Abstract: It has been reported that there are some obstacles in the implementation of the National Health Insurance, one of which is its referral system.The high number of referral in public health centers indicates that the implementation of the referral system has not gone well.This study aims to evaluate theimplementation of the outpatient referral system in a public health center in the national health insurance era. This study was qualitative research with a case study approach on eightinformants selected by purposive sampling method that was conducted in Singgani Community Health Center, Central Sulawesi, as one of the communityhealth centers in Indonesia. The data was obtainedthroughobservation, in-depth interviews, and document studies. The validity test was done with source triangulation and methodological triangulation and was analyzed by using Miles and Huberman analysis model.The results showed that the input in the form of human-related to doctors, machinesrelated to medical devices, and materials-related to the availability of drugs wasnot in line with the rules. The doctor's process of deciding to refer patients did not follow the rules of 155 diagnoses of diseases and the process of implementing referrals from the communityhealth center to the hospital was not listed in the waiting room. Besides, the output of the referral system was not optimal, seen from the suitability of the referral implementation at Singgani Community Health Center, which exceeded the ratio. Thus, it can be concluded thatthe application of the outpatient referral system on nationalhealth insurance participants is still not appropriate.