakibatkan penumpukan pasien yang berobat ke rumahsakit. Salah satu konsep yang dapat digunakan di era JKN untuk dapat memberikan kualitaspelayanan bagi pasien rujukan agar lebih efektif dan optimal, melakukan efisiensi biaya danjuga berorientasi kepada nilai walaupun dengan keterbatasan anggaran dan sumber daya yangdihadapi rumah sakit adalah dengan mengaplikasikan konsep Lean dalam pelayanankesehatan.Penelitian ini menunjukkan bahwa faktor penentu belum optimalnya pelayanan pasienrujukan JKN di poliklinik disebabkan oleh waktu tunggu berkas rekam medik lama, waktutunggu dokter spesialis lama, serta pasien yang menumpuk dan berkerumun menungguantrian. Berdasarkan Karakteristik Sistem Rujukan WHO, kurangnya SDM rekam medik,profesionalitas dokter, kurangnya kerjasama dan komunikasi pra rujukan, kelengkapanfasilitas sarana prasarana dan sumber daya pendukung yang kurang memadai, serta belumsempurnanya aplikasi SIMRS juga menyebabkan belum optimalnya pelayanan pasienrujukan JKN di poliklinik. Berdasarkan Current State Value Stream Mapping didapatkanaktivitas value added pada proses pelayanan hanya 7,32 % sampai 17,75 %, sedangkanaktivitas non value added mencapai 82,25 % sampai 92,6 %. Dengan memotong alurpelayanan, mengeliminasi waste yang ditemukan, dan implementasi tools Lean 5S, VisualManagement, Eror Proofing, dan Heijunka diharapkan pada Estimate Future State ValueStream Mapping akan menghasilkan penurunan waktu pelayanan sampai 87 menit, danmeningkatkan aktivitas value added sampai 34,95%.
Kata kunci : Pasien rujukan JKN, optimalisasi pelayanan, konsep lean, waktu tunggu.

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The phenomenon of high rates of referral of patients received by the hospital in theera of National Health Insurance resulted in a buildup of patients treated at the hospital . Oneconcept that can be used in the era JKN to be able to provide quality care for the patientsreferral to be more effective and optimal, cost efficiency and also oriented to value althoughwith limited budgets and resources faced by hospitals is to apply the concept of Lean inhealthcare.This study shows that the decisive factor is not optimal patient care referral JKN inpolyclinic are caused by long waiting time for medical record file, long waiting timespecialist doctors, and patients who accumulate and clump waiting queue. Based ReferralSystem Characteristics WHO, lack of human resources in medical records, physicianprofessionalism, lack of cooperation and communication pre references, completeinfrastructure facilities and supporting resources are inadequate, and incomplete applicationSIMRS also lead to non-optimal patient care referral JKN in polyclinic. Based on the CurrentState Value Stream Mapping, value added activities in the service only 7.32 % to 17.75 %,while the non-value added activity reached 82.25 % to 92.6 %. By cutting the service flow,eliminate waste were found, and implementation tools of Lean 5S, Visual Management, ErrorProofing , and Heijunka expected at Estimate Future State Value Stream Mapping will resultin reduced service time to 87 minutes , and increase value added activities until 34.95 % .
Key word : referral patient of JKN, optimization services, lean concept, waiting time.

Abstrak: Latar Belakang : Implementasi sistem rujukan nasional sudah dilakukan sejak tahun 2014 sebagai bagian dari Sistem Jaminan Kesehatan Nasional. Isu ini menjadi penting karena sistem rujukan regional menjamin setiap individu mendapatkan pelayanan kesehatan yang optimal pada setiap level pusat kesehatan per regional wilayah penetapan. Tujuan Penelitian : Dilakukan analisis penguatan fungsi RSUD Dr H. Mohamad Rabain Muara Enim sebagai salah satu rumah sakit rujukan regional di wilayah Provinsi Sumatera Selatan tahun 2016. Metode Penelitian : Suatu studi dengan pendekatan kualitatif untuk melakukan analisis penguatan fungsi RSUD Dr H. Mohamad Rabain Muara Enim sebagai salah satu rumah sakit rujukan regional di wilayah Propinsi Sumatera Selatan dengan metode telaah dokumen, wawancara mendalam dan Consensus Decision Making Group. Hasil Penelitian : Dijumpai dua kriteria penetapan yang belum sesuai dengan kriteria penetapan dari Kepmenkes Hk.02.02/Menkes/391/2014 tentang Pedoman Penetapan Rumah Sakit Sebagai Rumah Sakit Rujukan Regional, yaitu kelas rumah sakit dan akreditasi. Kesimpulan : Sebagian besar kriteria penetapan rumah sakit rujukan regional sudah dipenuhi oleh RSUD Dr.H. Mohamad Rabain Muara Enim. Diharapkan kriteria yang belum dipenuhi akan dilengkapi kurang dari lima tahun semenjak penunjukan. Kata Kunci : Penguatan fungsi, rumah sakit rujukan regional, RSUD Dr H. Mohamad Rabain Muara Enim Backgroud : Since 2014, the Indonesian goverment has been implementing the National health Insurance. Accordingly, the regional refferal system is crucial because its needed to ensure that individuals receive optimal care at the approprite level of health care. Aims of study : This study analyses factors in regional refferal hospital program of Muara Enim hospital. Methods :A qualitative study to evaluate Regional Refferal system in Rabain Hospital in Muara Enm Regency, Province Of South Sumatra, Indonesia, 2016. We compared the conformity between the decree of Indonesia Health Ministry about regional refferal system to the real condition in Rabain Hospital. Data was collected by document review, in-depth interview and Consensus Discussion Making Group. Informants of the study were top manajer and middle manager of Rabain Hospital as stakeholder in each their positions. Results: There were two incoherent criterias among specified criteria by Indonesia Health Ministry. We found hospital class and hospital accreditation were not in the rules. Rabain Hospital was in secondary class; should been in tertiary class and not acrreditated by national hospital accreditation committee yet. Conclusion: Our study results that mostly criterias have been fulfill by Muara Enim Hospital in regional refferal system. Between two incoherent criterias were in process of being accreditated on 2017 and upgraded class hospital being tertiary class by the time less then 5 years since apppointed. Needed commitment of all components in Rabain Hospital and supported by local goverment to accelerate its process. Keywords: Strengthening, Regional Refferal System, Rabain Hospital