Factors Related of Changing First Level Health Facilities (FKTP)
on JKN Mandiri Participants in Denpasar City
Iwan Abdi Suandana, Putu Ayu Indrayathi, Pande Putu Januraga
School Of Public Health, Medical Faculty, Udayana University, P.B. Sudirman, Kampus Sudirman, Denpasar,
Indonesia
Keywords: Factors, Changing, FKTP, JKN Mandiri, Denpasar.
Abstract: The desire to change first health level facilities (FKTP) is a form of patients dissatisfaction and will be a
step on the loyalty of patients in utilizing health services. In 2016, there was a significant increased of
participants JKN Mandiri who made the change FKTP on June is 453 peoples to become 504 peoples on
November in 2016. Based on interviews with BPJS Kesehatan Denpasar obtained data regarding the
complaints of JKN participants in Denpasar City include services that are less friendly, less informative,
long queues, rejection of patients outside the region and unserved patients for treatment outside working
hours FKTP. The purpose of this study is to know factors related of changing FKTP on JKN Mandiri
participants in Denpasar City. The design of this study used crossectional analytic with sample size is 108
peoples. The sampling technique was done by consecutive sampling at several FKTP in cooperation with
BPJS Kesehatan in Denpasar City. The data was collected by questioner and analyzed by univariate,
bivariate (chi-square) and multivariate (regresi logistic). Based on the result of mutivariate, there was a
correlation between facility availability (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), moved residential (p = 0,022, 95% CI = 1,34-
43,01) and service of doctor (p=0,005, 95% CI=2,02-55,32) with the intention to change FKTP. While the
most dominant factor on the desire change FKTP is waiting time (p = 0,000 and Adjusted OR = 37.38)
. For
the FKTP side, it is better to improve the quality of service provided to JKN participants and for BPJS
Kesehatan can increase the assessment of FKTP which cooperate with it in terms of FKTP credentialing and
recredensialing.
1 INTRODUCTION
The First Level Health Facility (FKTP) is a facility
that provides primary health care for JKN
participants, including Puskesmas, Doctor Practice,
Dental Practice, Primary Clinic, and Class D
Pratama Hospital. First-Level Health Facility
(FKTP) will be used by JKN participants to conduct
first-time treatment
(BPJS Kesehatan. 2014). BPJS
Kesehatan also facilitates for JKN participants who
wish to change FKTP, with a minimum requirement
of having to walk 3 months since registered in
previous health facility. With the existence of these
rules, in fact many JKN participants who want to
changing FKTP.
Based on the data of BPJS Kesehatan Denpasar
participants who perform changing FKTP more
dominated by participants JKN Mandiri. According
to data from BPJS Kesehatan Denpasar there was a
significant increase of participants JKN Mandiri in
Denpasar City who made the changing FKTP in
June as many as 453 people and become 504 people
in November 2016
(BPJS Kesehatan Denpasar,
2016). This situation indicates lack of quality of
service provide by FKTP that impact on satisfaction
of JKN patient. Based on interviews with BPJS
Kesehatan Denpasar, JKN participants in the
Denpasar City mostly complained about services
that are less friendly, less informative, long queues,
rejection of patients outside the region and unserved
patients for treatment outside FKTP working hours.
This is an indication of problems in satisfaction of
JKN patient.
Research by Widiastuti (2015) also states that
there is a significant relationship on the type of
FKTP selected with the satisfaction of JKN patients.
Dissatisfaction of patients or communities in using
health services tends to lead to non-compliance of
patients in treatment activities, not following advice
314
Suandana, I., Indrayathi, P. and Januraga, P.
Factors Related of Changing First Level Health Facilities (FKTP) on JKN Mandiri Participants in Denpasar City.
In Proceedings of the 4th Annual Meeting of the Indonesian Health Economics Association (INAHEA 2017), pages 314-318
ISBN: 978-989-758-335-3
Copyright © 2018 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved

and moving to other FKTP
(Pohan, 2006). From
preliminary study by interviewing 50 JKN
participants who had been changing FKTP in BPJS
Kesehatan Denpasar found that, there are several
factors influencing FKTP movement such as:
distance to FKTP, doctor service at FKTP, facility
available at FKTP, service time in FKTP, waiting
time to get service at FKTP, and moved residential.
The purpose of this study is to determine the factors
associated with the desire to change FKTP on
participants JKN Mandiri in Denpasar City.
2 METHODS
This study is a quantitative analytical research with
cross-sectional design. This study was conducted for
3 months (March-May 2017) in Denpasar City. This
study using non probability sampling with
consecutive sampling technique. Sample were
selected from 8 FKTP with 108 samples. The
inclusion criteria for study participant included JKN
Mandiri 1) participants registered in FKTP BPJS
Kesehatan Denpasar and at least have been visit
FKTP for 1 time 2) Aged at least 17 years old and 3)
able communicate and willing to be a respondent.
