"Pelayanan rujukan sebagai salah satu strategi pemerintah dalam memberikan pelayanan kesehatan secara berjenjang sudah dikembangkan lebih 30 (tiga puluh) tahun yaitu sejak dikeluarkannya keputusan Menteri Kesehatan nomor 032/Birhub/1972 tentang Sistem Rujukan (Referral System) temyata belum dapat berjalan sebagimana mestinya. Hal ini dapat dilihat dari indikator tenaga kesehatan dimana rasio jumlah tenaga kesehatan dibandingkan jumlah penduduk yang masih rendah. Seperti rasio dokter terhadap penduduk 1:5000, perawat 1.2850 dan bidan 1.2500 (Depkes, SKN, 2004).
Indikator penting lainnya adalah jumlah sarana kesehatan sebagai pelaksana rujukan yang belum Memadai. Jumlah Puskesmas di Indonesia sebanyak 7.237 unit, Puskesmas Pcmbantu scbanyak 21.267 unit, Puskesmas Kel'ua r g sebanyak 6.392 unit, rumah sakit 1.215 unit sementara jumlah penduduk Indonesia sebanyak 201.701537 (BPS 2001). Kedua indikator tersebut tentunya memerlukan p~rhatian untuk diperkecil kesenjangannya karena sangat berpengaruh terhadap mute (quality), keterjangkauan (affordability) dan keterc.apaian (accessibility) pelayanan rujukan.
Permasalahan yang diajukan untuk dilakukan penelitian adalah ingin mengetahui faktor-faktor yang berhubungan dengan terlaksananya rujukan yang efektif di RSUD Cianjur dilihat dan aspek pengirim rujukan yaitu masalah sarana, petugas kesehatan dan prosedur rujukan. Aspek keterjangkauan (affardibiliv) meliputi masalah penghasilan pasien, pola bayar dan biaya pelayanan. Aspek ketercapaian (accessibility) meliputi masalah jarak, waktu, kendaraan dan biaya transportasi dan aspek mute (quality) pelayanan peneri a rujukan meliputi masalah keadaan fisik yang dapat dirasakan langsung dan nyata (tangible) dan empati (empathy).
Penelitian yang dilakukan menggunakan pendekatan kuantitatif dengan rancangan Crass-Sectional yaitu mempelajari dinamika korelasi antara faktor-faktor resiko dengan efek, variabel-variabel yang terrnasuk faktor resiko dan efek diobservasi secara sekaligus dan bersamaan selama satu bulan sejak tanggal 28 Juni sampai dengan 27 Juli 2004 di Unit Rawat .nap dan Rawat Jalan RSUD Cianjur Jawa Barat dengan pengumpulan data menggunakan instrunien kuesioner clan telaah dokumen.
Populasi adalah seluruh pasien rujukan dan Puskesmas yang dirawat di 12SUD Cianjur dan sampelnya sebanyak 96 orang dengan kriteria pasien mampu menjawab pertanyaan dan bersedia men jawab tanpa ada unsur paksaan.
Dan hasil penelitian diperoleh gambaran bahwa dan sampel 96 orang terdapat 54 prang (56,3% pasien beranggapan bahwa peiayanan rujukan di RSUI) Cianjur sudah efektif, sedangkan 42 orang lainnya (43,7 %) beranggapan pelayanan rujukan belum efektif. Ke mudiain terdapat hubungan yang bermakna antara sarana, tenaga kesehatan, prosedur rujukan, penghasilan pasien, pola hayar, biaya pelayanan, jarak, waktu yang ditempuh pasien, bukti langsung dan nyata daa empati petugas terhadap terlaksananya rujukan yang efektif di RSUD Cianjur.
Dan variabel-variabel yang mempunyai huhungan bermakna dengan variabel terikat, terdapat variabel independen yang paling dominan berhubungan dengan variabel terikat yaittu variabel sarana.
