臺灣博碩士論文加值系統

Background: Indonesia has embarked on a path to achieve universal coverage through the implementation of a national health insurance scheme or locally known as Jaminan Kesehatan Nasional (JKN) program since January 2014 aiming to provide affordable healthcare services to all citizens by ensuring the quality of services provided by healthcare providers. In this study, we aimed to analyze the service quality of public hospitals from the perspective of Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan who administers the implementation of the JKN program.
Methods: This cross sectional study was conducted in November 2015 to 2016 in Indonesia to assess the service quality of public hospitals (classified as class A, class B, class C, and class D) based on BPJS Kesehatan expectations and perceptions. Samples were collected using purposive sampling based on the purpose of the study and the subject’s experiences and knowledge in managing the implementation of the JKN program. The main leaders of 120 main branch offices of BPJS Kesehatan within the country were selected to participate in this study. This research was carried out using a quantitative and qualitative study design by distributing a self-administered questionnaire by email to all main branch offices and conducting interviews. The study questionnaire was the modified SERVQUAL questionnaire, consisting of 20 items in six service quality dimensions: tangibles, reliability, responsiveness, assurance, professionalism, and core medical service using a Liker scale 1-5. Non-parametric test (Wilcoxon Rank Test and Kruskal Wallis) was used to analyze the data using IBM SPSS Version 21.
Results: For BPJS Kesehatan, healthcare quality refers to service aspects that bring satisfaction to patients and meeting clinical guidelines requirements and regulations. The main leaders of BPJS Kesehatan had strong expectation to tangibles dimension as the top most important dimension to provide better services to patients followed by the reliability, core medical service, assurance, responsiveness and professionalism dimension. Their overall perceptions of quality by public hospitals were average. Service quality gaps were seen in all six dimensions of quality and the overall quality of services of the tangibles, core medical service, and professionalism dimension obviously require most attention to be improve if quality gaps between BPJS Kesehatan’s expectations and perceptions are to be closed for public hospitals (class A, class B, class C, and class D). And our findings indicate that significant differences in service quality among public hospitals (class A, class B, class C, and class D) Indonesia exist. From totally 120 samples, there were 66 of respondents (55 % responses rate) who responded to fill the questionnaire form. 47.0% or 31 of respondents were female and 53.0% or 35 were male. Most of the respondents (64.6%) attained Bachelor level of education and 44.6% graduated from Medicine school.
Conclusion: The service quality gaps between BPJS Kesehatan expectations and perceptions indicate that quality of care provided by public hospitals in Indonesia should be improved. Therefore, action must be taken to achieve the satisfaction level of patients for public hospitals under the implementation of the national health insurance scheme or the JKN program. Proper planning and effective efforts also should be implemented by all stakeholders together with BPJS Kesehatan (i.e. the Ministry of Health/Health Office and Central/ local government as policy maker, public hospitals management as providers, and professional organizations/academicians) to meet patients’ needs and expectations.

Background: Indonesia has embarked on a path to achieve universal coverage through the implementation of a national health insurance scheme or locally known as Jaminan Kesehatan Nasional (JKN) program since January 2014 aiming to provide affordable healthcare services to all citizens by ensuring the quality of services provided by healthcare providers. In this study, we aimed to analyze the service quality of public hospitals from the perspective of Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan who administers the implementation of the JKN program.
Methods: This cross sectional study was conducted in November 2015 to 2016 in Indonesia to assess the service quality of public hospitals (classified as class A, class B, class C, and class D) based on BPJS Kesehatan expectations and perceptions. Samples were collected using purposive sampling based on the purpose of the study and the subject’s experiences and knowledge in managing the implementation of the JKN program. The main leaders of 120 main branch offices of BPJS Kesehatan within the country were selected to participate in this study. This research was carried out using a quantitative and qualitative study design by distributing a self-administered questionnaire by email to all main branch offices and conducting interviews. The study questionnaire was the modified SERVQUAL questionnaire, consisting of 20 items in six service quality dimensions: tangibles, reliability, responsiveness, assurance, professionalism, and core medical service using a Liker scale 1-5. Non-parametric test (Wilcoxon Rank Test and Kruskal Wallis) was used to analyze the data using IBM SPSS Version 21.
Results: For BPJS Kesehatan, healthcare quality refers to service aspects that bring satisfaction to patients and meeting clinical guidelines requirements and regulations. The main leaders of BPJS Kesehatan had strong expectation to tangibles dimension as the top most important dimension to provide better services to patients followed by the reliability, core medical service, assurance, responsiveness and professionalism dimension. Their overall perceptions of quality by public hospitals were average. Service quality gaps were seen in all six dimensions of quality and the overall quality of services of the tangibles, core medical service, and professionalism dimension obviously require most attention to be improve if quality gaps between BPJS Kesehatan’s expectations and perceptions are to be closed for public hospitals (class A, class B, class C, and class D). And our findings indicate that significant differences in service quality among public hospitals (class A, class B, class C, and class D) Indonesia exist. From totally 120 samples, there were 66 of respondents (55 % responses rate) who responded to fill the questionnaire form. 47.0% or 31 of respondents were female and 53.0% or 35 were male. Most of the respondents (64.6%) attained Bachelor level of education and 44.6% graduated from Medicine school.
Conclusion: The service quality gaps between BPJS Kesehatan expectations and perceptions indicate that quality of care provided by public hospitals in Indonesia should be improved. Therefore, action must be taken to achieve the satisfaction level of patients for public hospitals under the implementation of the national health insurance scheme or the JKN program. Proper planning and effective efforts also should be implemented by all stakeholders together with BPJS Kesehatan (i.e. the Ministry of Health/Health Office and Central/ local government as policy maker, public hospitals management as providers, and professional organizations/academicians) to meet patients’ needs and expectations.

