Did The Horizontal Referral Policy in Indonesia Create Cost Savings?

Aditya Darmasurya; Rahma Anindita; M Candra Ikhda

doi:10.53756/jjkn.v1i1.14

Authors

Aditya Darmasurya Indonesia's Social Security Administering Body for Health Sector, Sampit Branch Office, Indonesia
Rahma Anindita Primary Health Care Insurer Department, Indonesia's Social Security Administering Body for Health Sector Jakarta, Indonesia
M Candra Ikhda Primary Health Care Insurer Department, Indonesia's Social Security Administering Body for Health Sector Jakarta, Indonesia

DOI:

https://doi.org/10.53756/jjkn.v1i1.14

Keywords:

Cost saving, Horizontal referal, Outpatient visit

Abstract

Background: In Indonesia, the referrals to hospitals by Primary Care Providers (PCPs) is high. In 2018, more than 15 per cent of patients visiting PCPs were referred to hospitals, while the cost for outpatient visits reached 51.2 trillion rupiahs. As of September 2019, Indonesia’s Body of Social Security for Health of Indonesia (BPJS Kesehatan) enacted a horizontal referral policy. PCPs will refer patients to other PCPs with more resourced facilities. Objectives: To assess the impact of horizontal referral on hospital outpatient visits and how cost savings were made. Methods: This study is a non-experimental big-data analysis by observational descriptive method. Results: Data results were classified into two groups in order to separate data analysis affected by external COVID-19 pandemic factors. Group I consisted of data from September to December 2019 and group II consisted of data from January 2020 to October 2020. In data Group I, a total of 8.140 cases were referred horizontally and not referred to hospitals. Referral ratio decreased from 16,50% prior the policy enactment to 15,71% in December 2019. In data Group II, horizontal referral showed an increasing trend from January to October 2020 with 56.875 total cases being referred among primary care providers. Cost savings from September 2019 to October 2020 reached 25.891.347.236 rupiahs. Conclusions: The horizontal referral policy in Indonesia reduced the number of patients referred to hospitals, hence creating cost savings. It proposes collaboration among primary care providers, thus controlling unnecessary referrals to hospitals.

References

Kuttner R: Must good HMOs go bad? First of two parts: the commercialization of prepaid group health care. N Engl J Med. 1998; 338:1558–1563.

Ferris TG, Perrin JM, Manganello JA, Chang Y, Causino N, Blumenthal D: Switching to gatekeeping: changes in expenditures and utilization for children. Pediatrics. 2001;108 (2): 283-290. 10.1542/peds.108.2.283.

Barua B, Esmail N. Waiting Your Turn: Wait Times for Health Care in Canada. Vancouver: Fraser Institute. 2013; https://www.fraserinstitute.org/sites/default/files/waiting-your-turn- 2013.pdf. Accessed 2 December 2020.

Globerman S, Esmail N, Day B, Henderson DR. Reducing Wait Times for Health Care - What Canada Can Learn from Theory and International Experience. Vancouver: Fraser Institute. 2015; https://www.fraserinstitute.org/sites/default/files/reducing-wait-times-for- health-care.pdf. Accessed 2 December 2020.

Feng D, Zhang D, Li D, Zhang Y, Serrano R, Shi D, Liu Y, Zhang L: Does having a usual primary care provider reduce patient self-referrals in rural China’s rural multi-tiered medical system? A retrospective study in Qianjiang District, China. BMC Health Services Research. 2017; 17:778 DOI 10.1186/s12913-017-2673-6.

Yip W, Hsiao W. Harnessing the privatization of China's fragmented health-care delivery. Lancet. 2014; 384:805–18.

Duckett J, Hunt K, Munro N, et al. Does distrust in providers affect health-care utilization in China? Health Policy Plan. 2016; 31:1001–9.

Teklu et al.: Referral systems for preterm, low birth weight, and sick newborns in Ethiopia: a qualitative assessment. BMC Pediatrics. (2020); 20:409 https://doi.org/10.1186/s12887-020- 02311-6

Hill H, et al: Indonesia’s Changing Economic Geography. Working Paper in Economics and Development Studies. No. 200713. Center for Economics and Development Studies, Department of Economics, Padjadjaran University. 2007.

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 (3): 245-252. 10.1370/afm.68.

Zielinski et al: Differences in referral rates to specialised health care from four primary health care models in Klaipeda, Lithuania. BMC Family Practice 2008, 9:63 doi:10.1186/1471- 2296-9-63

Vehvilainen AT, Kumpusalo EA, Voutilainen SO, Takala JK: Does the doctors' professional experience reduce referral rates? Evidence from the Finnish referral study. Scand J Prim Health Care. 1996, 14 (1): 13-20. 10.3109/02813439608997063