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Abstrak :
Latar Belakang: Rumah sakit sebagai institusi pelayanan kesehatan memiliki keterbatasan fasilitas dan sumber daya manusia menjadi kendala pelayanan pasien di rumah sakit sehingga pasien memerlukan perpindahan fasilitas kesehatan. Perpindahan pasien membutuhkan kesinambungan pelayanan. RS Meilia mengalami kendala dalam merujuk pasien, dari segi sistem maupun sumber daya manusia. Selain itu belum tercapainya evaluasi rujukan dan evakuasi pasien pada penilaian akses dan kesinambungan pelayanan rumah sakit yang dilakukan oleh surveyor KARS pada  April 2023. Metode: penelitian ini menggunakan pendekatan kualitatif dengan desain studi kasus yang menganalisis elemen penilaian rujukan di dalam akses dan kesinambungan pelayanan di RS. Meilia pada bulan Mei-Juni 2023. Hasil: Pada proses penentuan dasar peraturan mengenai alur rujukan pada akses dan kesinambungan pelayanan, RS Meilia telah menetapkan dasar-dasar mengenai rujukan, namun masih menggunakan literatur yang sudah kurang relevan dengan saat ini. Pada proses perpindahan pasien masih terkendala tenaga SPGDT yang merangkap pelayanan dan belum optimalnya evaluasi sistem rujukan. Pada transportasi pasien tidak tersedianya fasilitas ambulans yang lengkap. Kesimpulan: RS Meilia telah melakukan proses rujukan berdasarkan elemen-elemen penilaian berdasarkan akses dan kesinambungan pelayanan rumah sakit, namun masih perlu perbaikan-perbaikan dalam proses evaluasi dan optimalisasi fungsi dan wewenang struktur organisasi khususnya pada pengelolaan rujukan. ......Background: Hospitals as health care institutions have limited facilities and human resources so that patients need to transfer to other health facilities. Transfer of patients requires continuity of care. Meilia Hospital experienced problems in referring patients, in terms of systems and human resources. In addition, the evaluation of patient referral and evacuation has not yet been achieved in April 2023. Methods: this study uses a qualitative approach with a case study design that analyzes referral assessment elements in access and continuity of services at Meilia Hospital in MayJune 2023. Results: In the process of determining the basic regulations regarding the flow of referrals on access and continuity of services, Meilia Hospital still uses literature that is less relevant at this time. In the process of transferring patients, the SPGDT staff also serve as services stff and the evaluation of the referral system has not been optimal. There is no complete ambulance facility for patient transportation. Conclusion: Meilia Hospital has carried out a referral process based on assessment elements based on access and continuity of hospital services, but still needs improvements in the evaluation process and optimizing the functions and authority of the organizational structure, especially in managing referrals.

Abstrak :
Kecenderungan biaya pelayanan kesehatan yang terus meningkat mendorong PT. Askes untuk mencari altematif pembiayaan yang dapat mengeiisienkan dana tanpa mengurangi mutu pelayanan. Salah satu sistem tersebut adalah Sistem Kapitasi Total dimana provider dibayar berdasar jumlah peserta terdaftar yang menjadi tanggungnya. Penerapan sistim kapitasi total tersebut perlu dipantau efektifitasnya dengan melihat kecendelungan angka kunjungan, angka rujukan menurut pesena terdaiiar dan angka rujukan menumt kunjungan. Penelitian ini diharapkan dapat diketahui bagaimana keoenderungan tersebut dan faktor-faktor apa yang mempengaruhinya. Pcnelitian dilakukan di Jakarta Pusat dengan rancangan cross sectional, jumlah sampel 37 puskesmas, menggunakan wawancara terstruktur dan wawancara mendalam, menggunakan data sekmmdcr tahun 1999-2000 , analisis data menggunakan SPSS. Hasil penelitian menunjukkan bahwa setelah penerapan selamzr 2 tahun, angka kunjungan cendenmg menurun, begitu pula angka rujukan menurut jumlah peserta terdatiar sedangkan angka nrjukan menunrt kunjungan oendenmg meningkat. Tingkat puskesmas dan besamya jasa yang diterima dari PT. Askes ternyata berhubungan dengan angka kunjungan, sedangkan status kepegawaian kepala puskesmas dan pengetahuan kepala puskesmas teniang kapitasi total berhubungan dengan angka mjukan menurut kunj ungan Disarankan agar kapitasi total disosialisasikan kepada provider maupun kepada pwert; sistem pendataan pesqrta diyrerkuat., dilakukan pemantauan langsung oleh PT. Askes ke puskesmas dan kemungkinan agar PT.Askes dapat kontrak langsung dengan puskesmas,

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The increasing tendency of the health care cost had forced PT.Askes to seek an alternative in iinancing system , without decreasing the quality of services. One of the system used is the total capitation where the providers are paid based on the amount of members registered The effectiveness of the capitation system should be monitored through visit rates, referrals rates per member registered and refenal rates per visit. 'I'hc objective of the study is to describes the rates and factors influencing them. The study is conducted in Central Jakarta , using cross sectional design, involving 37 primary care facilities as unit amalysis. The Structured and in-depth interview were used as well as the 1999- 2000 secondary data, quantitative analysis has been done using SPSS. The result of the study showed that after 2 yeais of implementation, the visit rates had a tendency to decrease, similar result can also be seen on the referral rates per member registered, while the number of referralrates per visit tended to increase. The referral rate is related to' the grade of primary health care facility and the amount of payment received from PT. Ashes The study revealed that the referral per visit rate is related to employment status and the knowledge of the total capitation of the head ofthe primary health care facilities. The study suggested that capitation system should be socialized to the providers and the members. The membership data base system should be improved, PT. Askes should conduct direct monitoring to primary health care facilities and finally to review the possibility of direct contract with the primary health C818 facilities.