Patient Satisfaction of the Indonesian National Health Insurance

(JKN) Implementation: A Literature Study

Anne Anggiana

Faculty of Public Health, Universitas Airlangga, Mulyorejo, Surabaya, Indonesia

anneanggiana@gmail.com

Keywords: The Indonesian National Health Insurance (JKN), Patient satisfaction, Literature study.

Abstract: Indonesian National Health Insurance (JKN) is part of the Indonesian National Social Insurance System

(SJSN) that was implemented under the social insurance obligation mechanism. The purpose is to comply

with the public’s basic health needs. It has been three years since JKN was implemented. The road map of

JKN aims to ensure that 75% of patients are satisfied with the quality of the health facilities. The objective

of this research is to report by way of a literature study on the patient satisfaction towards the Indonesian

National Health Insurance (JKN). The secondary data was collected from BPJS Kesehatan and JKN

publications, and other relevant studies. The quantitative data was descriptively analysed to explain the

problem of the recent years’ patient satisfaction to do with The Indonesian National Health Insurance

implementation. The results showed that the level of patient satisfaction towards JKN is still lower than the

target that has been set. To determine the consumer’s expectations and perceptions of a service that is

believed to represent service quality researcher mostly used the SERVQUAL Instrument. Various factors

such as health facilities level, the type of health care, and resources also has an influence on the patient

satisfactory rating towards the implementation of JKN.

1 INTRODUCTION

Based on the UN Declaration in 1948 on Human

Rights, Article 25, paragraph (1) and the WHA

Resolution of 2005 in Geneva, it is explained that

each country needs to develop Universal Health

Coverage (UHC) through social health insurance

mechanisms to ensure sustainable health financing

(World Health Organization, 2005). In response to

this, in accordance with the 1945 Constitution of the

Republic of Indonesia, article 28H and 34 stating

that health insurance should be obtained by all

Indonesian citizens to achieve equality and justice,

Law No. 40 of 2004 of the National Social Security

System (SJSN). SJSN is intended to provide a

guarantee of the fulfillment of the basic needs of

decent living for the participants and members of

their families, including in relation to the health

aspect that is through JKN.

JKN is a form of social security in the form of

health protection, so that the participants can obtain

health care protection benefits when meeting their

basic health needs which are given to everyone who

has paid their dues. JKN's Prorgram is implemented

by a legal entity of the Social Security

Administering Body (BPJS) established as the

organiser of the national guarantee program.

JKN is nationally organised under the principles

of social insurance and equity principles. Through

the principle of social insurance, JKN membership is

mandatory for the entire population. With this

principle, it is hoped that there will be mutual

cooperation between the participant that has a

disease risk from the healthy population to the sick

population and the risk of big health expenditures

from the rich to the poor. Thus, it will support the

implementation of the equity principle (similarity in

obtaining services in accordance with the medical

needs), so that no more people encounter obstacles,

especially financial barriers, when it comes to

accessing health services.

JKN programs classifies the participants into

three categories: Beneficiaries of Contribution

(PBI), Wage Workers, and Non-Wage Workers. PBI

is a poor and inadequate group, so the contributions

are paid by the government. Wage workers are

people who work and receive regular wages such as

civil servants, military/police, and private

employees. Non-Beneficial Workers Wages are self-

employed/self-employed workers, so they must

Anggiana, A.

Patient Satisfaction of the Indonesian National Health Insurance (JKN) Implementation: A Literature Study.

In Proceedings of the 4th Annual Meeting of the Indonesian Health Economics Association (INAHEA 2017), pages 92-95

ISBN: 978-989-758-335-3

voluntarily.

Implementation of JKN or social insurance is

new for the people of Indonesia. Although the

regulation has been established since 2004 (SJSN

Act), 2011 BPJS replaces the old social security

institutions, and by 2014 BPJS is enacted, education

/ provision of information related to JKN is still

lacking. This can be seen in the tendency of people

who do not understand the flow of JKN participation

including the obligations and benefits gained. Until

now the problem has always appeared in the form of

a deficit BPJS budget. This is because residents do

not regularly pay dues and more and more citizens

who come to get free treatment.

2 METHOD

The author has used the literature study method to

analyse the patient’s satisfaction towards the

Indonesian national health insurance’s (JKN)

implementation. The objective is to know whether or

not the patients are satisfied with the implementation

of JKN by reviewing and summarising the relevant

publications and journals. Data was collected from

BPJS Kesehatan and JKN publications, and google

scholar using keyword: satisfication;

implementation; BPJS; JKN; and patient. The

quantitative data was descriptively analysed to

explain the problem of the recent years’ patient

satisfaction to do with The Indonesian National

Health Insurance implementation.

3 RESULT

Since January 1

, 2014, the JKN Program has been

officially implemented. This program is expected to

provide many changes to the health system in

Indonesia, such as financing management, health

service management, information management,

cross-sector coordination, and others. Furthermore,

the system is also expected to affect other aspects

beyond the health system itself, such as economic

aspects, business aspects, employment aspects and

wage aspects. This is in addition to the aspect of

poverty reduction and social protection and up to the

aspect of data collection and the recording of the

population.

The participants of JKN as of January 1

, 2014

are participants of the health insurance programs that

are transferred directly to the JKN program. The

health insurance program is a form of social security

provided by the government for civil servants

(Jamkesmas, Askes PNS, Health Insurance

TNI/POLRI, and JPK Jamsostek). From that

moment onwards, BPJS Health opened up

registration for every citizen who wanted to register

with JKN. BPJS Health estimates the number of

participants of JKN as of January 1

, 2014 as being

as much as 48.2% of the total population of

Indonesia, or as many as 110.4 million people.

