medicolegal aspect referral system in

Indonesia and the overseas

aspek medikolegal sistem rujukan
di indonesia dan di luar negeri
Disusun Oleh :
UPN :
1. Afria Beny Safitri
2. Maulana Wasis Waskito
3. Tuti Alawiyah
TRISAKTI :
4. Akbar Fadeli
5. Muhammad Aries
6. Nur Triastuti
7. Syarfina Rosyadah

DOSEN PENGUJI :
dr. Arief Rahman Sadad,
Sp.F, SH, MSi.Med, DHM

RESIDEN PEMBIMBING :
dr. Julia Ike

Background
- According to constitution of indonesia,
healthcare is one of the basic rights to all people.
- Healthcare distribution in indonesia has not
very well distributed so it will become a massive
problem to us to providing healthcare for people.
It shown that a grade A,B and C hospitals are just
built in big city.
- For this problems, the government built a
system to solve this problem called a referral
system. This systems work to sending patient
from the primary healthcare to secondary or third
healthcare provider.

Learning issue
Definition of medicolegal aspect??
Definition of delivery patient, the systems
that work on it and the legal basis for referral
systems??
Type of the delivery systems and the legal
basis of it?
How the delivery patients work ?
How referral looks like??
What we can use for reference to deliver the
patients as a GP ??

Definition
medic
Legal

medical profession
law

Medicolegal : standard procedure

that set how medicals profession can
be work on law.

Definition
Referral system is a system that
work how to send patients from the
primary health care to a higher
healthcare provider ( the vertical
ways) or the same levels of
healthcare provider (the horizontal
ways).

Permenkes no 001 tahun 2012

pasal 4
1) Pelayanan kesehatan dilaksanakan secara berjenjang, sesuai
kebutuhan medis dimulaidari pelayanan kesehatan tingkat
pertama.
2) Pelayanan kesehatan tingkat kedua hanya dapat diberikan
atas rujukandari pelayanan kesehatan tingkat pertama.
3) Pelayanan kesehatan tingkat ketiga hanya dapat diberikan
atas rujukan dari pelayanan kesehatan tingkat kedua atau
tingkat pertama.
4) Bidan dan perawat hanya dapat melakukan rujukan ke dokter
dan/atau dokter gigi pemberi pelayanan kesehatan tingkat
pertama.
5) Ketentuan sebagaimana dimaksud pada ayat (1), ayat (2),
ayat (3), dan ayat(4)dikecualikan pada keadaan gawat
darurat, bencana, kekhususan permasalahan kesehatan
pasien, dan pertimbangan geografis.

Type of the referral systems

Medical referral systems : a systems can used as
a horizontal or vertical ways for a curing or
rehabilitation reasons.
Health referral systems : a systems can used as
a horinzontal or vertical ways for improvement
of health or preventing disease reasons.
Those systems has been written on PermenkesRI
Nomor 001 Tahun 2012 pasal 7,8,9, dan 10.
Internal referral system
External referral system

goverm
ent
benefits

society
Healthca
re
provider

Alur
Sistem
Rujuka
n

Surat pengantar
rujukan
Peraturan Menteri Kesehatan RI Nomor 001 Tahun 2012
Tentang Sistem Rujukan Pelayanan Kesehatan Perorangan
Pasal 15
Surat pengantar rujukan sebagaimana dimaksud dalam
Pasal 13 huruf sekurang-kurangnya memuat :
(a)Identitas pasien;
(b)Hasil pemeriksaan (anamnesis, pemeriksaan fisik dan
pemeriksaanpenunjang) yang telah dilakukan;
(c)Diagnosis kerja;
(d)terapi dan/atau tindakan yang telah diberikan;
(e)Tujuan rujukan; dan
(f) nama dan tanda tangan tenaga kesehatan yang
memberikan pelayanan.

Reference for GP to make a

referral
Personal patients health issues
diagnostic reasons
Specimens
Knowledge

Community patients health issues

KLINIKPRATAMA ..................................................................................................
Alamat ...................................................................................
______________________________________________________________________________________________
SURAT
PENGANTAR RUJUKAN
Nomer : .........................
Kepada Yth.
................................................
................................................
Dengan ini kami mengirimkan pasien :
Nama : Tn. Anmar jenis kelamin : Laki-laki
tanggal lahir : 3 mei 1959
pekerjaan
: pensiunan PNS
alamat : jalan solo 5 semarang
dengan :
anamnesis : keluhan utama :nyeri menjalar ke leher, muntah (+)
pemeriksaan fisik : TD : 160/100 mmHg, N: 100x/permenit, RR: 26x/menit tidak di temukan kelianan pada
jantung dan paru
pemeriksaan penunjang : tidak dilakukan
diagnosis kerja: MCI
terapi dan/atau tindakan yang telah diberikan : pemberian oksigen,infus RL, isosorbit dinitrat sublingual
tujuan rujukan : untuk dilakukan pemeriksaan lebih lengkap dan penangan lebih lengkap
Terimakasih.
tanggal dan waktu : 16 mei 2015 pukul 13.00 WIB
nama dan tanda tangan tenaga kesehatan ...............................................................................
Catatan :
Rujukan telah mendapatkan Persetujuan dari pasien dan/atau keluarganya.
Persetujuan diberikan setelah pasien dan/atau keluarganya mendapatkan Penjelasan, meliputi: diagnosis dan
terapi dan/atau tindakan medis yang diperlukan; alasan dan tujuan dilakukan rujukan; risiko yang dapat timbul
apabila rujukan tidak dilakukan; ransportasi rujukan; danrisiko atau penyulit yang dapat timbul selama dalam
perjalanan.

MALAYSIA

Gambar sistem kesehatan tersier

Diagram healthcare system in Malaysia

REFERRAL SYSTEM IN
MALAYSIA

Germany healthcare system

Germany is one of the nation that
supporting health insurance. With
this systems they believe all
germanies will be get a good health
services and they can built a good
quality of life.
Fee for
health
services for
all the
workers

Independen
t
managemen
t health
insurance

From the
worker to
the worker

Healthcare insurance system in

germany
Public
insurance

Middle-Poor
society

Private
insurance

High class
society

Insurance

Healthcare provider

Referral system

none

All citizens can come to

healthcare services

Healthcare system in
indonesia,malaysia and germany
Subject

Indonesia

Malaysia

Germany

Referral system

Step by step

Step by step
with additional
cost.

none

Operational
hour

limitless

limitless

40 hours per 5
days

Work place for

doctor

3 places

1 place

1 place

Medication

Free

Free

< 18 years old

are free for
public health
insurance

Conclusion
Medicolegal is standard procedure
that set how medicals profession can
be work on law.
in Indonesia referral systems has
been set on permenkes no.001 tahun
2012 pasal 4.
Referral letter should be including
patient ID, examination that has
been done, WD, and medical
treatment.

Suggestion
Government should be considerate
medical aspect especially facility and
medical resources for a better health
services.
The medical employer should be
understanding the referral systems
and knows when to send the patient
beyond their capability.