Acknowledgements ii
Abstract iii
Table of Contents v
Lists of Tables v
Lists of Figures v
Abbreviations vi
CHAPTER 1: INTRODUCTION 1
1.1 Background 1
1.2 Statement of Problems 4
1.3 Significance of the Study 6
1.4 Objectives of the Study 6
CHAPTER 2: LITERATURE REVIEW 7
2.1 Overview of Indonesian Healthcare System 7
2.2 The National Health Insurance System in Indonesia 10
2.3 The Social Security Agency or Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan 13
2.4 Service Quality 14
2.5 Service Quality in Healthcare 15
2.6 Measurement Issues in Healthcare Service Quality 16
2.7 Universal Health Coverage: Learning from International Experiences 23
2.8 Literature Review Summary 26
CHAPTER 3: METHODS 27
3.1 Quantitative Methods 27
3.1.1 Study Design 27
3.1.2 Study Setting 27
3.1.3 Population and Sampling 28
3.1.4 Instrument 28
3.1.5 Validity 29
3.1.6 Reliability 29
3.1.7 Conceptual Framework 30
3.1.8 Operational Definition 31
3.1.9 Hypothesis 32
3.1.10 Data Collection 32
3.1.11 Data Analysis 32
3.2 Qualitative Methods 32
3.3 Ethical Clearance 33
CHAPTER 4: RESULTS 34
4.1 Quantitative Results 34
4.1.1 Description of Samples 34
4.1.2 Demographic Distribution of Samples 36
4.1.3 Service quality expectations of respondents analysis 37
4.1.4 Service quality perceptions of respondents analysis 37
4.1.5 The difference of public hospitals in regard with the six dimensions of quality 41
4.2 Qualitative Results 55
CHAPTER 5: DISCUSSIONS 66
5.1 Hospital service quality dimensions importance score from the perspective of BPJS Kesehatan’s expectations 67
5.2 Perceived service quality of public hospitals 70
5.3 The Differences of Quality among Public Hospitals 73
5.4 Other issues regarding the service quality of public hospitals in Indonesia from the survey comments 73
5.5 Study Limitations 76
CHAPTER 6: CONCLUSIONS AND SUGGESTIONS 78
6.1 Conclusions 78
6.2 Policy Implications and Suggestions 80
REFERENCES 83
APPENDIXES 90
Appendix 1: Study Questionnaire (English Version) 90
Appendix 2: Study Questionnaire (Bahasa Indonesia Version) 97
Appendix 3: Ethical Clearance 104
Appendix 4: Study Approval Letter from BPJS Kesehatan 106
Appendix 5: Notification of Study Approval 107
Appendix 6: Content Validity Index (CVI) 108
Appendix 7: Reliability Test 114

Lists of Tables
Table 1 Premium Contribution under the National Health Insurance Scheme (JKN) 12
Table 2 Overview of authors’ dimensions of service quality in healthcare settings 21
Table 3 Healthcare Service Quality Evaluation Criteria and Criteria Group 22
Table 4 Chi-square Goodness-of-Fit (α = 0.05) 35
Table 5 Respondents Demographic Backgrounds (N = 66) 43
Table 6 The state of expectation of participants of the study 44
Table 7 The state of perception of participants of the study by hospital class A 44
Table 8 The state of perception of participants of the study by hospital class B 44
Table 9 The state of perception of participants of the study by hospital class C 45
Table 10 The state of perception of participants of the study by hospital class D 45
Table 11 Descriptive Table of Service Quality Dimensions from Respondents Expectation 46
Table 12 Descriptive Table of Service Quality Dimensions from Respondents Perception 47
Table 13 Service Quality and Gap Score (hospital class A) 49
Table 14 Service Quality and Gap Score (hospital class B) 50
Table 15 Service Quality and Gap Score (hospital class C) 51
Table 16 Service Quality and Gap Score (hospital class D) 52
Table 17 Kruskal-Wallis Test of Perception on Hospital Service Quality 55
Table 18 Kruskal-Wallis Test of Hospital Service Quality Gaps Scores 55
Table 19 Basic information about the interviewees 56
Table 20 Survey Comments Category and Frequency 63

Lists of Figures
Figure 1 Hospital Classification in Indonesia 9
Figure 2 Mechanism of the Indonesian National Health Insurance 14
Figure 3. Conceptual Framework of the Study 30
Figure 4 Hospital class A Service Quality 53
Figure 5 Hospital class B Service Quality 53
Figure 6 Hospital class C Service Quality 54
Figure 7 Hospital class D Service Quality 54

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