Analysis of integrated health referral systems in the era of regional autonomy in West Sulawesi
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"apellidos" => "Pasinringi" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130862120303533?idApp=UINPBA00004N" "url" => "/11308621/00000030000000S6/v1_202010100748/S1130862120303533/v1_202010100748/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "titulo" => "Analysis of integrated health referral systems in the era of regional autonomy in West Sulawesi" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "59" "paginaFinal" => "62" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => " Marwayani, Veni Hadju, Idayanti Nursyamsi" "autores" => array:3 [ 0 => array:3 [ "apellidos" => "Marwayani" "email" => array:2 [ 0 => "marwayani_mamuju@yahoo.com" 1 => "pmc@agri.unhas.ac.id" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Veni" "apellidos" => "Hadju" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Idayanti" "apellidos" => "Nursyamsi" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Regional Planning and Development Department, Post Graduated School, Hasanuddin University, Makassar, Indonesia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Faculty of Public Health, Hasanuddin University, Makassar, Indonesia" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Faculty of Economy and Business, Hasanuddin University, Makassar, Indonesia" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1006 "Ancho" => 1341 "Tamanyo" => 98709 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Health facilities.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">12</span></a></p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">In this era of globalization, health services continue to grow and advance over time. Awareness about the importance of social security guarantees continues to grow according to the mandate of the amendment to the 1945 Constitution Article 134 paragraph 2, which states that the State develops a Social Security System for all Indonesian people.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">To realize global commitments as mandated by the 58th World Health Association (WHA) resolution in 2005 in Geneva, which wanted every country to develop Universal Health Coverage (UHC) for the entire population, the government was responsible for implementing public health insurance through the National Health Insurance Program (JKN).<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">2–4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">National Health Insurance (JKN) is an effort made by the government to ensure the health of all Indonesian people in a comprehensive, inexpensive, affordable and quality manner, through a well-established referral system. According to research conducted by Bapna et al. (1991), it was found that many patients do bypass for diseases that can be treated in primary health facilities.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">5</span></a> This has become one of the causes of the accumulation of patients in government hospitals. Weak referral systems have an impact on the use of HR and sophisticated technology that is not appropriate. The taking off social insurance participant rights in health services by independent participants and social insurance participants who do not follow the tiered referral rules. A not yet optimal referral system can be seen in referrals that are not following indications of referrals and referrals that are not running. All of that results in the accumulation of patients that occur in hospitals and ultimately has an impact on the declining quality of health services. The issue of health worker compliance with the implementation of policies and guidelines on the referral system also affects the implementation of the referral system.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The health service referral system is the organization of health services that regulates the mutual assignment of tasks and responsibilities of health services both vertically and horizontally. Vertical referral is a referral between health services of different levels can be made from lower service levels to higher service levels or vice versa while horizontal referral is a referral between health services in one level, carried out if the referrer cannot provide health services according to patient needs due to limited facilities, equipment and/or personnel that are temporary or permanent (PMK No. 001 of 2012).<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In the current era of regional autonomy, each region is required to develop the potential of the region itself<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a> and guarantee every citizen in the region both the security and welfare of the community, as well as health. With regional autonomy, each region will be given the freedom to develop programs and submit them to the central government.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">9</span></a> So that each region needs to have minimum service standards on health in the area. This study aims to determine and analyze the integrated health referral system in the era of regional autonomy in Mamuju Regency, West Sulawesi Province.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="par0030" class="elsevierStylePara elsevierViewall">The literature review is carried out through international journal literature searches. National journals, as well as government regulations. The search was carried out through Elsevier, DOAJ and the Google Scholar search engine. The search included articles published in English and Indonesian for the period 2014–2018. The inclusion criteria for this study were the type of health insurance reference, year of publication, and regional autonomy. We include 14 journals.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">West Sulawesi Province which has capital in Mamuju is located between 0°12′–3°38′ South Latitude and 118°43′15″–119°54′3″ East Longitude, Administratively, the border of West Sulawesi Province is bordered by the Province Sulawesi Central in the north and Makassar Strait in the west. The total area of West Sulawesi Province is 16,937.16<span class="elsevierStyleHsp" style=""></span>km<span class="elsevierStyleSup">2</span> which cover 6 regencies.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a> Map of West Sulawesi Province can be seen in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Total Population Based on statistical data from BPS South Sulawesi Province (Central Statistics Agency). The total population is as much as the Population of the Province of South Sulawesi 2018: 1,355,554 lives spread across 6 districts.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The modern referral system was first conceived in the UK and has been established by the nationalization of hospitals since 1948. Referral services are an inseparable part of a functioning health system to ensure patients can be managed according to the level of health facilities, capability, capacity, receiving services and management cost-effective and quality.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a> Referral based on ability to pay, and able to service according to the level and type of service as illustrated in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The concept of a health hierarchy system is socialized based on the idea of the system, where certain populations in a Watershed (DAS) are provided according to the level determined from the service system. Whereas from research on referral activities in Pakistan many are dissatisfied, especially women and children. Considering they are often restricted from visiting health facilities in most socio-cultural settings in Pakistan. But in terms of referral services in this country, it has functioned effectively as the first contact of many people with the health system in general and in particular with the referral process.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a> Whereas if seen from services based on health service facilities are as follow in <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Stefanini, 1999 referral system services to patients can not only be referred to higher levels (or secondary tertiary service facilities) but also referred to lower levels suitable for the needs of disease diagnosis results to improve the quality and effectiveness of services.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">12</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Based on the results of the research, to ensure access and sustainability of the JKN program it is necessary to develop a referral system model by region as follow in <a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">In the previous regionalization of the referral system based on Pergub, each region was divided into public health care (PHC) working areas and districts/cities with one referral hospital, while the development of community models in the border area of the subdistrict area could choose the nearest (PHC) both in terms of distance (demographics, topography) and travel time.