The data was collected by questioner and analyzed
by univariate, bivariate (chi-square) and multivariate
(regresi logistic). The research had been approved
by the ethical commission with ethical clearance
number 834/UN.14.2/KEP/2017 from Research
Ethical Commission Udayana University Medicine
Faculty/Sanglah Hospital, Denpasar
3 RESULTS
3.1 Respondent’s Characteristic
Figure 1: Respondent’s Characteristics
Characteristic description of respondents based
on the desire to change FKTP is done by using
crosstab between dependent variable (age,
education, and occupation) with the desire to change
FKTP. The results show more respondents want to
change FKTP dominately by respondents aged 17-
37 years (41,67%), high education (≥SMA) and
working participant with percentage respectively
(37,93%) and (39.39%).
3.2 Result Of Bivariate Analysis Factors
Related with Desire to Change
FKTP on JKN Mandiri Participants
in Denpasar City (n=108)
Figure 2: Bivariate Analysis Result
Result of bivariate analysis using chi square
there are 6 variables that have a significant
relationship (p <0.05) with changing FKTP namely
facility availability (p=0,0242, 95% CI=1,96-19,2,
Crude OR=4), doctor services (p=0,0043, 95%
CI=1,37-24,8, Crude OR=5,33) service time
(p=0,0157, 95% CI=1,55-13,78, Crude OR=2,42),
waiting time (p=0,0000, 95% CI=3,1- 150,2, Crude
OR=15,88) , distance (p=0,0000, 95% CI=2,93-27,5,
Crude OR=8,71) , and moved residential (p=0,0006,
95% CI=1,93-48,2, Crude OR=8,21)
Factors Related of Changing First Level Health Facilities (FKTP) on JKN Mandiri Participants in Denpasar City
315

3.3 Final Model Result of Multivariate
Analysis Factors Related with Desire
to Change FKTP on JKN Mandiri
Participants in Denpasar City
(n=108)
Figure 3: Final Model Result
Multivariate test with logistic regression showed
that five variables which be significantly related to
the desire of change FKTP are facility availability (p
= 0,005, 95% CI = 2,05-56,57, Adjusted OR=10,78),
waiting time (p = 0,000, 95% CI = 5,98-233,68,
Adjusted OR=37,38), distance (p = 0,000, 95% CI
=3,66-51,92, Adjusted OR=13,78), moved
residential (p = 0,022, 95% CI = 1,34-43,01,
Adjusted OR=7,60) service of doctor (p=0,005,
95% CI=2,02-55,32, Adjusted OR= 10,56) with the
intention to change FKTP. The waiting time variable
has a chance of 37.38 times higher than the other
variable Adjusted OR = 37,38 (95% CI: 5,98-
233,68). Statistically predictable, waiting time is the
most dominant variable affecting the willingness of
changing FKTP on JKN Mandiri participants in
Denpasar City
4 DISCUSSION
4.1 Description Desire to Change FKTP
Based on Socio demography
Result of research indicate as much (37,04%)
respondent want to change FKTP and based on socio
demographic characteristics, respondents who want
to change FKTP more dominantly by respondents
aged 17-37 years (41,67%), high education (≥SMA)
and working participant with percentage respectively
(37,93%) and (39.39%). This is in accordance with
research conducted by Indriyani (2013) which states
adult age (> 40 years) tend to be more loyal in
utilizing health services in a health service.
Conversely, younger people (≤ 40 years old) tend to
be less loyal to utilize health services and want to
seek new health services
(Indryani, 2013).
The results of this study are also in line with
research Khudhori (2012) which states the higher the
client's education, the level of satisfaction and
loyalty in utilizing health services is lower and tend
to want to seek new health services
(Khudhori,
2012). This is well-founded, because usually a low-
educated client does not have too high expectations
of others. Conversely, a highly educated person
usually has high expectations of others over him.
While in terms of work, clients who are already
working tend to be less loyal to health services
provided and want to seek new health services. This
is because they already have income and they tend to
prefer to seek health services more optimal without
taking into account the cost
(Khudhori, 2012).
4.2 Relationship of Facility Availability
with the Desire to Change FKTP
Research indicate that there is significant correlation
between facility availability in FKTP with the desire
to change FKTP. This research finding in line with
research by Indryani (2013) which states the facility
availability has a relationship with the loyalty of
antenatal care patients at Puri Cinere Hospital
(Indryani, 2013). Incomplete availability of facilities
in a health service, so the fewer people who want to
use health services and have an impact with the
desire to seek other health services.
