Since 2014, the Indonesian government has been implementing the National Health Insurance (JKN). Accordingly, the health referral system is crucial because it concerns the sustainability of health care ranging from primary health care in puskesmas up to the tertiary level of health care in the hospital, but moreover, because a referral system is needed to ensure that individuals receive optimal care at the appropriate level of health care.
The Minister of Health regulation (Permenkes) No. 1 Year 2012 on Individual Health Care Referral System article 11 (1) requires each health care provider to refer patients when necessary, unless there is a legitimate reason not to, and approved by the patient or their family.
The East Java Province, with support of the Australia – Indonesia Partnership for Health Systems Strengthening (AIPHSS), has issued guidelines specific to the region as a follow up to the Governor Decree SK no 188/786 / KPTS / 013/2013 governing the referral system.
The Process of Setting Up and Regionalising the Referral System
The setting up of the referral system in East Java was developed based on the results of a case study in the AIPHSS districts in East Java (Sampang, Bangkalan, Situbondo and Bondowoso).
The commitment of the East Java Regional Government- led by the East Java Provincial Health Office- to produce a basic law governing the referral system in East Java province is driven by:
The new governor decree is enacted following the seven (7) stages of the improvement process and development of the referral system, namely:
The Governor’s Decree No. 118/359 / KPTS / 013/2015 determines that the regionalisation of the referral system in East Java is divided into eight (8) regional and tertiary hospitals as follows: 1). RSU Dr. Saiful Anwar, Malang; 2). RSU Haji, Surabaya; 3). Ibn Sina Hospital, Gresik; 4). Sidoarjo Hospital; 5). Jombang Hospital; 6). Iskak Hospital, Tulung Agung; 7). RSU Dr Soedono, Madiun; 8). Dr Soebandi Hospital, Jember. Each hospital serves as a Center of Referral for the surrounding areas.
Learning from East Java, other areas may follow similar steps to develop a referral system in their region using the Governor decree or regional regulation. The process to establish a legal basis for this regulation should involve as many agencies and other relevant stakeholders as possible, as well as community groups, including the private sector and health professional organisations. This can be done through forums, hearings and other similar events according to the local need. These processes are part of the process of improving the understanding of the Health Office and other regional bodies, as well as the process of grounding legislation according to the real need of the people. When the legislation is drafted, these processes should also be applied to members of the Legislature, which upon having a better understanding of health, will provide legislative support to the Governor.
MAINTAINING SUSTAINABILITY OF REGIONAL REFERRAL SYSTEM
To ensure the sustainable implementation of a regional referral system, the local budget commitment should be allocated and improved for: