Faktor-Faktor Yang Berhubungan Dengan Keinginan Perpindahan Fasilitas Kesehatan Tingkat Pertama Pada Peserta JKN Mandiri Di Kota Denpasar Tahun 2017

Abstract

ABSTRAK
 Keinginan pindah fasilitas kesehatan tingkat pertama merupakan salah satu bentuk ketidakpuasan pasien serta akan berdampak pada loyalitas pasien dalam memanfaatkan pelayanan kesehatan. Pada tahun 2016, terjadi peningkatan yang signifikan pada peserta JKN Mandiri di Kota Denpasar yang melakukan perpindahan FKTP yaitu di bulan Juni sebanyak 453 orang dan menjadi 504 orang pada bulan November 2016. Berdasarkan hasil wawancara dengan pihak BPJS Kesehatan Cabang Denpasar didapatkan data mengenai keluhan peserta JKN di FKTP di Kota Denpasar meliputi pelayanan yang kurang ramah, kurang informatif, antrian panjang, penolakan pasien luar wilayah dan pasien tidak terlayani karena berobat di luar jam kerja FKTP. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan keinginan pindah FKTP pada peserta JKN Mandiri di Kota Denpasar. Desain penelitian ini menggunakan analitik crossectional dengan jumlah sampel 108 orang. Teknik pengambilan sampel dilakukan dengan cara consecutive sampling di beberapa FKTP yang bekerjasama dengan BPJS Kesehatan di Kota Denpasar. Pengumpulan data dilakukan dengan kuesioner dan dianalisis dengan analisis univariat, bivariat (chi-square) dan multivariat (regresi logistik) Berdasarkan hasil mutivariat didapatkan hasil terdapat hubungan antara ketersediaan fasilitas (p=0,005, 95% CI=2,05-56,57), waktu tunggu (p=0,000, 95% CI=5,98-233,68), jarak (p=0,000, 95% CI=3,66-51,92), pindah domisili (p=0,022, 95% CI=1,34-43,01) dan pelayanan dokter (p=0,005, 95% CI=2,02-55,32) dengan keinginan pindah FKTP, sedangkan waktu pelayanan tidak mempunyai hubungan dengan keinginan pindah FKTP (p=0,138, 95% CI=0,50-147,25). Adapun faktor yang paling dominan terhadap keinginan pindah FKTP yaitu waktu tunggu (p=0,000 dan Adjust OR= 37,38) Bagi pihak FKTP sebaiknya dapat meningkatkan kualitas mutu pelayanan yang diberikan pada peserta JKN serta bagi BPJS Kesehatan dapat meningkatkan penilaian terhadap FKTP yang bekerjasama dengannya dalam hal kredensialing dan rekredensialing FKTP.
 Kata Kunci: Perpindahan, FKTP, JKN
 
 ABSTRACT
 The desire to move first-level health facilities is one form of patient dissatisfaction and will have an impact on patient loyalty in utilizing health services. In 2016, there was a significant increase in JKN Mandiri participants in Denpasar City who moved FKTP in June as many as 453 people and became 504 people in November 2016. Based on interviews with BPJS Health Denpasar Branch data obtained about JKN participants' complaints in FKTP in Denpasar City includes services that are not friendly, less informative, long queues, rejection of patients outside the region and patients not served because of treatment outside FKTP working hours. This study aims to determine the factors associated with the desire to move FKTP on JKN Mandiri participants in Denpasar City. The design of this study used cross-sectional analytics with a sample of 108 people. The sampling technique was done by consecutive sampling in several FKTP in collaboration with BPJS Health in Denpasar City. Data collection was carried out by questionnaire and analyzed by univariate, bivariate (chi-square) and multivariate (logistic regression) analysis. Based on the results of the mutivariat, there was a correlation between the availability of facilities (p = 0.005, 95% CI = 2.05-56.57) , waiting time (p = 0,000, 95% CI = 5.98-233.68), distance (p = 0,000, 95% CI = 3.66-51.92), moving domicile (p = 0.022, 95% CI = 1.34-43.01) and doctor's service (p = 0.005, 95% CI = 2.02-55.32) with the desire to move FKTP, while the service time has no relationship with the desire to move FKTP (p = 0.138, 95 % CI = 0.50-147.25). The most dominant factor for the desire to move FKTP is the waiting time (p = 0,000 and Adjust OR = 37.38) For the FKTP it should be able to improve the quality of service provided to JKN participants and for BPJS Health can improve the assessment of FKTP in collaboration with in terms of FKTP credentialing and recruitment.
 Keywords: Displacement, FKTP, JKN

Individual Determinant Factors of Patients with Hypertension and the Utilization of Chronic Disease Management Program (Prolanis) Services in First-Level Healthcare Facilities in Pesawaran District, Lampung, Indonesia

“…Primary Healthcare Services are integrated and accessible health services managed by clinicians responsible for carrying out individual health efforts, developing ongoing relationships with patients, and carrying out their practice within the family and community of all groups of people ( 28). This study's results are similar to those of previous studies, which found a relationship between access/(geography, transportation) and service utilization (20,(29)(30)(31)(32)(33) Other research states that respondents who live in urban areas with affordable access are related to the use of Prolanis. There are accessibility gaps in visiting routines, treatment appropriateness, and disease control based on the type of FKTP and place of residence (34).…”

Reasons for switching the primary health providers among national health insurance participants in Klungkung District, Bali Province, Indonesia

“…This is in line with other studies which show that the comfort level, which consists of inadequate facilities during treatment and the lack of health human resources, is the reason for moving helath providers among independent NHI participants in Denpasar City. 11,13 This shows that the availability of human resources, facilities and capacity of service providers in the implementation of health services plays an important role as organizational goals can be implemented and health services can be carried out optimally. Primary health providers can increase their capacity including queues and waiting rooms, improve medical facilities which include examination rooms, pharmacies and basic laboratories and nonmedical facilities such as providing parking lots, maintaining physical buildings, and creating good air circulation and lighting.…”

“…The results of this study are in line with other studies which show that the failure of service interaction which includes the negative attitude of service workers who rush and convey information that is unclear is the reason for the switching of health providers among independent NHI participants in Denpasar City. 11,13 Therefore, it is important to make efforts to improve primary health providers based on the reason of sustainability of social relations, particularly by training health workers on how to communicate well, to display a friendly and polite attitude and provide appropriate information to patients which led to a sustainable positive relationship.…”

“…A previous study in Denpasar City found several factors were associated with the switching of provider among NHI participants including waiting time, facility availability, doctor services and also relocation of residential home. 11 This study aims to understand the reasons for primary health providers switching based on spatial and non-spatial aspects in NHI participants and primary health providers efforts to minimize the switching in Klungkung District.…”

Perceived importance of structural factors are associated with the selection of primary care by national health insurance participants

“…There are clinics with 51,717 participants with a ratio of 1:10,000, while there are individual practicing doctors with a very small number of only two participants. 3 Health facilities with high number of patients or unbalanced ratios have a tendency to bring about a decline in service quality, while primary care with a small number of participants will find it difficult to finance their health services. 4 A balance is required between the number of registered participants, operational adequacy and service quality through equal distribution of participant ratios throughout the primary care.…”