Getting To Know The Latest BPJS Referral System And Its Alur

YOGYAKARTA - The latest Health BPJS referral system brings fresh air to its members. With a more structured mechanism, participants can get more targeted health services.

Starting from an easier referral process to stricter treatment monitoring, all services are designed to provide comfort and certainty for participants.

Since the enactment of Law Number 40 of 2004 and Law Number 24 of 2011, the implementation of national health insurance in Indonesia has been entrusted to the Health Social Security Administration (BPJS).

BPJS Kesehatan, which is a public legal entity, officially started its operations on January 1, 2014 with the aim of providing access to health services for all Indonesian citizens.

Reporting from the BPJS Health referral guidebook, this agency has a health referral system which is a rule that regulates the flow of a patient in obtaining medical treatment. Starting from the initial examination at the nearest health facility, to referrals to specialist doctors if needed.

The purpose of the latest referral system is so that each patient gets the right treatment according to their needs.

Also read the article that discusses BPJS Health Emergency Criteria and Borne Types of Services

There are two referral systems implemented by BPJS Kesehatan, namely, horizontal and vertical, so what's the difference?

The horizontal recommendation is the transfer of patients from one health facility to another that is equivalent in the health care hierarchy. Decrees to refer horizontally are generally taken when the original health facility cannot meet the patient's medical needs due to resource constraints.

Meanwhile, vertical referrals are a mechanism for transferring patients between health facilities at different levels.

This recommendation generally occurs when the patient's condition requires further treatment by specialist doctors or when the initial health facility does not have adequate resources to provide optimal care.

For example, a vertical reference is when a patient with a heart disease may be referred to a hospital that has a cardiac care unit. The vertical reference from higher service rates to lower levels can occur when:

(a) The patient's health condition has made it possible to be treated in lower health facilities in accordance with the competencies possessed

(b) the first or second level of service has better ability to handle similar cases

(c) patients require more appropriate and efficient further care if done in lower health facilities, especially for long-term services

"(d) health facilities that refer to not having adequate facilities, infrastructure, or human resources to provide services needed by patients."

The BPJS Health referral system itself is designed to ensure that patients get the right service according to their medical needs. In general, the referral flow starts from Faskes I, then to Faskes II, and so on.

However, there are several exceptions, such as cases of emergency, disaster, or certain medical conditions that require special treatment.

In addition, midwives and nurses can also provide first-degree health services under certain conditions, but referrals to doctors are still needed except in emergency situations.

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