Implementation of First Level Outpatient Reference of BPJS Health Insurance Participants at Community Health Centres in Maros Regency

Abstract

This study aims to analyze implementation of first-level outpatients reference of social insurance administration organization (BPJS) health insurance participant at community health centers (Puskesmas) in Maros regency. This study was conducted in descriptive research type at two Puskesmas included Puskesmas Mandai and Puskesmas Turikale. The data was collected by interviews, observations and document study. The data were analyzed qualitatively and supported by quantitative data. The result showed implementation was good in term of human resources. Besides, there was good understanding among doctors about capitation system and medical indication as well as non-medical needs. However, there were lacking medical equipment facilities included medical equipment for single use (BMHP) and availability of drugs. Most of references from Puskesmas Mandai are for hypertension and diabetes mellitus while hypertension, rheumatism and diabetes mellitus for Puskesmas Turikale. The patients usually initiated for outpatient references without any medical indication due to patients already admitted in hospital. Other reasons included requested from doctor in the hospital, preference to have treatment from medical specialist and limitation of drugs, BMHP and medical equipment.