In JKN era the application of credentialing at
present it is quite difficult, especially in meeting the
requirements indicators as they relate to large
budgets in completing tools and facilities, while the
amount of capitation they will receive is not worth
the cost they spend to provide it complete facilities,
so some FKTP that do not have complete facilities
this makes some respondents prefer to move to
FKTP which has complete facilities (Ulandari &
Indrayathi, 2016).
4.3 Relationship of Doctor's Service with
the Desire to Change FKTP
From result of research indicate there is significant
relation between doctor service at FKTP with desire
to change FKTP. The results of this study are in line
with Hanif's (2011) theories which states that
doctors have a very important role in the process of
health services both treatment, healing, and health
care of patients, so the better the patient's perception
of the doctor, the better the impact on patient health
INAHEA 2017 - 4th Annual Meeting of the Indonesian Health Economics Association
316

and utilization of health services. Where the better
the doctor's service then the possibility of patients
will return again to treatment at the doctor, and the
less good the doctor's service then the possibility of
patients want to find a new doctor
(Hanif, 2011).
4.4 Relationship of Service Time with the
Desire to Change FKTP
Research indicate that there is no relation between
service time in FKTP with the desire to change
FKTP. Further research conducted by Dinik (2008)
also shows that there is correlation between
suitability of service schedule in Bringin District
Health Center of Semarang with level of patient
satisfaction which progressively according to service
schedule hence more high level of patient
satisfaction
(Dinik, 2008). This level of patient
satisfaction will lead to loyalty of patients in
utilizing health services, where patients will tend to
reuse health services if the promised service
schedule in accordance with their working time and
if the service schedule is less appropriate then
patients prefer to seek new health services
(Dinik,
2008).
Based on the result of the research, the service
time in FKTP shows that 94.44% is in accordance
with the work schedule. This means that most
participants are satisfied with the service time in
FKTP. This is why there is no relationship between
time of service with the desire to change FKTP.
4.5 Relationship of Waiting Time with
the Desire to Change FKTP
Research indicate that waiting time has significant
relationship and become the most dominant factor
with the desire to change FKTP. The results of this
study are in line with research conducted by
Bambang (2011) which mentions the waiting time
has a strong relationship with patient family
satisfaction and impact on loyalty of patients in
utilizing health services.
Based on the research (Aisyah, 2015) mentioned
that long waiting time in health service is due to
high number of patient visits, lack of officers at
registration booths, limited space available, and also
due to lack of medical personnel (doctors, midwives,
nurses) to service patients who come. Where if the
waiting time to get medical services quickly then
patients will tend to re-utilize the FKTP and if the
time to get medical services too long, then the
patient will likely have a desire to seek new health
services.
4.6 Relationship Distance with the Desire
to Change FKTP
The results of the analysis test also shows that there
is a significant relationship between the distance to
FKTP with the desire to change FKTP. The results
of this study are in line with research conducted
Meylanie (2010) which states that there is a
significant relationship between access to health
facilities with the selection of health service.
The farther the geographical location of the
FKTP is from residence, the more respondents who
want to change FKTP and the closer the
geographical location of the FKTP from the
residence causes the fewer who want to change
FKTP. This is what makes distance is one of the
important considerations in choosing health services
and the emergence of the desire to change FKTP if
the health facilities far from residence.
4.7 Relationship Moved Residential with
the Desire to Change FKTP
The result of the analysis also shows that there is a
significant correlation between moving residential
with the desire to change FKTP. At the time of the
survey, it was because there were still many
participants of JKN Mandiri in Denpasar City where
their residence was not permanent, they moved due
to work, lecture / school, and had a new house. This
is what makes them have the desire to get health
care insurance in a new residence. Based on research
Rahmad (2016) also shows patients who have
moved residence tend to choose health services close
to his new residence. This is what causes a
significant relationship between ever moved
residential with the desire to change FKTP on the
participants JKN Mandiri in the city of Denpasar.
As for the limitations of this study are On the
questionnaire, the answer to the question of
availability of facilities and distance, the respondent
can not predict exactly the availability of facilities in
his FKTP and distance from residential address to
FKTP. So there are some respondents can only give
answers in accordance with its estimates.
There are several limitations to this study. Some of
the respondents can not predict exactly the distance
from their residential address to the health facilities
(FKTP). It might affect the results of the study due
to respondents bias. Moreover, respondents do not
really know what is the requirement of facilities in
FKTP so the answer really based on their
Factors Related of Changing First Level Health Facilities (FKTP) on JKN Mandiri Participants in Denpasar City
317

subjectivity not the standard of credentialing from
BPJS Kesehatan.
