Evaluation Of The Multi Level Referral System Policy In Health Service Facilities
Keywords:
Referral System, National Health Insurance, Policy Evaluation, Health Service FacilitiesAbstract
Access to equitable health services in Indonesia is supported by a tiered referral system within the National Health Insurance (JKN) program, which regulates service continuity between primary and advanced healthcare facilities. Although this system has expanded service access and reduced financial barriers, its implementation remains challenged by infrastructure limitations, unequal distribution of health workers, weak inter-facility coordination, and low public understanding of referral procedures. This study aimed to evaluate the implementation of the multi-level referral system policy within the JKN framework in Indonesian health service facilities. A structured literature review was conducted using the Google Scholar database. Articles published between 2020 and 2025 were screened and selected using predefined inclusion and exclusion criteria. A total of six eligible studies were analyzed using thematic analysis to identify recurring patterns related to implementation effectiveness, resource availability, coordination mechanisms, and public understanding. The results show that the JKN program has improved access to healthcare services and reduced financial barriers; however, the referral system has not functioned optimally due to disparities in infrastructure, limited human resource capacity, weak coordination between service levels, and insufficient program socialization. The novelty of this study lies in its integrative synthesis of structural, organizational, and behavioral dimensions in evaluating referral system performance. This study provides evidence-based insights to support policy strengthening aimed at improving efficiency, equity, and sustainability of health services and accelerating the achievement of universal health coverage in Indonesia.
References
Akbar, M. I. (2020). Studi Implementasi Program Jaminan Kesehatan Nasional di Kabupaten Muna. Jurnal Kesehatan Masyarakat Celebes, 1(03), 21-27. https://doi.org/10.30597/jkmm.v1i3.8826
Muharram, F. R., Sulistya, H. A., Swannjo, J. B., Firmansyah, F. F., Rizal, M. M., Izza, A., ... & Romdhoni, A. C. (2024). Adequacy and distribution of the health workforce in Indonesia. WHO South-East Asia journal of public health, 13(2), 45-55. https://doi.org/10.4103/WHO-SEAJPH.WHO-SEAJPH_28_24
Iskandar, C., & Hartono, B. (2023). Analisis Implementasi Mutu Kebijakan Jaminan Kesehatan Nasional Di Dinas Kesehatan Provinsi Riau Melalui Pendekatan SDMK (Systematic Literature Riview). Jurnal Ilmiah Kesehatan Indonesia, 1(2). https://doi.org/10.70437/komunika.v1i1.110
Faiz, M. N., Kandau, R. S. R., & Gurning, F. P. (2025). Evaluasi implementasi JKN dalam peningkatan akses pelayanan kesehatan di Medan. Jurnal Kolaboratif Sains, 8(7), 4095-4103.
Risky, S., & Munir, S. (2023). Evaluasi Tata Kelola Sistem Rujukan Kesehatan di Puskesmas Kabupaten Konawe Utara. Media Publikasi Promosi Kesehatan Indonesia (MPPKI), 6(7), 1374-1383. https://doi.org/10.56338/mppki.v6i7.3563
Kurniawaty, G., & Setiawan, E. (2023). Jurnal Ekonomi Kesehatan Indonesia Pelayanan Kesehatan Primer Sebagai Gatekeeper Dan Kebijakan Diskusi Peer Revie : Antara Kualitas dan Realitas untuk Menurunkan Kasus Rujukan Non. 8(2). https://doi.org/10.7454/eki.v8i2.5482
Mariani, T., Rahma, S., Amira, A. P., & Gurning, F. P. (2024). Literatur Review: Analisis Pemahaman Pasien terhadap Sistem Rujukan Berjenjang Jaminan Kesehatan Nasional (JKN). El-Mujtama: Jurnal Pengabdian Masyarakat, 4(2), 981-991. https://doi.org/10.47467/elmujtama.v4i2.995
Nugraheni, A. I., Putriyanti, C. E., & Kurnianto, A. (2023). Tinjauan Literatur: Evaluasi Program Jaminan Kesehatan Nasional (JKN) di Indonesia. Jurnal Kesehatan, 12(2). https://doi.org/10.46815/jk.v12i2.184
Ramadhani, R. V., Nisa, K., Nurlatifah, S., Gani, A., Kurniawaty, G., & Setiawan, E. (2024). Pelayanan Kesehatan Primer Sebagai Gatekeeper Dan Kebijakan Diskusi Peer Review : Antara Kualitas Dan Realitas Untuk Menurunkan Kasus Rujukan Non Spesialistik. 8(2). https://doi.org/10.7454/eki.v8i2.5482
Ramadhani, S. N. (2020). Studi Literatur : Analisis Faktor Penyebab Tingginya Angka Rujukan Di Puskesmas Pada Era Jkn Analysis Of Factors Causing High Referral Rates At Primary Health Center In The Jkn Era : A Literature Review. https://doi.org/10.20473/mgk.v9i2.2020.57-66
Setiawati, M. E., & Nurrizka, R. H. (2020). Evaluasi Pelaksanaan Sistem Rujukan Berjenjang Dalam Program Jaminan Kesehatan Nasional. 08(01), 35–40.
Sirait, R. A., Sumantri, B., Kasim, F., Kurnia, A., & Ginting, L. R. B. (2024). Socialization of BPJS Participation in National Health Insurance (JKN) Program as an Effort to Achieve Universal Health Coverage in Perbarakan Village, Deli Serdang Regency. JURNAL PENGMAS KESTRA (JPK), 4(2), 260-267. https://doi.org/10.35451/jpk.v4i2.2413
Suryati, D. (2023). Literature Review: Analisis Faktor Penyebab Tingginya Angka Rujukan di Puskesmas Bangun Purba. Jurnal Ilmiah Kesehatan Indonesia, 1(1), 79-85.
Susiloningtyas, L. (2020). Sistem Rujukan dalam Sistem Pelayanan Kesehatan Maternal Perinatal di Indonesia Refferal System in Maternal Perinatal Health. Jurnal Sistem Rujukan Dalam Sistem Pelayanan, 2(1), 6-16. https://doi.org/10.53599/jip.v2i1.57
Widjaja, G., Yustanti, D. E., Sijabat, H. H., & Dhanudibroto, H. (2025). Evaluasi Implementasi Kebijakan Jaminan Kesehatan Nasional (JKN) dalam Meningkatkan Akses Layanan Kesehatan Masyarakat di Indonesia. Jurnal Kesehatan, 3(2), 177-188.
Zahrina, Z., Ramadani, R. V., Nurlatifah, S., Andalan, A., Gani, A., Kurniawaty, G., & Setiawan, E. (2023). Pelayanan Kesehatan Primer Sebagai Gatekeeper Dan Kebijakan Diskusi Peer Review: Antara Kualitas Dan Realitas Untuk Menurunkan Kasus Rujukan Non Spesialistik. Jurnal Ekonomi Kesehatan Indonesia, 8(2), 7. https://doi.org/10.7454/eki.v8i2.5482
