Analysis and Dynamic Routing Implementation of Hierarcical Healthcare Referral System

Khairurizal Alfathdyanto


Abstract—Hierarchical Healthcare Referral System (HHRS) is implemented by National Insurance Providing Agency (BPJS) as part of the healthcare insurance policies. Patients who want to get health insurance in a hospital should get a referral from the community health center in which they are registered. Congestion of patients happens in certain hospital as there is no policy implemented to govern the referral system. In this paper, HHRS is modeled as a network of queuing system and is analyzed for its queue performances. Analysis of queuing network performances shows the influence patient preferences to buildup congestion of patients in hospitals. Referral is then controlled by means of dynamic routing with considering patient preferences. Estimation of arrival rate is done with hypercube queuing theory which concerns user preference. Simulation shows that patient preferences affect the arrival rate at each hospital, the application of dynamic routing can reduce the maximum utility and reduce the average waiting time, prioritization of patients improve dynamic routing performance on systems with a high workload.

Keywords—dynamic routing; hierarchical healthcare referral system; patient priority; queueing networks;

Full Text:



Dede S. 2015, ‘Analisis Pelaksanaan Sistem Rujukan Rawat Jalan Tingkat Pertama (RJTP) pada Peserta BPJS Kesehatan di Puskesmas 5 Ilir dan Puskesmas Merdeka’, Repositori Universitas Sriwijaya.

Mengyu G., dkk. 2011, ‘Effectiveness of Referral Incentive Policy: Exploring Using Queueing Network Model with Blocking’, dalam International Conference on Service Systems and Service Management (ICSSSM), 2011, hal. 1-6.

Cayirli, T. dkk. 2006, ‘Designing Appointment Scheduling Systems for Ambulatory Care Services’, Journal of Health Care Management Sciences, no. 9, hal. 47-58.

Trivedi, K.S. 2001, Probability and Statistics with Reliability, Queuing, and Computer Science Applications, 2nd Ed, Wiley, New Jersey.

Oliver, C.I. 2011, Fundamentals of Stochastic Network, Wiley, New Jersey.

Larson, R.C. 1981, Urban Operation Research, Prentice-Hall, New Jersey.

Zhang Y., dkk., “A Performance Comparison of Adaptive and Static Load Balancing in Heterogeneous Distributed Systems,” Proc. IEEE 28th Ann. Simulation Symp., pp. 332-340, Phoenix, Ariz., April 1995.

Watts, J. dan Taylor, S. “A Practical Approach to Dynamic Load Balancing,” IEEE Trans. Parallel and Distributed Systems, vol. 9, no. 3, pp. 235-248, March 1998.

Larson, R.C. 1974, Urban Emergency Service System: An Iterative Procedure for Approximating Performance Characteristics, The Rand Institute, New York.


  • There are currently no refbacks.