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

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.