5 CONCLUSIONS
Most respondents (37.04%) want to change FKTP
and there is a relationship between the availability of
facilities in FKTP, waiting time at FKTP, distance to
FKTP, doctor service at FKTP and move domicile
with the desire to change FKTP. The most dominant
factor is the waiting time, so that for FKTP can
improve the quality of service provided to the JKN
participants such as conducting training to medical
personnel, increasing human resources, especially
medical personnel and improving facilities and
infrastructure, and for BPJS Kesehatan can improve
FKTP assessment which cooperated with it in
credentialing and recredensialing of FKTP.
BPJS Kesehatan can also immediately apply
Presidential Regulation No. 19 of 2016 article 29
reaffirmed on BPJS Regulation No. 1 of 2017
concerning Equitable of Participants in First Level
Health Facilities so that the number of registered
participants in each FKTP can be evenly distributed
to overcome waiting time to get service in the old
FKTP.
ACKNOWLEDGMENTS
Acknowledgments delivered to all parties who have
helped smooth the process of this research, whether
in the form of technical support, motivation and
support to complete this research
REFERENCES
Aisyah. 2015. Pengaruh Waktu tunggu Pasien di Tempat
Pendaftaran Pasien Rawat Jalan Terhadap Tingkat
Kepuasan Pasien di RSUD DR.R.M Djoelham Binjal
Tahun 2016. Akademi Perekam Medik dan Informasi
Kesehatan (Apikes) Imelda Meda
Bambang. 2011. Kepuasan Keluarga Pasien Terhadap
Waktu Tunggu Pelayanan di Instalasi Rawat Jalan
Rumah Sakit Jiwa Propinsi Kalimantan Barat. Tesis.
Uiniveritas Gadjah Mada
BPJS Kesehatan. 2014. Alur Kerja BPJS Kesehatan tahun
2014. Jakarta
BPJS Kesehatan Cabang Denpasar. (2016). Laporan
Mapping, Kunjungan, Rujuk Kantor Cabang
Denpasar Bulan November Tahun 2016. Denpasar
Dinik, Retnowati. (2008). Kualitas Pelayanan Kesehatan
di Puskesmas Bringin Kabupaten Semarang. Skripsi.
Fakultas Ilmu Sosial dan Ilmu Politik. Universitas
Diponegoro
Hanif, Mufriady Akmal. 2011. Analisis Tingkat
Permintaan Pasien terhadap Pelayanan Rawat Jalan di
Poliklinik Penyakit Dalam RSUP Dr. M Djamil
Padang Tahun 2011. Thesis. Program Studi Kajian
Rumah Sakit. Prgram Pasca Sarjana, Fakultas
Kesehatan Masyarakat Universitas Indonesia
Indryani. (2013). Analisis Faktor- faktor yang
Berhubungan Dengan Utilisasi Pelayanan Rumah
Sakit Puri Cinere Tahun 2013. Fakultas Kedokteran
Islam Negeri Syarif Hidayatullah Jakarta
Khudhori. 2012. Analisis Faktor- faktor yang
Mempengaruhi Keputusan Pemilihan Tempat
Persalinan Poliklinik Kandungan dan Kebidanan
Rumah Sakit IMC Bintaro Tahun 2012. Tesis Program
Studi Kesehatan Masyarakat. Universitas Indonesia
Meylani,d.r. (2010). Faktor-Faktor yang Berhubungan
dengan Pemilihan Tenaga Penolong Persalinan di
Wilayah Kerja Puskesmas Jelbuk Kabupaten Jember
Tahun 2010. Skripsi. FKM UI
Pohan, I., 2006. Jaminan Mutu Layanan Kesehatan
Dasar-dasar Pengertian dan Penerapan, Jakarta: EG
Rahmad, Ridwan. (2016). Faktor Yang Berhubungan
Dengan Pemilihan Fasilitas Kesehatan Tingkat
Pertama Pada Peserta Non Pnerima Bantuan Iuran di
Wilayah Kerja Puskesmas Lima Kaum I Kabupaten
Tanah Datar Tahun 2016. Diploma thesis, Universitas
Andalas
Ulandari, LPS & Indrayathi, PA. (2016). The
Implementation of Credentialing for First-Level
Health Facilities of Badan Penyelenggara Jaminan
Sosial (BPJS)
Kesehatan Denpasar. Public Health of Udayana
University. Kemas:Jurnal Kesehatan Masyarakat
12(1)(2016) ,150-156
Widiastuti, M. (2015). Hubungan Jenis Fasilitas
Kesehatan Tingkat Pertama, Status Kepesertaan Dan
Karakteristik Sosio Demografis Dengan Tingkat
Kepuasan Pasien JKN Di Kota Denpasar. Program
Pascasarjana Universitas Udayana Denpasar 2015.
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