To achieve quality and sustainable health

insurance in the National Medium-Term

Development Plan (RPJMN) 2015-2019, the

government targeted BPJS participants to increase to

cover as much as 95% of the population and for the

participants of PBI to increase to as many as 107.2

million inhabitants. Until 2016, the number of

participants increased to 50.9 million people from

January 2014. Coverage as per 2016 reached 67.6%

of the total population, out of 180 million people.

In addition to participation, to optimise the

services to the community, BPJS cooperates with

health facilities in Indonesia. By 2016, BPJS has

successfully expanded its cooperation with

approximately 25,000 healthcare facilities consisting

of 19,969 first-level health facilities (Puskesmas,

Practice physicians, and primary clinics), 1,847

hospitals, 2,813 supporting facilities (pharmacies

and optics) and others.

4 DISCUSSION

With the momentum of the changes in the BPJS

Health management positions in 2016-2021, BPJS

Health established three main focuses as a

continuous step forward for implementing the JKN

program, which is sustainable financial

management, service stabilisation, and the

optimisation of the mental health revolution. The

second focus, the stabilisation of the services, is in

order to improve the satisfaction of all pesetas. At

the beginning of 2014, the BPJS health target was

that the participants' satisfaction should reach 75%.

This target has continued to increase along with

efforts to improve the health care system. The next

target is in 2019; it is expected that the Participant

Satisfaction Index can reach 85%. According to the

data from BPJS, the achievement of participant

satisfaction in 2016 was79% of the 156.7 million

participants of BPJS. Compared to the 2014, the

achievement of JKN participants' satisfaction is

considered to have increased, which is interpreted as

Patient Satisfaction of the Indonesian National Health Insurance (JKN) Implementation: A Literature Study

being the hope of the community to continue being

in the JKN program.

Patient satisfaction in the implementation of JKN

cannot be separated from public complaints about

the services provided. The majority of complaints

are in the form of queue length or the difficulty in

getting hospitalisation. There are at least tens of

thousands of complaints related to the services

provided.

A study was conducted on the customer gaps or

inappropriate service expectations that were

obtained by patients to do with the services received

at RSAL by Dr. Ramelan Surabaya. Using these

analyses, the difference between the services that

impact on patient satisfaction can be seen

(Handini

and Chalidyanto, 2015). The majority of the patients

showed very high service expectations to do with the

BPJS services, especially in terms of communication

and empathy. According to a study on the four types

of first-rate health facilities (Puskesmas,

Government Clinic, Private Clinic, and General

Practitioner) in Denpasar City, the satisfaction level

is still lower than the JKN target of 69.59%

(Widiastuti, et al., 2015).

There is a significant correlation between

hospital service quality and patient satisfaction level

for BPJS (Putri, et al., 2014). Therefore the

improvement of good service from the indicator of

service quality, human resources, and hospital

facilities needs to be done by each health facility to

be able to increase patient satisfaction back to BPJS.

Factors that many complained about include the lack

of physical facilities and the abilities of the health

workers. At Udayana Level II Hospital, for example,

some of the third classrooms have not been equipped

with barriers so that the patients are less

comfortable.

The main factors causing patient dissatisfaction

are the lack of hospital physical facilities such as

patient seats and beds, the long service waiting time,

and poor service complaints (Larasati, 2016). It can

also be found in RSUD Panembahan Senopati

Bantul that the patient's satisfaction is less because

of the obstacles to do with the services including the

lack of human resources in the registration section,

the lack of integration of hospital information

systems, and the poor implementation of referrals

(Firdaus and Dewi, 2015). Low satisfaction levels

have also been found in Makassar. The number of

unsatisfied patients to do with hospital services is

still high, so the implementation of JKN in Makassar

is still in receipt of a lot of complaints. The main

complaints that are dirty inpatient rooms and no

explanation from the doctor or pharmacist related to

the consumption of drugs (Pasinringi, et al., 2015).

However, unlike the results of the research

conducted in hospitals, the research on patient

satisfaction at Puskesmas showed good results.

Patients who received health services at Puskesmas

were considered to be more satisfied. From the

research that was conducted, as many as 51.9%

expressed satisfaction towards the health service at

Puskesmas Tuminting Manado Gaghana, 2014). A

similar statement was found at Tegal Angus

Tangerang Community Health Centre in which the

patients were satisfied with the majority of the

services provided (Yusnita and Widianti, 2017).

This study may have several shortage considered

by limitation of author capability. The lack comes

from basic data that used. The secondary data that

used were not covering all open-sources journal

sites. Beside that obtained/used journal is chosen

merely using keyword: satisfication;

implementation; BPJS; JKN; and patient on google

scholar website.

5 CONCLUSIONS

Since it was implemented in 2014, the national

insurance system of Indonesia JKN has been

frequently criticised. This cannot be denied because

the insurance system is not widely known by the

people of Indonesia, especially people with a

middle-level income. Many complaints have been

reported either by the media or through research

studies. It is necessary to measure patient

satisfaction on the implementation of JKN as it has

been running for four years. The government itself

has implemented an 85% satisfaction target for

2019. To achieve this, it is necessary to improve and

cooperate efforts among the health services so as to

improve the quality of health services that impact on

patient satisfaction towards BPJS.

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Patient Satisfaction of the Indonesian National Health Insurance (JKN) Implementation: A Literature Study