Healthcare Provider Engagement and Its Effects on Patient Rereferral: Insights from Indonesia

Felicia Setiawan, Department of Hospital Administration, Faculty of Medicine, Universitas Pelita Harapan, Tangerang 15811, IndonesiaFollow

ORCID ID

Felicia Setiawan: 0009-0004-6398-9132

Abstract

Background: In the highly competitive landscape of healthcare, nurturing strong relationships between referring healthcare providers and healthcare facilities is essential for maintaining patient loyalty. This study explores the factors influencing referring health care provider engagement and its subsequent impact on the willingness to rerefer to healthcare facilities.

Methods: A cross-sectional quantitative survey was conducted with 181 healthcare providers who regularly refer patients to a private hospital in Jakarta. Data were collected through an online structured questionnaire consisting of 29 questions. The following dimensions were covered: specialist characteristics, practice characteristics, healthcare provider–specialist interaction, patient–specialist interaction, returning referral, training opportunity, healthcare provider engagement, and willingness to rerefer to hospital.

Results: The study yielded significant findings, with five out of the six antecedents associated with healthcare provider engagement demonstrating statistical significance (p < 0.05). The most significant coefficient value pertaining to healthcare provider engagement was observed in patient–specialist interaction (β = 0.287, p < 0.05). Furthermore, the analysis indicated a substantial and positive correlation between health care provider engagement and willingness to rerefer to the healthcare provider (p < 0.05).

Conclusions: Healthcare providers who demonstrate engagement with the hospital are likely willing to rerefer their patients to the hospital. Therefore, to increase the willingness to rerefer patients to the hospital, hospital management should prioritize fostering engagement with healthcare providers, particularly by improving patient and specialist interaction experiences.

References

BPJS Kesehatan. Panduan Praktis Sistem Rujukan Berjenjang. Jakarta: BPJS Kesehatan; 2015.
Handayani PW, Saladdin IR, Pinem AA, Azzahro F, Hidayanto AN, Ayuningtyas D. Health referral system user acceptance model in Indonesia. Heliyon. 2018;4:e01048.
Graffigna G, Palamenghi L, Boccia S, Barello S. Relationship between citizens' health engagement and intention to take the COVID-19 vaccine in Italy: A mediation analysis. Vaccines (Basel). 2020;8:576.
Ignatowicz A, Greenfield G, Pappas Y, Car J, Majeed A, Harris M. Achieving provider engagement: Providers' perceptions of implementing and delivering integrated care. Qual Health Res. 2014;24:1711–20.
Diba F, Ichsan I, Muhsin M, Marthoenis M, Sofyan H, Andalas M, et al. Healthcare providers' perception of the referral system in maternal care facilities in Aceh, Indonesia: A cross-sectional study. BMJ Open. 2019;9:e031484.
Eskawati MY, Murti B, Tamtomo D. Implementation of the referral system policy in the national health insurance scheme at community health centers, Ngawi District, East Java. J Health Policy Manag. 2017;2:104–13.
Johnson JT, Barksdale HC, Boles JS. Factors associated with customer willingness to refer leads to salespeople. J Bus Res. 2003;56:257–63.
Hollebeek LD, Glynn MS, Brodie RJ. Consumer brand engagement in social media: Conceptualization, scale development and validation. J Interact Market. 2014;28:149–65.
Shantz A, Alfes K, Whiley L. HRM in healthcare: The role of work engagement. Pers Rev. 2016;45:274–95.
Seyed-Nezhad M, Ahmadi B, Akbari-Sari A. Factors affecting the successful implementation of the referral system: A scoping review. J Fam Med Prim Care. 2021;10:4364–75.
Mohammad Al Ghamdi O, Al Malki BM, Eid Nahhas A, Al-Malki A. Rate of referral from primary health care to secondary health care among governmental hospitals in Taif governorate, KSA. Int J Med Sci Public Health. 2015;4:1457–63.
Kinchen KS, Cooper LA, Levine D, Wang NY, Powe NR. Referral of patients to specialists: Factors affecting choice of specialist by primary care physicians. Ann Fam Med. 2004;2:245–52.
Memon MA, Ting H, Cheah J-H, Thurasamy R, Chuah F, Cham TH. Sample size for survey research: Review and recommendations. J Appl Struct Equ Modeling. 2020;4:i–xx.
Chomeya R. Quality of psychology test between Likert scale 5 and 6 points. J Soc Sci. 2010;6:399–403.
Wang R, Hempton B, Dugan JP, Komives SR. Cultural differences: Why do Asians avoid extreme responses? Surv Pract. 2008;1:1–8.
Ringle CM, Sarstedt M. Gain more insight from your PLS-SEM results: The importance-performance map analysis. Ind Manag Data Syst. 2016;116:1865–86.
Hair JF, Sarstedt M, Ringle CM, Gudergan SP. Advanced issues in partial least squares structural equation modeling. 2nd ed. Thousand Oaks, CA: SAGE Publications, Inc.; 2024.
Hair JF, Hult GTM, Ringle CM, Sarstedt M. A primer on partial least squares structural equation modeling (PLS-SEM). 3rd ed. Thousand Oaks, CA: SAGE Publications, Inc.; 2022.
Hair JF, Risher JJ, Sarstedt M, Ringle CM. When to use and how to report the results of PLS-SEM. Eur Bus Rev. 2019;31:2–24.
Forrest CB, Glade GB, Baker AE, Bocian A, von Schrader S, Starfield B. Coordination of specialty referrals and physician satisfaction with referral care. Arch Pediatr Adolesc Med. 2000;154:499–506.
Chan BT, Austin PC. Patient, physician, and community factors affecting referrals to specialists in Ontario, Canada: A population-based, multi-level modelling approach. Med Care. 2003;41:500–11.
Soeripto ND. The implementation of clinical procedures in the vertical referral system in a primary healthcare center. Indones J Health Adm. 2019;7:73–80.
Ramadhani SN. Analysis of factors causing high referral rates at primary health center in the JKN era: A literature review. Media Gizi Kesmas. 2020;9:57–66.
Hartini H, Arso S, Sriatmi A. Analisis pelayanan rujukan pasien BPJS di RSUD Chatib Quzwain Kabupaten Sarolangun Provinsi Jambi. Jurnal Kesehatan Masyarakat (e-Journal). 2016;4:45–59.
Amin AN, Aledia A. An eConsults program to improve patient access to specialty care in an academic health system. J Clin Outcomes Manag. 2020;27:115–22.
Alkhodair AA, Aleisa SN, Alghamdi MA, Alodhayani AA, Alghamdi YA, Alsenaidi YI. Satisfaction level among nephrologists towards chronic kidney disease patients referred from primary health care system. Egypt J Hosp Med. 2018;70:1801–7.
Kim KK, Yeong LL, Caterson ID, Harris MF. Analysis of factors influencing general practitioners' decision to refer obese patients in Australia: A qualitative study. BMC Fam Pract. 2015;16:45.
Milakovic M, Corrado AM, Tadrous M, Nguyen ME, Vuong S, Ivers NM. Effects of a single-entry intake system on access to outpatient visits to specialist physicians and allied health professionals: A systematic review. CMAJ Open. 2021;9:E413–23.
Goldstein R, Azuz-Lieberman N, Sarid M, Gaver A. Patient's evaluations and expectations of primary care medicine in Israel revisited after two decades - Health Service Research. Patient Educ Couns. 2022;105:734.
Ackerman SL, Gleason N, Monacelli J, Collado D, Wang M, Ho C, et al. When to repatriate? Clinicians' perspectives on the transfer of patient management from specialty to primary care. J Gen Intern Med. 2014;29:1355–61.