| Summary: | Background: Claim ratio of membership of PT. Askes is always above 80%. This causes difficulties for the company and therefore, it needs service and cost control by the provider. The ratio of first-level outpatient referral in Banyumas (18.01%) is so high, i.e. above the referral ratio for Central Java and Yogyakarta (11.14%). The implementation of alternative-1 total capital model is that the Community Health Centers should function as gatekeepers capable of controlling the first-level outpatient service as optimum as possible. This study was aimed at finding out the factors affecting physicians in the community health centers as gatekeepers referencing the outpatients to the hospital and to find out the strength of the relationship among those factors.
Methods: This was an observational, non-experimental study using a cross-sectional approach. The location was in the area covered by PT. Askes of Banyumas regency. The total samplings were 40 community health centers. The instruments were questionnaires and the statistical analysis used step-wise multi-regression test.
Results: The step-wise regression analysis showed on capitation understanding (p=0.03), financial risk perception (p=0.047), medical needs perception (p=0.00) and the distance from the community health center to the nearest referral (p=0.187). The variable of medical needs perception was the most dominant factor affecting the referral ratio (32.5%), the second variable was capital understanding (18.3%), the third was variable of financial risk perception affecting referral ratio 5.5%, and 43.7% was affected by other variables.
Conclusions: There was significant relationship between on capitation understanding, medical needs perception, financial risk perception and referral ratio. There was no relationship between the distance of community health center and outpatient referral ratio.
Keywords: referral system, health insurance, managed care, gatekeeper, capitation
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