“medicolegal aspect referral system in Indonesia and the overseas ”

“aspek medikolegal sistem rujukan di indonesia dan di luar negeri”

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

MSi.Med, DHM

RESIDEN PEMBIMBING :dr. Julia Ike

Disusun Oleh :UPN : 1. Afria Beny Safitri2. Maulana Wasis Waskito3. Tuti Alawiyah

TRISAKTI :4. Akbar Fadeli5. Muhammad Aries6. Nur Triastuti7. Syarfina Rosyadah

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 medical profession

• Legal 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 2012pasal 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

society

goverment

benefits

Healthcare provider

Alur Sistem

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.

Surat pengantar rujukan

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-lakitanggal lahir : 3 mei 1959 pekerjaan : pensiunan PNSalamat : jalan solo 5 semarangdengan :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 parupemeriksaan penunjang : tidak dilakukandiagnosis kerja : MCIterapi dan/atau tindakan yang telah diberikan : pemberian oksigen,infus RL, isosorbit dinitrat sublingualtujuan rujukan : untuk dilakukan pemeriksaan lebih lengkap dan penangan lebih lengkapTerimakasih.tanggal dan waktu : 16 mei 2015 pukul 13.00 WIBnama 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

From the worker to the

worker

Independent management

health insurance

Healthcare insurance system in germany

Insurance

Public insurance

Private insurance

Middle-Poor society

High class society

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.