Akbar et al./ The Influence of Personal Factors of the Patient, Doctor, Payment Method

The Influence of Personal Factors of the Patient, Doctor, Payment Method and Type of Class to the Quality and Satisfaction of Inpatient Care Services in Dr. Hospital Surakarta

Prima Soultoni Akbar 1), Rita Benya Adriani 2), Bhisma Murti 1)

1)Masters Program of Public Health, Sebelas Maret University, Surakarta 2)School of Health Polytechnics, Surakarta

ABSTRACT

Background: The quality of hospital care is an important element in the implementation of healthcare service. The quality which is perceived is an assessment and a form of evaluation of healthcare users. Improvement on healthcare service is continually conducted to enhance the quality of service and patients‘ satisfaction. The study aimed to explain the influence of patients‘ personal factors, doctors, payment methods and types of class toward the quality and satisfaction of inpatient care. Subjects and Methods: This was an analytic observational study with cross-sectional design. This study was conducted at Dr. Moewardi Hospital, Surakarta, from March to April 2017. A total of 144 subjects were selected by stratified random sampling. Exogenous variables in this study were family income, level of education, length of stay, doctor‘s salary, the surgeon, type of insurance, and type of class. Endogenous variables were patient‘s satisfaction and quality of service. The data were collected by a set of questionnaires and secondary data of doctor‘s working period and salary. Data analyzed by path analysis. Results: Patient‘s satisfaction were affected by family income (b=-0.08; SE=0.48; p=0.093), level of education (b=-0.44; SE= 0.27; p= 0.102), length of stay (b=0.19; SE=0.99; p=0.059), doctor‘s salary (b= 0.02; SE=0.01; p=0.060), doctor's working period (b=0.99; SE=0.44; p=0.024), type of insurance (b= 0.72; SE=0.32; p=0.027), type of class (b= 2.11; SE=0.38; p<0.001), and quality of health services (b=0.16; SE=0.51; p=0.002). Quality of health services were affected by family income (b=-0.15; SE=0.07; p=0.039), length of stay (b=0.37; SE=0.15; p=0.017), doctor's working period (b= 0.13; SE=0.68; p=0.056), insurance types (b= 1.04; SE=0.50; p= 0.036), and type of class (b=2.24; SE=0.59; p<0.001). Conclusion: Patient‘s satisfaction are affected by family income, level of education, length of stay, doctor‘s salary, doctor's working period, type of insurance, type of class and quality of health services. Quality of health services are affected by family income, length of stay, doctor‘s working period, insurance types, and type of class.

Keywords: quality of health services, patient‘s satisfaction

Correspondence: Prima Soultoni Akbar. Masters Program of Public Health, Sebelas Maret University, Surakarta. Email: [email protected]. Mobile: +6285258777994.

BACKGROUND kes RI, 2016). Healthcare system is benefi- Health system is an important matter with- cial to fulfill the needs of healthcare of indi- in a country. National Healthcare System is vidual, family, group, and community. The a management of healthcare organized by purpose of healthcare system is to establish all components of the nation in integrated good healthcare service, responsive toward and inter dependent manner in order to communities‘ expectation and owns equi- ensure the accomplishment of community table financial contribution (WHO, 2009). health status as high as possible (Permen- e-ISSN: 2549-0281 (Online) 1 Journal of Health Policy and Management (2017), 2(1): 1-15 https://doi.org/10.26911/thejhpm.2017.02.01.01

Improvements in healthcare service ments availability, and the completeness of are recurrently conducted to increase the medicines needed (Andaleeb et al., 2007). quality of service and patient‘s satisfaction. Knowledge, skills and good manner of Patients‘ satisfaction is positively associated healthcare workers give the sense of con- with the quality assessment of a healthcare vinced on assurance to the patients. The service (Anjaryani, 2009) assurance can be in a form of healthcare Hospital is one form of public health- workers who are competent in diagnosing, care service that should improve its service interpreting the result of examination. The toward excellent service. Excellent service sense of assurance may generate patients‘ is a service that give good even the best satisfaction. The bigger patients‘ conviction service based on customer oriented or cus- toward the assurance is, the higher pa- tomer focus (Irawati and Primadha, 2008; tients‘ satisfaction will be (Andaleeb et al., Nurfauzi, 2013). To give excellent service 2007). means it is not allowed to conduct any form Good tangibility of physical facilities of discrimination (discrimination based on such as equipments, hospitals‘ occupational ethnic group, race, group, religion, social hygienists, toilets, examination rooms, status, payment method and others (Si- wards, and beds may influence patients‘ nambela, 2006). Along with the improving impression toward the hospital. The better condition of civil society, the people aware- tangibility of healthcare service facilities ness toward healthcare service quality is and providers is, the higher patients‘ satis- also improving (Faizin et al., 2015). faction will be (Andaleeb et al., 2007).

