Title : Psychiatric disorders frequently referred from first-level health facilities: An analysis of sample data from the Indonesian BPJS (social security agency) on health in 2015-2020
Abstract:
BPJS on Health in Indonesia has been operating for more than 5 years, accompanied by policies related to disease and the competence of doctors serving on the front line called first-level health facilities (fasilitas kesehatan tingkat pertama - FKTP). These policies are designed to enhance the utilization of FKTP and diminish the need for hospital referrals. However not much has been revealed about their on-site implementation. This research aims to see the availability of FKTP to treat psychiatric disorders by looking at the higher percentage of referral cases to health services in hospitals. The secondary data used was obtained from the BPJS Health data portal generally accessible. The unit of analysis is psychiatric case visits to FKTP in 2015-2020. The number of visits analyzed was 21553 visits. Data analysis used univariable, bivariable, and multivariable analysis with a significance level set at p<0.005 with the STATA 17 version statistical program. The dependent variable is a referral to a hospital, while the independent variables are the type of primary care facility, psychiatric diagnosis, and participant segmentation. The diagnoses chosen for analysis focus on dementia, insomnia, somatoform, depression, mixed anxiety depression, and schizophrenia given these five disorders that are frequently found in health facilities in Indonesia. The results of the analysis showed that the psychiatric disorders in association with referral were dementia with adj odds ratio ((adj OR) = 3,911, 95%CI 2,170-7.046, p=0.001); depression (adj OR =2,066.95%CI 1,737-2,457, p=0.001) and mixed anxiety depression disorder (adj OR =1,526, 95%CI 1,333-1,747, p=0.001). More patients were referred from independent private clinics (adj OR =3,150, 95%CI 2,847-3,486, p=0.001) and doctors' practices (adj OR =1,894, 95%CI 1,719-2,087, p=0.001). Doctors had not fully implemented the referral system policy set by the government in which depression should be treated in primary facilities, while somatoforms that should be referred do not appear to be associated with the referral. The results of this research can be used to improve policies regarding the doctors' competence level in handling psychiatric cases.
Audience Take Away:
- The results of this study describe the implementation of psychiatric patient referrals in correlation with National Health Insurance policy.
- The capacity of first-level health facilities to manage patients with psychiatric disorders varies, especially between government-owned health centers, private clinics and independent doctor's practices. Private clinics and independent doctor’s practices tend to refer more patients to hospitals. The full implementation of the referral policy was not achieved.
- The results of this research may be used to improve health system policies.
