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All Journal Jurnal Penelitian Pendidikan IPA (JPPIPA)
Sastrawan Sastrawan
Qamarul Huda Badaruddin Bagu University
Agriculture, Biological Sciences & Forestry Biochemistry, Genetics & Molecular Biology Chemical Engineering, Chemistry & Bioengineering Chemistry Education Materials Science & Nanotechnology Physics

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Case Study: Factors Causing the High Referral Ratio of BPJS Outpatients at the Mataram Police Primary Clinic in 2025 Ida Ayu Swathi Antari; Sastrawan Sastrawan; Lalu Abdul Khalik
Jurnal Penelitian Pendidikan IPA Vol 12 No 4 (2026)
Publisher : Postgraduate, University of Mataram

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.29303/jppipa.v12i4.14756

Abstract

The high referral ratio of BPJS outpatients at the Mataram Police Department's Primary Clinic in 2024 is a serious problem because it exceeds established standards, potentially leading to service inefficiencies. This study aims to analyze the causes of this high referral ratio through a review of the structure, process, and outcome aspects, as well as the contextual conditions at the Mataram Police Department's Primary Clinic. The research method used was a qualitative case study design. Data collection was conducted through in-depth interviews with key informants and supporting staff, observation, and document review related to the 2024 referral data. The results showed that, in terms of structure, the main causes of referrals were limited medical infrastructure, inadequate laboratory facilities, and the limited availability of certain medications. In terms of process, it was found that lack of compliance with Standard Operating Procedures (SOPs) and the strong desire of patients to be referred directly to hospitals were driving factors. In terms of outcome, a high rate of non-specialist referrals was still found. Contextual conditions, such as the clinic's position as a National Police health facility, also influenced referral patterns related to internal coordination. In conclusion, the high referral rate at the Mataram Police Department's Primary Clinic in 2024 was due to limited physical resources (structure) and high patient demand (process). It is recommended that primary healthcare facility standards be met and patient education on the tiered referral system strengthened to reduce referral rates
The Impact of BPJS Health Post-Claim Refunds on Hospital Administrative Services Baiq Dian Septina; Sastrawan Sastrawan; Sabar Setiawan
Jurnal Penelitian Pendidikan IPA Vol 12 No 5 (2026)
Publisher : Postgraduate, University of Mataram

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.29303/jppipa.v12i5.15067

Abstract

A high rate of post-claim refunds indicates challenges in the claims administration process, including incomplete documentation, administrative errors, and inconsistencies with BPJS Kesehatan verification standards. These issues may delay claim payments and affect hospital financial and operational performance. This study aimed to analyze the impact of post-claim refunds on hospital administrative services. This study employed a qualitative descriptive approach. Data were collected through in-depth interviews, observations, focus group discussions, and document reviews. Data were analyzed using the interactive model of Miles and Huberman, which consists of data reduction, data display, and conclusion drawing and verification. The results showed that post-claim refunds from BPJS Kesehatan have significant implications for hospital administrative services. Delays in claim reimbursement disrupt cash flow, reduce financial liquidity, and complicate budget planning. Furthermore, the refund process increases administrative workload, requires intensive coordination among hospital units, and may delay the procurement of facilities, payment of service incentives, and other operational activities. These conditions can affect administrative efficiency and the continuity of healthcare services. In conclusion, post-claim refunds have substantial impacts on hospital administrative and financial management. Strengthening claim verification procedures, improving documentation quality, and enhancing coordination among related units are necessary to minimize refund occurrences and support the sustainability of hospital services
Co-Authors Baiq Dian Septina Ida Ayu Swathi Antari Lalu Abdul Khalik Sabar Setiawan