<![CDATA[Medical referral systems function to transfer patient care from primary-level facilities to more competent advanced-level facilities based on clinical indications. Although the choice of referral facility is generally aligned with designated service areas and official networks, personal preferences often lead patients to select facilities outside these parameters. The geography of Muaro Jambi Regency, which encircles Jambi City, makes healthcare facilities in the city relatively accessible. This study analyzes the determinants of selecting out-of-region referral hospitals among patients at the Muara Kumpeh Community Health Center (Puskesmas) the primary referral hub in Muaro Jambi Regency, which handled 2,105 cases in 2025. Employing a cross-sectional design and a quantitative approach, a sample of 336 respondents was recruited via accidental sampling and analyzed using Chi-Square tests and logistic regression. The results indicate that the majority of respondents (210 individuals, or 62.5%) chose referral facilities outside Muaro Jambi Regency. Variables found to have a significant correlation included accessibility ($p=0.001$), service quality ($p=0.025$), facility completeness ($p=0.015$), and the availability of medical personnel ($p=0.006$). Conversely, administrative factors, age, education level, and occupation showed no significant correlation. Accessibility was identified as the strongest predictor, with an odds ratio (OR) of 2.100 (95% CI: 1.311–3.366). Overall, the selection of out-of-region referral hospitals is influenced by access, service quality, facilities, and the availability of physicians, with accessibility exerting the most dominant influence.]]>
