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CHAPTER 1

PRELIMINARY

1.1 Background

Health efforts are each activity and / or a series of activities carried out in an
integrated manner, integrated and continuous to maintain and improve public
health in the form of disease prevention, health promotion, disease treatment and
health recovery by the government and / or community (Law No. 36 of 2009).

Social Security Agency (BPJS) is a public legal entity created to implement social
security programs. These include BPJS BPJS BPJS Employment and Health.
BPJS Health is a legal entity created to carry out the health insurance program.
Implementation BPJS Health began operations on January 1, 2014. The entire
Indonesian citizens must register to become a participant of health insurance is
run BPJS including foreigners who are already working in Indonesia at least six
months and had to pay a premium. Health Insurance is a guarantee in the form of
health protection so that participants get the benefit of health care and protection
in order to meet the primary health needs addressed for each participant who has
paid the premium or premiums paid by the government (Ministry of Health,
2013).

The number of participants is the national health BPJS as many as 170 213 981
inhabitants / participants that recorded in 2016. According BPJS Rule No. 4
(2014), participants were divided into two health BPJS first is people can not
afford the premiums will be borne by the government called the participants
Recipients Fee assistance (PBI) and the second is non PBI participants consisted
of participants Receiver Wages (PPU), participant not Receiver Wages (PBPU)
and not Worker premiums borne or collectively to BPJS.

Early implementation of the program JKN many experienced some constraints

such as the population there who have registered as participants, distribution of
health services is not equitable, quality health services varies, and health care is
still not optimal (BPJS Health Regulations No. 1, 2014). Problems found by the
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National Social Security Council (DJSN) ie still have a lot of complaints from the
public about the existing service system, because people do not understand and
know the appropriate service methods (Saputra, 2015).

Patient satisfaction is considered as one of the very important dimension, quality

and is one of the main indicators of the standard of a health facility which is due
to the influence of health care on the hospital side. This makes the measurement
of patient satisfaction become an important component, which is closely related
patient satisfaction with hospital marketing. Patients who are satisfied will come
back to control or require other services. So satisfying service will get more
customers (Hayaza, 2013).

A previous study done by Damayanti (2017) who studied the differences in the
level of patient satisfaction and Non BPJS BPJS on service quality registration Air
Force Central Hospital dr. S. Hardjolukito Bantul. Research shows that there are
differences in the level of patient satisfaction with the level of patient satisfaction
BPJS non BPJS on service quality in RSPAU registration dr. S. Hardjolukito
Bantul (p value = 0.000).

Research on patient satisfaction had previously been done by Kuntoro, (2017),

which examines the patient satisfaction rate on the Quality of Care in the
Outpatient Registration Place Health Center Kretek, Bantul, Yogyakarta. Research
shows 84% said they were satisfied with the services in the TPP. Dimensions that
need to be improved is the dimension Assurance on the ability of officers. Based
on the statistical test of Kruskal-Wallis and Mann-Whitney no differences in
levels of patient satisfaction with care at outpatient registration based on the
characteristics of patient education, with a value of p (sig) of 0.003.
According to research Ismawan (2009) using the four bases in the measurement of
patient satisfaction with the level of service that seen in patients BPJS not only
from the medical side, but also the administration where before getting medical
care of patients also get the services of BPJS first. This affects the satisfaction of
the patient to the hospital itself, because of its connection with the waiting time to
get service BPJS before getting medical services. Process tiered referral system
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that is being experienced after their BPJS, this also affect patient satisfaction with
BPJS itself.

Tobelo district general hospitals is one of the hospitals in North Halmahera in

North Maluku province that serve patients coming from various groups including
groups can not afford. Based on data from hospital registers show in 2017 BPJS
number of patient visits in January-December as many as 13 587 people, and the
9356 general patient data and the number of visits in 2018 in January-August as
many as 12 028 patients, with an average visit as many as 1,665 per month and an
average of 80 patients per day visit.

Based on the observations that are often seen in the registration service that is
often seen patients piled up in the place of registration, it is caused due to long
queues and lack of facilities and infrastructure available in the registration so that
sometimes patients BPJS complained of difficulty while waiting in line at a place
registration services. The hospital in this case in particular where the registration
service can determine the quality of service that is provided is good or not from
the patient through the feedback given to hospital patients, especially in places
such registration. So it can be input to improve services in the registration.

Based on the background bekang above, the researcher is interested in studying

"The difference in the level of patient satisfaction and Non BPJS BPJS against
registration services in hospitals Tobelo.

1.2 Problem Formulation

The formulation of the problem in this research is "Is there any difference in the
level of patient satisfaction and Non BPJS BPJS against registration services in
hospitals Tobelo"?

1.3 Research Objectives

The purpose of this study was to analyze the differences in the level of patient
satisfaction and Non BPJS BPJS against registration services in hospitals Tobelo
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1.3.1 General Purpose

The purpose of this study was to determine the difference in the level of patient
satisfaction and Non BPJS BPJS against registration services in hospitals Tobelo

1.3.2 Special Purpose

Specific Objectives of this research are:

1. To determine the level of patient satisfaction with the services BPJS

registration in hospitals Tobelo
2. To determine the level of patient satisfaction with the services Non BPJS
registration in hospitals Tobelo
3. To determine differences in the level of patient satisfaction and Non BPJS
BPJS against registration services in hospitals Tobelo.

1.4 Benefits of research

The expected results of this study will benefit all parties, namely:

1. For the Hospital

Hospital manager may use the results of this study as a reference material
and quality improvement of registration services, especially to people who
are not able to.

2. for researchers
This study can be made of experience and add to the knowledge of
researchers on the research process that can support the interests of the
tasks in the future
3. For further research
The results of this study can be used as a reference in the development of
further research.