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Abstract

Primary health care (PHC) facilities serve as gatekeepers within Indonesia’s tiered health system. However, PHC referral patterns to hospitals still show substantial variation and remain insufficiently characterized by disease groupings based on the International Classification of Diseases, 10th Revision (ICD-10). This study aimed to identify the most frequently referred diagnoses from PHC to secondary or tertiary care facilities and to determine the participant characteristics associated with referrals. This observational study employed a cross-sectional design using secondary data from the National Health Insurance (Jaminan Kesehatan Nasional – JKN) claims database for the period 2017–2024. The unit of analysis was each patient visit to a PHC facility. The outcome variable was referral status (referred vs. not referred), with ICD-10 diagnostic codes as the main independent variable, while age and sex were covariates. Descriptive and inferential analyses, including binary logistic regression, were conducted to identify factors associated with referral likelihood. Of 1.2 billion visit episodes, 14% resulted in referrals to higher-level facilities. The most frequent diagnoses were classified under ICD-10 Code J (respiratory system diseases, 21.5%), yet referrals were most common among cases under Code C (neoplasms). Referrals were also more frequent among older adults and male patients.

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Bahasa Abstract

Fasilitas pelayanan kesehatan primer (primary health care – PHC) berperan sebagai penjaga gerbang dalam sistem rujukan berjenjang di Indonesia. Namun, pola rujukan PHC ke rumah sakit masih menunjukkan variasi yang beragam dan belum terkarakterisasi berdasarkan pengelompokan penyakit menurut International Classification of Diseases, 10th Revision (ICD-10). Penelitian ini bertujuan untuk mengidentifikasi diagnosis yang paling sering dirujuk dari PHC ke fasilitas pelayanan sekunder atau tersier serta untuk menentukan karakteristik peserta yang terkait dengan rujukan. Penelitian observasional ini menggunakan desain potong lintang (cross-sectional) dengan memanfaatkan data sekunder dari data sampel klaim program Jaminan Kesehatan Nasional (JKN) periode 2017–2024. Unit analisis dalam penelitian ini adalah kunjungan pasien ke fasilitas PHC. Variabel luaran adalah status rujukan (dirujuk dan tidak dirujuk), dengan kode diagnosis ICD-10 sebagai variabel independen utama, sedangkan usia dan jenis kelamin sebagai kovariat. Analisis deskriptif dan inferensial, termasuk regresi logistik biner, dilakukan untuk mengidentifikasi faktor-faktor yang terkait dengan kemungkinan rujukan. Dari total 1,2 miliar episode kunjungan, sebanyak 14% menghasilkan rujukan ke fasilitas tingkat yang lebih tinggi. Diagnosis yang paling sering termasuk dalam ICD-10 Kode J (penyakit sistem pernapasan, 21,5%), namun rujukan paling umum terjadi pada kasus dalam Kode C (neoplasma). Rujukan juga lebih sering terjadi pada kelompok usia lanjut dan pasien laki-laki.

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