According to the result of previous Empathy and understanding of health- studies, in developing countries, patients‘ care workers on patients‘ problem and satisfaction is used as the yardstick of needs can intensely influence patients‘ sa- healthcare service quality. The consequence tisfaction. Personal care and psychological of patients‘ dissatisfaction toward health- support reflect the empathy service of care service among others are: not follow- healthcare service providers. The bigger ing the medical procedures well, not con- empathy obtained by the patients is, the ducting follow-up examination, and even bigger patients‘ satisfaction will be (Anda- emerging negative rumors that influence leeb et al., 2007). users of the healthcare service. Healthcare In addition to service factors, cost of service which is oriented to doctors‘ per- care is another factor that influences pa- sonal factors is discovered to have strong tients‘ satisfaction. Based on the result of influence toward patients‘ satisfaction at some studies in developing countries, cost the hospital (Andaleeb et al., 2007). is one of considerations in looking for

Factors which influence patients‘ satis- healthcare service, moreover, for low in- faction, among others are: reliability, assu- come patients. Healthcare service cost in rance, responsiveness, tangibility of physic- this matter includes cost for consultation, al service and empathy. Reliability refers to laboratory tests, medicines and accommo- the ability of healthcare service providers to dation. Some countries even have provided give reliable and accurate services. Respon- primary healthcare service for free through siveness means that health workers is res- the existence of health insurance system. ponsive to patients‘ needs, accuracy in diag- The description shows that patients‘ per- nosing patients, the condition of instru- ception toward expensive cost for health-

2 e-ISSN: 2549-0257 (Online) Akbar et al./ The Influence of Personal Factors of the Patient, Doctor, Payment Method care service may decline patients‘ satis- Endogenous variables were healthcare ser- faction (Andaleeb et al., 2007). vice quality and patients‘ satisfaction. The study aimed to analyze the influ- The quality of care was evaluated ence of patients‘ personal factors, doctors, based on patients‘ personal factors, doctors‘ payment method and types of class toward personal factors, payment method and hos- the quality and satisfaction of inpatient care pital types of class. Patients‘ personal factor in RSUD Dr. Moewardi, Surakarta. was evaluated from level of education, fa- mily income, and length of stay. Doctors‘ SUBJECTS AND METHODS personal factors include doctor‘s working 1. Research Design period, and doctors‘ salary. Patients‘ pay- The type of the study was analytic obser- ment method to hospital was evaluated vational with cross sectional design. The based on patients‘ insurance status that con- study was conducted from March to April sists of non insurance, Self-reliance Nation- 2007 in RSUD Dr. Moewardi, Surakarta. al Healthcare Security (BPJS Mandiri), Na- 2. Population and Sample tional Healthcare Security for Company The subject of the study were patients of (BPJS Perusahaan) and Aid Recipient (PBI) inpatient ward with type of class I, II, III of 4. Data Analysis RSUD Dr. Moewardi, Surakarta. The inclu- Data of service quality and patients‘ satis- sion criteria of the study was inpatient care faction were collected using questionnaires. patients who are older than 17 years old. A reliability test was conducted on the There were a total of 144 subjects of the questionnaires to 15 inpatient care patients, study who were selected using stratified before it was used in the study. Data of random sampling with probability samp- doctors‘ working period and the total of ling. doctors‘ salary were obtained from secon- 3. Research Variables dary data observation. The data were ana- Exogenous variables in the study were fa- lyzed using path analysis. mily income, patients‘ level of education, length of stay, doctors‘ salary, type of insu- rance and type of class of inpatient ward.