</p><p id="par0070" class="elsevierStylePara elsevierViewall">This developed system of referral system regionalization provides an opportunity for border communities and for primary level service providers (PHC and clinics) to make referrals for patients to the nearest advanced-level health care provider. For example, people who are in the border health center area of the Majene Regency and Mamuju Regency can be referred to the District Hospital in the regency. Mamuju which is closer and easier in terms of accessibility.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">To develop systems became necessary to protect the referral facility into a regional care network without damaging their economic feasibility. It will be very helpful in policy development if a study can identify what incentives are and how they can be funded. The solutions that arise will vary depending on the characteristics of an area and the availability and specific conditions and characteristics of patients.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">14</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Later in the study, it was found that government policy has become a facilitator of collaborative practice. Mechanism of the health system through which health services are provided. Since 2014, through JKN the Indonesian health system has provided Universal access to various services. in this scheme government policies regarding health services, such as health centers, to ensure quality health services must be accredited.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">15</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Model for Regionalizing the Integrated Health Insurance Referral System in the Province:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">a.</span><p id="par0090" class="elsevierStylePara elsevierViewall">Short-term: According to<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">16</span></a> in his research that leaders both governors, regents/mayors have a direct influence on the level of interest, community participation in the payment scheme in advance (Premiums) (Community Health Funds) causes of inability to pay for membership contributions, low quality of care, and lack of public trust to dreamers in Tanzania in taking part in a health insurance.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">17</span></a></p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">b.</span><p id="par0095" class="elsevierStylePara elsevierViewall">Long-term: Search on policy analysis has been widely carried out by academics and practitioners, but little attention has been paid to how to conduct policy analysis, research design, theories or methods that best inform policy analysis. This research focuses on the regionalization of the JKN hospital referral system for its members, drawing on several frameworks and theories, methodologies and designs that can be used in health policy analysis, giving examples of recent studies. Implications of case studies and temporality in exploratory research designs. Attention is directed to the importance of reflexivity and the position of researchers in the research process and the role of policy researchers.</p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusion</span><p id="par0100" class="elsevierStylePara elsevierViewall">The application of the modern referral system has been implemented in the UK since 1948, to ensure that people who need health services get quality services at an efficient cost according to the class of service.</p><p id="par0105" class="elsevierStylePara elsevierViewall">In contrast to the application of the referral system in developing countries such as Pakistan. Public dissatisfaction with health services is still found, especially for women and children.</p><p id="par0110" class="elsevierStylePara elsevierViewall">The implementation of national health insurance (JKN) in Indonesia since 2014 has provided a referral system to ensure public access to quality and accreted health services. However, there are various obstacles in its implementation considering the geographical area of the islands. and the application of regional autonomy including health becomes its challenges and constraints.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The implementation of the medical referral system in the JKN era was better than the previous JKN, especially in several aspects such as health workers’ compliance with referral policies and SOPs, communication aspects of health facilities, completeness and procedures.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1396918" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1279997" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Method" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusion" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 8 => array:2 [ "identificador" => "xack485980" "titulo" => "Acknowledgments" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-11-08" "fechaAceptado" => "2020-06-02" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1279997" "palabras" => array:3 [ 0 => "Health" 1 => "Referral system" 2 => "Autonomy" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">This research was conducted to find out and analyze the integrated health referral system in the era or region autonomy in Mamuju Regency, West Sulawesi Province.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The literature review is carried out through international and national journal literature, government regulations. The search was carried out through Elsevier, DOAJ and the Google Scholar search engine for the period 2014–2018. The inclusion criteria for this study were the type of health insurance reference and regional autonomy. We include 14 journals.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">This developed referral system regionalization provides an opportunity for border communities and for primary level service providers to make referrals for patients to the nearest advanced-level health care provider. For example, people who are in the border health center area of the Majene Regency and Mamuju Regency can be referred to the District Hospital in the regency. Mamuju which is closer and easier in terms of accessibility.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The implementation of national health insurance (JKN) in Indonesia since 2014 has provided a referral system to ensure public access to quality and accreted health services. However, there are various obstacles in its implementation considering the geographical area of the islands.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Peer-review under responsibility of the scientific committee of the 4th International Conference Hospital Administration (ICHA4). Full-text and the content of it is under responsibility of authors of the article.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2122 "Ancho" => 1508 "Tamanyo" => 359652 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Map of West Sulawesi Province.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">10</span></a></p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1011 "Ancho" => 1341 "Tamanyo" => 119887 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Level of services.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a></p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1006 "Ancho" => 1341 "Tamanyo" => 98709 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Health facilities.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">12</span></a></p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1345 "Ancho" => 1341 "Tamanyo" => 160684 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Model of referral system integrated national health insurance referral system.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">13</span></a></p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:17 [ 0 => array:3 [ "identificador" => "bib0090" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Peraturan Menteri Kesehatan Republik Indonesia Nomor 51 Tahun 2018 Tentang Pengenaan Urun Biaya Dan Selisih Biaya Dalam Program Jaminan Kesehatan" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Kementrian Kesehatan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2018" "paginaInicial" => "1" "paginaFinal" => "14" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0095" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Input Sistem Rujukan Badan Penyelanggara Jaminan Sosial (BPJS) Kesehatan di Fasilitas Kesehatan Tingkat Pertama (FKTP) Kabupaten Jepara STIKES Muhammadiyah Kudus, Indonesia Abstrak" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "I. 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