Analysis of the Increase in Referrals to Specialists at Yayasan Kesehatan XYZ Regional III


  •   Adhiwinata Aman

  •   Mursyid Hasan Basri


The referral is defined by the World Health Organization (WHO) as the process of giving support or transferring the patient's management to a higher level (Hort et al., 2019). Yayasan Kesehatan (Yakes) XYZ has clinics that provide primary health services and manage advanced health services for its participants. As a non-profit institution, Yakes XYZ focuses on cost efficiency while maintaining service quality. This study was conducted from 2020 to 2021 at Yakes XYZ Regional III. In 2021, the number of referrals to specialists increased by 39% compared to the previous year at the three clinics owned, which increased costs by 13% (y-o-y), thus providing a gap of Rp6,036,364,222 compared to the previous year. This increase was inversely proportional to the decrease in first-level outpatient visits by minus 2% in 2021. Referrals to specialists can occur after the patient has made a first-level outpatient visit to the clinic. According to the literature, it is known that four factors influence referrals to specialists, including the nature of the referral system policy, the nature of health problems, facilities and infrastructure, and then the general practitioner (GP)'s workload. This research used a quantitative approach and was conducted using the official secondary data from Yakes XYZ Regional III. Based on the analysis of the business situation at Yakes XYZ Regional III and the results from the hypothesis testing conducted, the author concluded root cause of the problem arose. The unclear referral policy, lack of offline service capacity, lack of GP competence, and unsupported facilities and infrastructure are the four root causes of increased referrals to specialists in 2021. Furthermore, the author makes several business solutions as recommendations to control the increase in referrals to specialists, aligning with efficiency in costs. The estimated cost that can be streamlined is Rp1,185,792,688.

Keywords: Advanced Outpatient Cost, Offline Service, Referral Policy, Referrals to Specialist, Service Capacity, Telemedicine, Workload.


Ang, K., Ho, B., Mimi, O., Salmah, N., Salmiah, M. & Noridah, M. (2014). Factors influencing the role of primary care providers as gatekeepers in the Malaysian public healthcare system. Malaysian Family Physician: The Official Journal of The Academy of Family Physicians of Malaysia, 9(2).

Ekawati, F. M., Claramita, M., Hort, K., Furler, J., Licqurish, S. & Gunn, J. (2017). Patients’ experience of using primary care services in the context of indonesian universal health coverage reforms. Asia Pacific Family Medicine, 16, 1-10.

Faller Ii, K. J., Prendes, J. & Barreto, A. (2005). Platform independent implementation of 3d-sound computer interface icons for subjects with visual impairments. The 9th World Multiconference on Systemics, Cybernetics and Informatics (Wmsci 05), Orlando, Fl. Citeseer.

Hort, K., Gilbert, K., Basnayaka, P., and Annear, P. L. (2019). Strategies To Strengthen Referral from Primary Care To Secondary Care In Low- And Middle-Income Countries. World Health Organization. Regional Office for South-East Asia. Policy Brief, 6(2).

Jacobs, F. R. & Chase, R. B. (2018). Aggregate planning techniques. Operations and Supply Chain Management. (15 Ed.). New York: Mcgraw-Hill Education.

Kesehatan, Y. (2021a). (Yakes) XYZ Regional III. Data Kepesertaan Yakes XYZ Regional III Periode 2017-2021. Unpublished Manuscript.

Kesehatan, Y. (2021b). (Yakes) XYZ Regional III. Patient Visit Report 2020 - 2021. Unpublished Manuscript.

Kesehatan, Y. (2021c). (Yakes) XYZ Regional III. The Annual Claim Cost (CC) and Beban Pengobatan Pegawai (BPP) Performance Report 2020 - 2021. Unpublished Manuscript.

Kesehatan, Y. (2021d). (Yakes) XYZ Regional III. Patient Visit Report 2020 - 2021. Unpublished Manuscript.

Kim, S., Mabin, V. J. & Davies, J. (2008). The theory of constraints thinking processes: retrospect and prospect. International Journal of Operations & Production Management.

Kim, B.-S., Kim, J.-H., Park, S.-H., Seo, H.-S., Lee, H.-S. & Lee, M.-M. 2018. Effect of a respiratory training program using wind instruments on cardiopulmonary function, endurance, and quality of life of elderly women. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, 24, 5271.

Konsil Kedokteran Indonesia. (2012). Standar Kompetensi Dokter Indonesia. Jakarta Pusat, Konsil Kedokteran Indonesia.

Kushnir, T., Greenberg, D., Madjar, N., Hadari, I., Yermiahu, Y. & Bachner, Y. G. (2014). Is burnout associated with referral rates among primary care physicians in community clinics? Family Practice, 31, 44-50.

Ramadhani, S. N. (2020). Analysis of factors causing high referral rates at primary health center in the JKN era: A literature review. Media Gizi Kesmas, 9, 57-66.

Zou, K. H., Tuncali, K. & Silverman, S. G. (2003). Correlation and simple linear regression. Radiology, 227, 617-628.


Download data is not yet available.


How to Cite
Aman, A., & Basri, M. H. (2022). Analysis of the Increase in Referrals to Specialists at Yayasan Kesehatan XYZ Regional III. European Journal of Business and Management Research, 7(6), 127–136.