Factors Influencing BPJS Patient Referrals at UPTD Puskesmas Biru-Biru, Deli Serdang Regency in 2026
DOI:
https://doi.org/10.35451/ea42h784Keywords:
Referrals, Patients, Health, BPJSAbstract
Background: The referral system in the National Health Insurance (JKN) is an important mechanism to ensure effective, efficient, and tiered health services. Community health centers (Puskesmas), as Primary Health Care Facilities (FKTP), play a gatekeeper role in determining whether patients need to be referred to Advanced Referral Health Care Facilities (FKRTL). However, its implementation still shows a high number of BPJS patient referrals, including cases that should actually be manageable at the primary care level. This condition may lead to inefficiency in health financing, increased burden on hospitals, and suboptimal functioning of community health centers. Objective: This study aimed to analyze the factors influencing BPJS patient referrals at UPTD Puskesmas Biru-Biru, Deli Serdang Regency, in 2025. Methods: This study used a quantitative descriptive-analytic design with a cross-sectional approach. The study population consisted of BPJS patients receiving services at UPTD Puskesmas Biru-Biru, with samples selected according to the research criteria. The independent variables included the availability of facilities and infrastructure, the competence of health workers, and access to information, while the dependent variable was BPJS patient referral. Data were analyzed using univariate analysis, bivariate analysis with the Chi-Square test, and multivariate analysis using logistic regression. Results: The availability of facilities and infrastructure did not have a significant effect on BPJS patient referrals (p = 0.262). In contrast, the competence of health workers had a significant effect (p = 0.001), as did access to information (p = 0.023). In the multivariate analysis, access to information remained statistically significant (p = 0.013). Conclusion: BPJS patient referrals at UPTD Puskesmas Biru-Biru were significantly influenced by the competence of health workers and access to information, while facilities and infrastructure had no significant effect
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