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Abstrak :
Jaminan Kesehatan Nasional merupakan implementasi dari UU No. 40 tahun 2004 tentang Sistem Jaminan Sosial Nasional di bidang kesehatan dengan konsep Universal Health Coverage yang memaksa pesertanya mengikuti sistem rujukan berjenjang untuk mendapatkan pelayanan kesehatan yang komprehensif, murah dan terjangkau namun berkualitas. Belum effektifnya sistem rujukan yang ada di Indonesia, membawa berbagai permasalahan dalam dunia kesehatan dan berdampak pada penumpukan pasien di fasilitas kesehatan lanjutan yang berakibat pemanfaatan tenaga terampil dan peralatan canggih secara tidak tepat guna dan menurunnya kualitas pelayanan kesehatan. Penelitian ini menggunakan pendekatan kualitatif, dengan arah penelitian pada Sistem Rujukan Jaminan Kesehatan Nasional RSUD dr. Adjidarmo di kabupaten Lebak. Metode analisa yang digunakan adalah Content Analysis berdasarkan triangulasi metode, triangulasi sumber dan triangulasi teori. Dengan menganalisis aspek yang terdapat didalamnya, hasil penelitian dan pembahasan dibagi dalam 2 komponen, yaitu Karakteristik Sistem Rujukan Medis dan Sistem Rujukan Berjenjang. Dari hasil penelitian menunjukan bahwa pada Karakteristik Sistem Rujukan Medis implementasi Jaminan Kesehatan Nasional membawa perbaikan dalam sistem rujukan di RSUD dr. Adjidarmo Kabupaten Lebak walaupun belum signifikan dan dari komponen Sistem Rujukan Berjenjang, perbaikan baru nampak pada aspek kebijakan dan prosedur, sehingga masih diperlukan upaya yang keras untuk meningkatkan aspek lainnya untuk menciptakan sistem rujukan yang lebih baik.

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National Health Insurance is an implementation of the Law No. 40 of 2004 on National Social Security System in the field of healthcare with the concept of Universal Health Coverage that forced participants to follow a tiered referral system for health services are comprehensive, affordable, cheap and quality. The ineffectiveness of the existing referral system in Indonesia, bringing a variety of health problems in the world and have an impact on the accumulation of patients in healthcare facilities resulting in continued utilization of skilled personnel and sophisticated equipment is not appropriate and the declining quality of health care. By analyzing aspects contained therein, the results obtained and the discussion is divided into two components, namely the Medical Referral System Characteristics and Referral System Tiered,. From the results of the study showed that the implementation of the Medical Referral System Characteristics of National Health Insurance to bring improvements in the referral system in Public Hospital of dr. Adjidarmo Lebak although not significant and tiered referral system components improvements just occured in both policy and procedures, so that a strong effort is still needed to improve other aspects of creating a better referral system. It is expected that the results of this study may be one of the input for the management of hospitals and related institutions in improving various aspects related to the successful implementation of a tiered referral system in Lebak district in order to achieve Universal Health Coverage in Indonesia.

Abstrak :
Tuberculosis merupakan penyakit infeksi penyebab kematian terbesar di dunia dimana jumlah penderita tuberculosis di Indonesia adalah nomor tiga terbesar di dunia, dan merupakan penyebab kematian nomor empat di Propinsi Jambi. Indonesia sejak tahun 1995/1996 telah melaksanakan strategi DOTS (Directly Observed Treatment Shortcourse), dimana untuk melaksanakan strategi ini telah dibentuk Puskesmas Rujukan Mikroskopis (PRM). Salah satu komponen yang berperan adalah petugas laboratorium dalam pemeriksaan sputum secara mikroskopis. Kinerja petugas Laboratorium PRM di Propinsi Jambi masih rendah, yang terlihat dari hasil cross check yang dilakukan oleh Balai Laboratorium Kesehatan Jambi mempunyai tingkat kesalahan diatas 5%. Penelitian ini bertujuan untuk memperoleh informasi mengenai gambaran kinerja dan faktor-faktor yang berhubungan dengan kinerja petugas laboratorium dalam pemeriksaan mikroskopis BTA + pada PRM di Propinsi Jambi. Penelitian ini merupakan studi observational dengan rancangan cross sectional. Sampel yang diambil adalah populasi total, dengan jumlah sampel sebanyak 38 orang petugas Laboratorium PRM. Pengumpulan data dilakukan dengan wawancara dan observasi menggunakan instrument berupa kuesioner dan check list. Hasil penelitian menemukan, pada tingkat kepercayaan 95%, terdapat hubungan yang signifikan antara faktor internal seperti pendidikan, pelatihan, motivasi, dan faktor eksternal seperti supervisi, sarana dan prasarana, prosedur tetap, dan imbalan terhadap kinerja petugas laboratorium. Diantara variabel supervisi, pendidikan, pelatihan, imbalan dan prosedur tetap yang paling berhubungan adalah supervisi, diantara variabel motivasi, pendidikan, pelatihan, imbalan dan supervisi yang paling berhubungan adalah supervisi, sedangkan diantara variabel pendidikan, pelatihan, imbalan, sarana prasarana yang paling berhubungan adalah pendidikan. Upaya yang dapat dilakukan untuk mendukung program pemerintah dalam pemberantasan tuberculosis, khusus dibidang laboratorium diantaranya adalah dengan melakukan supervisi oleh pimpinan secara terjadwal serta melengkapi sarana dan prasarana sesuai dengan kondisi puskesmas. Daftar bacaan : 47 (1974 - 2001)

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Analysis of Factor that Related to Microscopic Referral Health Center Laboratory Officer's Performance at Jambi Province, 2002.Tuberculosis is an infection disease that causes the biggest death in the world, which the number of tuberculosis sufferers in Indonesia was the third biggest in the world, and as the number four causes of death in Jambi Province. Since 1995/1996 Indonesia has conducted the Directly Observed Treatment Short Course (DOTS), where to did this strategy has been established Microscopic Referral Health Center (MRH}. One of the component that having role was the laboratory officer who checking the sputum microscopically. The performance of MRH officer at Jambi Province is still low, it was seen from the result of cross-check that conducted by the Health Laboratory Center of Jambi that having error level over than 5%. The objective of this study is to obtain an information on the description of performance and the factors that related to the performance of laboratory officer in checking the BTA microscopic + on MRH at Jambi Province. This study was as observation study by cross-sectional design. The sample that taken was total population, with the number of sample was 38 MRH laboratory officers. The data collection that conducted was in-depth interview and observation using instrument in the form of questionnaire and checklist. The result of this study found that on the level of belief was 95%, there was significant relationship between internal factor, such as education, training, motivation, and external factor such supervision, means and infrastructure, permanent procedure, also income of laboratory officer's performance. Between supervisor variable, education, training, income and permanent procedure that the most relationship was supervision. Between motivation variable, education, training, income and supervision that the most having relationship was supervision, whereas between education variable, training, income, means and infrastructure that the most having relationship was means and infrastructure. The effort that can be done to support the government program in combating tuberculosis, especially in the field of laboratory, among others doing supervision by the leader as schedule and accompanied with the means and infrastructure that correspond to the health center condition. References: 47 (1974-2001).