Berdasar basil penelitian maka saran yang diajukan peneliti dan aspek sarana berupa audit kelengkapan sarana di Puskesmas oleh Dinas Kesehatan Kabupaten Cianjur serta menambah kelengkapan penunjang seperti peralatan komunikasi dan ambulans, dari aspek prosedur berupa membuat aturan tertuiis mengenai prosedur penanganan rujukan dan mensosialisasikan kepada petugas serta menyempumakan prosedur pencatatan dan pelaporan, dan aspek bukti fisik berupa penambahan sarana tempt duduk dan dan aspek empati berupa peningkatan kemampuan komunikasi petugas melalui pelatihan customer service.
Analyze Factors Which Deal With The Reference Effectiveness In UD Regency of Cianjur 2004Strive to improve the awareness, willingness and healthy life ability for every people to be existed by degree of optimal health by majoring healthy behavior and in healthy environment, owning ability to reach the certifiable health service fairly and flatten at five the last year experience of the challenge which enough heavily.Reference service as one of governmental strategy in giving gradually health service have been developed more 30 years since releasing of Health Minister Decree of 032Birhub11972 about Reference System in the reality not yet ambulatory. This matter is visible from indicator of health energy where ratio sum up the health worker compared to population amount which still lower. Like doctor ratio to population 15000, nurse 1:2850 and midwife 1:2600 (Depkes, SKN, 2004).Other important indicator is amount of health medium as reference executor which not yet adequate. Sum up the puskesmas in Indonesia as much 7.237 unit, ministrant puskesmas as much 21.267 unit, puskesmas circle as much 6.392 unit, hospital 1.215 unit whereas amount of Indonesia resident as much 201.703.537 (BPS 2001). Both of indicators need the attention to be minimized its difference because having an effect on quality, affordability and accessibility of reference service.Problems raised to be conducted by a research is wishing to know the factors which deal with executing of effective reference in RSUD Regency of Cianjur seen from aspect of reference consignor that is medium problem, worker of health and reference procedure. Aspect of affordability cover the problem of patient income, pattern of paying and service expense. Aspect of accessibility cover the problem of distance, lime, vehicles and expense of transportation and quality aspect of reference receiver cover the real and direct evidence (tangible), responsiveness and empathy_Research done use the quantitative approach with the device Cross-Sectional that is learn the correlation dynamics between risk factors with the effect, variables which is the inclusive of factor of risk and observation effect at once and at the same time during one month from 28 June up to 27 July 2004 in Unit Take care of to Lodge and Take Care Of RSUD Regency of Cianjur West Java with the data collecting use the instrument questioner and analyze document Population is entire of reference patient from puskesmas which taken care of RSUD Regency of Cianjur and its sampling as much 96 people with the patient criterion able to reply the question and ready to reply without constraint element_Description from each accurate to be researched variable conducted by analysis univariate and for knowing link of dependent variables with the independent variable done bivariate analysis through test of statistic Chi Square because data in this research in the form of categorical data Later done analysis multivariate by using doubled test regretion logistics to know the most dominant independent variable relate to the dependent variable.From research result obtained description that from sampling 96 people of 54 people (56,3%) patient of opinion that reference service in RSUD Regency of Cianjur have effective, while its 42 others (43,7 %) of opinion reference service not yet effective. Later there are relation of meaning among medium, health energy, reference procedure, patient production, pattern of paying, service expense, distance, time, real and direct evidence and worker empathy to executing of effective reference in RSUD Regency of Cianjur.From variable having relation of meaning with the dependent variable, there are most dominant independent variable relate to the dependent variable that is medium variable.Based on research result hence suggestion raised by researcher from medium aspect in the form of assessment of medium equipment in puskesmas by Public Health Service of Regency of Cianjur and also add the supporter equipment like equipments of communications and ambulance, from procedure aspect in the form of making order written to hit the procedure of reference handling and socialize to worker and also complete the procedure of record-keeping and reporting, from aspect of physical evidence in the form of addition of seat medium and from empathy aspect in the form of make-up of ability of worker communications through training of customer service."
