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  • 學位論文

公立醫院之服務品質評估─以Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan為例

Service Quality Assessment of Public Hospitals in Indonesia: The Perspective of Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan

指導教授 : 許怡欣

摘要


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.

並列摘要


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.

參考文獻


Joint Commisssion International. (2003). Joint commission International Accreditation Standards for Hospitals (Second Edition ed.): The U.S.A: Joint Commission Resources.
Ikegami, N., Yoo, B.-K., Hashimoto, H., Matsumoto, M., Ogata, H., Babazono, A., . . . Kobayashi, Y. (2011). Japanese universal health coverage: evolution, achievements, and challenges. The Lancet, 378(9796), 1106-1115. doi: http://dx.doi.org/10.1016/S0140-6736(11)60828-3
Li, M., Lowrie, D. B., Huang, C.-Y., Lu, X.-C., Zhu, Y.-C., Wu, X.-H., . . . Lu, H.-Z. (2015). Evaluating patients' perception of service quality at hospitals in nine Chinese cities by use of the ServQual scale. Asian Pacific Journal of Tropical Biomedicine, 5(6), 497-504. doi: http://dx.doi.org/10.1016/j.apjtb.2015.02.003
Aghamolaei, T., Eftekhaari, T. E., Rafati, S., Kahnouji, K., Ahangari, S., Shahrzad, M. E., . . . Hoseini, S. H. (2014). Service quality assessment of a referral hospital in Southern Iran with SERVQUAL technique: patients’ perspective. BMC Health Services Research, 14(1), 1.
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