Table 1. The result of reliability test on questionnaires about healthcare service quality and patients‘ satisfaction No Variables Item Total Correlation (r) Cronbach's Alpha 1 Tangible ≥0.25 0.87 2 Reliability ≥0.35 0.85 3 Responsiveness ≥0.26 0.84 4 Assurance ≥0.34 0.76 5 Empathy ≥0.30 0.73 6 Satisfaction ≥0.29 0.85

RESULTS the subjects of the study were explained in 1. Univariate Analysis Table 3. Based on Table 2 most subjects of Univariate analysis included the character- the study were patients of inpatient care istics of the subjects of the study and the who were <40 years old, that was 54 people variables of the study. The characteristics of (37.5%). Majority of the subjects were male as many as 84 people (58.3%). Most pa- e-ISSN: 2549-0281 (Online) 3 Journal of Health Policy and Management (2017), 2(1): 1-15 https://doi.org/10.26911/thejhpm.2017.02.01.01

tients of inpatient care were high school/ who had income ≥Regional Minimum Wage vocational high school graduates, that was (56.9%). As many as 55 subjects of inpa- 39 people (27.1%). There were 30 patients tients study (53.5%) travelled ≤30 km from who were farmers (20.8%). Most subjects their homes to RSUD Dr. Moewardi, Sura- of the study were patients of inpatient care karta.

Table 2. Characteristics of the subjects of the study Characteristics Criteria n % Patients‘ age < 40 years 54 37.5 41-50 years 46 31.9 51-60 years 34 23.6 ≥ 60 years 10 6.9 Sex types Male 84 58.3 Female 60 41.7 Patients‘ Education No School 6 4.2 Primary 16 11.1 Secondary 25 17.4 High School/ Vocational High School 39 27.1 Associate Degree 35 24.3 Bachelor‘s Degree 23 16.0 Occupation Unemployed 24 16.7 Students 13 9.0 Civil Servants/ Armed Force/ Police Department 10 6.9 Private Employee 22 15.3 Self Employed 28 19.4 Farmer 30 20.8 Others 17 11.8 Patients‘ Income 60 Km 29 20.1

Table 3. Descriptive analysis of the variables of the study Variables Mean SD Minimum Maximum Family Income 18.56 8.15 5 49 Length of Stay 6.36 2.97 2 14 Doctors‘ Salary 57.19 27.66 40 126 Doctors‘ Working Period 11.79 6.73 1 28 Quality of Care 127.05 6.23 114 145 Patients‘ satisfaction 30.47 4.72 21 40

Table 3 showed the descriptive ana- doctors‘ salary, doctors‘ working period, lysis of the variables of the study which was status of insurance, type of class and described based on minimum and maxi- healthcare service quality toward patients‘ mum value, mean, and deviation standard, satisfaction. Table 4 showed the average of each had relatively high disparity of data patients‘ satisfaction in RSUD Dr. Moe- 2. Bivariate Analysis wardi was categorized as satisfied and very Bivariate analysis was used to analyze the satisfied. Chi Square test result showed association between patients‘ income, pa- patients‘ satisfaction had a significant asso- tients‘ education, patients‘ length of stay, ciation with education (OR= 0.30; 95% CI=

4 e-ISSN: 2549-0257 (Online) Akbar et al./ The Influence of Personal Factors of the Patient, Doctor, Payment Method

0.14 to 0.64; p= 0.001), length of stay (OR= 0.25; 95% CI= 0.12 to 0.52; p< 0.001), dan 3.00; 95% CI= 1.47 to 6.14; p= 0.002), doc- and service quality (OR= 6.62; 95% CI= tors‘ working period (OR= 2.82; 95% CI= 3.31 to 16.55; p< 0.001). However patients‘ 1.43 to 5.56; p= 0.003), type of insurance satisfaction had an insignificant with family OR= 3.40; 95% CI=1.53 to 7.53; p= 0.002), income (OR= 0.66; 95% CI= 0.34 to1.30; Class I type toward class II and III (OR= p= 0.228) and doctors‘ salary (OR=1.72; 5.80; 95% CI= 2.54 to 13.33; p< 0.001), 95% CI= 0.88 to 3.36; p= 0.108) Class III type toward class I and II (OR=

Table 4. Bivariate analysis on factors that influence patients‘ satisfaction. Patients‘ Satisfaction 95% CI Variables Satified Very Satisfied OR Lower Upper p n (%) n (%) Limit Limit Family Income

4) Number of Parameters = 34 = (9 x (9+1))/2 œ (2 + 7 + 34) Degree of freedom formula, is as = 45-43 follow = 2 df = (number of observed variables x Result of degree of freedom (df) was 2 it (number of observed variables + 1))/2 œ means over identified or path analysis was (endogenous variables + exogenous vari- possible to conduct. ables + number of parameter)

Picture 1. Structural model of path analysis with estimate.

