Analysis Of Factors Influencing The High Rate Of Patient Referrals At The Regional Specialized Dental And Oral Hospital Of South Sulawesi Province

Fatma Sudirman; Mustamim Mustamim; Muhammad Basir

doi:10.63922/ijebir.v5i06.6739

Fatma Sudirman Fakultas Pascasarjana Administrasi Rumah Sakit, Universitas Megarezky, Makassar, Indonesia.
Mustamim Mustamim Fakultas Pascasarjana Administrasi Rumah Sakit, Universitas Megarezky, Makassar, Indonesia.
Muhammad Basir Fakultas Pascasarjana Administrasi Rumah Sakit, Universitas Megarezky, Makassar, Indonesia.

DOI: https://doi.org/10.63922/ijebir.v5i06.6739

Keywords: Patient referrals, healthcare service quality, government policies, public knowledge, RSKD Dental and Oral Hospital.

Abstract

The high rate of patient referrals from Community Health Centers (Puskesmas) to the Regional Specialized Dental and Oral Hospital (RSKD) of South Sulawesi Province has become an important issue in healthcare services. This condition may lead to excessive workloads, long waiting times, and decreased service effectiveness at higher-level healthcare facilities. This study aimed to analyze the effects of healthcare service quality, government policies, and the level of public knowledge on the high rate of patient referrals at the RSKD Dental and Oral Hospital of South Sulawesi Province. The study population consisted of all referred patients who visited the RSKD Dental and Oral Hospital of South Sulawesi Province during the period from October to December 2025, totaling 18,956 patients, with a sample of 100 respondents selected using accidental sampling. Data were collected through structured questionnaires and official hospital documents. Data analysis included univariate analysis, bivariate analysis using the Chi-Square test, and multivariate analysis using multiple logistic regression to determine the partial and simultaneous effects of the independent variables on patient referrals. The results showed that the majority of patients rated the quality of healthcare services as good (74%), considered government policies appropriate (82%), and had a good level of knowledge (72%). The bivariate analysis indicated that all independent variables were significantly associated with patient referrals. Multiple logistic regression showed that healthcare service quality had a negative and significant effect on patient referrals, whereas government policies had no significant effect. Certain categories of public knowledge also had a significant negative effect. Simultaneously, the three independent variables significantly affected patient referrals. In conclusion, improving healthcare service quality and public knowledge can reduce the likelihood of high referral rates. It is recommended that the RSKD improve service quality, provide oral and dental health education to the community, and monitor the implementation of government policies to make the referral system more efficient and effective.

