<![CDATA[The referral system is an essential component in the implementation of the National Health Insurance (JKN) managed by BPJS Kesehatan, aiming to ensure the continuity of tiered healthcare services. However, its implementation in hospitals still faces various complex challenges. Objective: To identify and analyze the obstacles in the implementation of the BPJS Kesehatan patient referral system through a literature review. This study employs a narrative review design based on eight articles retrieved from Google Scholar (2020–2025). Results: The review indicates that referral system barriers include limited human resources, low understanding of referral procedures, information system issues, weak internal coordination, and technical problems in online referrals. Administrative barriers and external factors such as low patient understanding, service disparities, and geographic constraints also worsen system effectiveness. Conclusion: Internal and external barriers in the BPJS Health patient referral system in hospitals require comprehensive improvements through strengthening human resources, governance, infrastructure, and community education in an integrated manner.]]>
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