Policy Analysis toward the Effectiveness of Implementation of a Referral Program on Indonesia Social Health Insurance: Lessons Learned from Depok City Hospital in Indonesia

Abstract

Health is fundamental right of all people, and all citizens are entitled to have health care services. Indonesia is experiencing a trend change in disease, from infectious diseases to noncommunicable diseases, including chronic diseases. The increasing number of noncommunicable diseases has put a double burden on the health service. BPJS Kesehatan, a legal entity formed to organize the health insurance program, offers an effective service system in its back-referral program (BRP) for chronic disease patients who have received treatment in the hospital and whose conditions have stabilized enough for outpatient treatment in a primary health care setting. There are nine types of diseases included in this back-referral program. The study’s aim was to examine the effectiveness of implementation of a BRP on Social Health Program members in Depok City Hospital. This study used a qualitative method with a case study approach using a theory conducted by Van Horn and Van Meter. There were six variables measured to determinethe the program’s effectiveness. The variables were standard—policy objective; resources; communication; characteristics of implementing agencies; implementor disposition; and social, economic, and political. The results showed that according to the six variables, the implementation of the BRP in Depok City Hospital has not been effective.

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