References

Anang, H. I. Robbihi. (2021). Hubungan pengetahuan dengan perilaku kesehatan gigi dan mulut. Jurnal Ilmu Kesehatan.
Andika, W., et al. (2025). Pelaksanaan rujukan rawat jalan tingkat pertama peserta Jaminan Kesehatan Nasional di Puskesmas X. Indonesian Journal of Health Science.
Ardini, D., Fitriani, A., & Rahmawati, S. (2023). Faktor-faktor yang memengaruhi pelaksanaan sistem rujukan berjenjang pada fasilitas kesehatan tingkat pertama. Jurnal Kesehatan, 16(2), 145–154.
Dindin, S. H., Suryani, Ruhyat, E., T., M. D., & Pamungkas, G. (2023). Hubungan kualitas pelayanan rujukan BPJS Kesehatan dengan kepuasan pasien di Puskesmas Pamengpeuk Kabupaten Bandung.
Friska, D. S., et al. (2022). Faktor-faktor yang mempengaruhi keputusan masyarakat mengunjungi fasilitas kesehatan gigi dan mulut. Dental Therapist Journal.
Ghanbarzadegan, A., Bastani, P., Ramezani, M., Kavosi, Z., & Ravangard, R. (2021). Inequality in dental services: A scoping review on the role of access toward achieving universal health coverage in oral health. BMC Oral Health, 21, 406. https://doi.org/10.1186/s12903-021-01765-3
Juwita, R., & Santoso, B. (2025). Analisis implementasi sistem rujukan berjenjang pada era Jaminan Kesehatan Nasional. Jurnal Kebijakan Kesehatan Indonesia, 14(1), 25–34.
Kementerian Kesehatan Republik Indonesia. (2023). Mendorong layanan rujukan dapat diakses oleh seluruh pasien di pelosok Indonesia.
Kementerian Kesehatan Republik Indonesia. (2024). Peraturan Menteri Kesehatan Republik Indonesia tentang sistem rujukan pelayanan kesehatan perseorangan.
Kruk, M. E., Gage, A. D., Arsenault, C., et al. (2022). High-quality health systems in the Sustainable Development Goals era: Time for a revolution. The Lancet Global Health, 10(8), e1196–e1252.
Lestari, P. D., Himawati, M., & Nawawi, A. P. (2024). Korelasi persepsi kesehatan gigi dan mulut terhadap minat masyarakat untuk berobat ke dokter gigi. Jurnal Kedokteran Gigi Universitas Padjadjaran.
Levesque, J. F., Harris, M. F., & Russell, G. (2020). Patient-centred access to health care: Conceptualising access at the interface of health systems and populations. International Journal for Equity in Health, 19(1), 1–9.
Macinko, J., & Wright, B. (2020). Primary care and health outcomes: A global perspective. Health Services Research, 55(Suppl. 2), 6–15.
Nicholson, C., Jackson, C., Marley, J., & Wells, R. (2021). The Australian experiment: How primary health care organizations supported the COVID-19 response. International Journal of Integrated Care, 21(1), 1–10.
Novianingrum, I. R., Rosyidah, & Ruliyandari, R. (2025). Faktor-faktor mutu pelayanan kesehatan yang berhubungan dengan kepuasan pasien gigi: Literature review. PREPOTIF: Jurnal Kesehatan Masyarakat.
Nutbeam, D., & Lloyd, J. E. (2021). Understanding and responding to health literacy as a social determinant of health. Annual Review of Public Health, 42, 159–173. https://doi.org/10.1146/annurev-publhealth-090419-102529
Organisation for Economic Co-operation and Development. (2020). Realising the potential of primary health care. OECD Publishing. https://doi.org/10.1787/a92adee4-en
Paakkari, L., & Okan, O. (2020). COVID-19: Health literacy is an underestimated problem. The Lancet Public Health, 5(5), e249–e250.
Permatasari, P., & Ernawaty, E. (2019). Analisis rasio rujukan rawat jalan peserta Jaminan Kesehatan Nasional pada fasilitas kesehatan tingkat pertama. Media Gizi Kesmas, 8(2), 78–86.
Purba, M. R., Hasibuan, R., & Astuty, D. A. (2024). Analisis pelaksanaan rujukan pasien JKN di Puskesmas Bahorok. Universitas Islam Negeri Sumatera Utara.
Ramadhani, S. N. (2020). Analysis of factors causing high referral rates at primary health center in the JKN era: A literature review. Universitas Airlangga.
Ridwan, R., & Ramadhan, S. (2025). Influencing factors in patient referrals: A doctor's perspective. Jurnal Jaminan Kesehatan Nasional.
Safari, R. O. A., Syamsu, R. F., & Makmun, A. (2023). Faktor penyebab tingginya angka rujukan di fasilitas kesehatan tingkat pertama pada era JKN: Literature review. PREPOTIF: Jurnal Kesehatan Masyarakat.
Semarajana, I. N. G., et al. (2022). Faktor-faktor yang berhubungan dengan tingginya rujukan kasus non spesialistik di era JKN: Systematic review. Jurnal ARSI: Administrasi Rumah Sakit Indonesia.
Shi, L., Starfield, B., & Kennedy, B. (2021). Primary care, specialty care, and life chances. International Journal of Health Services, 51(2), 149–164.
Simamora, F. D., Sidabutar, M., Manu, A. A., & Laba, M. M. (2022). Faktor-faktor yang mempengaruhi keputusan masyarakat mengunjungi fasilitas kesehatan gigi dan mulut. Dental Therapist Journal.
Sinaga, A. P. I. (2022). Korelasi disparitas ketersediaan tenaga medis gigi antardaerah terhadap pemanfaatan layanan gigi dan mulut di Indonesia. Jurnal Manajemen Pelayanan Kesehatan: The Indonesian Journal of Health Service Management.
Sørensen, K., Van den Broucke, S., Fullam, J., et al. (2021). Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health.
Suryana, A. Y. (2020). Hubungan pengetahuan tentang rujukan dengan pelayanan rujukan berjenjang secara online pada pasien BPJS Kesehatan. Jurnal Ilmiah Wijaya.
Watt, R. G., Daly, B., Allison, P., et al. (2021). Ending the neglect of global oral health: Time for radical action. The Lancet, 397(10283), 261–272. https://doi.org/10.1016/S0140-6736(21)00232-2
World Health Organization. (2021). Primary health care measurement framework and indicators: Monitoring health systems through a primary health care lens. World Health Organization. https://www.who.int/publications/i/item/9789240044210
Zuhri, M. A., et al. (2022). Pelaksanaan sistem rujukan berbasis pemerintah di pelayanan kesehatan: Tinjauan literatur. Jurnal Ilmiah Keperawatan.