Picture 1 shows structural models after data. Patients‘ satisfaction was influenced estimation was made by using SPSS Amos by family income, patients‘ level of edu- program. Indicators that showed model cation, length of stay, doctors‘ salary, doc- conformity in Figure 1 was the result of tors‘ working period, type of insurance, CMIN fit index (Normed Chi Square) as type of class and quality of healthcare ser- much as 1.835 with p= 0.399 > 0.05; NFI vice. (Normed Fit Index)= 0.99 ≥ 0.90; CFI Each unit of increase in family income (Comparative Fit Index)= 1.00 ≥ 0.90; GFI would decrease the score of inpatient care (Goodness of Fit Index)= 0.99 ≥ 0.90; patients‘ satisfaction by 0.08. Each unit of RMSEA (Root Mean Square Error of Ap- increase in education level would decrease proximation)<0.001 ≤ 0.08. The value showed that the model fit- the score of inpatient care patients‘ satis- ted the criteria that were determined and faction by 0.44. Each unit of increase in confirmed as in accordance with empirical length of stay would increase the score of inpatient care patients‘ satisfaction by 0.19.

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Table 5. The result of path analysis on the influence of patients‘ personal factors, payment method, and type of class toward service quality and satisfaction Endogenous Variables Exogenous Variables b* SE P Ã** Direct Influence Satisfaction Family Income≥Regional -0.08 0.48 0.093 -0.14 Minimum Wage Satisfaction Education ≥ High School -0.44 0.27 0.102 -0.13 Satisfaction Length of stay ≥ 7 days 0.19 0.99 0.059 0.12 Satisfaction Doctors‘ salary≥ 5.8 million 0.02 0.01 0.060 0.11 Satisfaction Doctors‘ working period ≥ 12 0.99 0.44 0.024 0.14 tahun Satisfaction Aid Recipient Insurance 0.72 0.32 0.027 0.17 Satisfaction Type of class I 2.11 0.38 <0.001 0.37 Satisfaction Very good quality of service 0.16 0.51 0.002 0,21 Indirect Influence Quality Family Income≥Regional -0.15 0.07 0.039 -.0.19 Minimum Wage Quality Length of stay ≥ 7 days 0.37 0.15 0.017 0.18 Quality Doctors‘ working period ≥ 12 0.13 0.68 0.056 0.14 tahun Quality Aid Recipient Insurance 1.04 0.50 0.036 0.18 Quality Type of class I 2.24 0.59 <0.001 0.29 Fit Model p = 0.399 ( > 0.050 ) CMIN = 1.835 GFI = 0.99 ( > 0.90 ) CFI = 1.00 ( > 0.90 ) NFI = 0.99 ( > 0.90 ) RMSEA = 0.00 ( < 0.80 ) *=unstandardized path coefficient **= standardized path coefficient

Each unit of increase in doctors‘ sa- service quality by 0.15. Each unit of increase lary would increase the score of inpatient in length of stay would increase the score of care patients‘ satisfaction by 0.02. Each inpatient care service quality by 0.37. Each unit of increase in doctors‘ working period unit of increase in doctors‘ working period would increase the score of inpatient care would increase the score of inpatient care patients‘ satisfaction by 0.99. Each unit of service quality by 0.13. Each unit of increase increase in type of insurance would in- in type of insurance would increase the crease the score of inpatient care patients‘ score of inpatient care service quality by satisfaction by 0.72. Each unit of increase 1.04. Each unit of increase in type of class in type of class would increase the score of would increase the score of inpatient care inpatient care patients‘ satisfaction by 2.11. service quality by 2.24. Each unit of increase in service quality would increase the score of inpatient care DISCUSSION patients‘ satisfaction by 0.16. A. The influence of family income Quality of service was influenced by toward patients‘ satisfaction. family income, length of stay, doctors‘ work- The result of path analysis of the study ing period, type insurance and type of class. showed that there was a directly negative Each unit of increase in family income association between family income and in- would decrease the score of inpatient care e-ISSN: 2549-0281 (Online) 7 Journal of Health Policy and Management (2017), 2(1): 1-15 https://doi.org/10.26911/thejhpm.2017.02.01.01

patient care patients‘ satisfaction in RSUD with low income are likely to have limited Dr. Moewardi and statistically significant. options in the quality of healthcare service. It is in accordance with the result stu- Meanwhile those with high income will dy of Haviland et al., (2005) that states low choose class with good standard of quality social economy status will influence pa- (Bravema et al, 2011). tients‘ satisfaction and ability to buy care B. The influence of level of education service is influenced by patients‘ income. toward patients‘ satisfaction. Someone with high income is likely to be The result of the study showed that there outspoken to question additional treatment was negative association between level of to be conducted for the sake of health education with patients‘ satisfaction of in- improvement and the disease suffered, in patient care in RSUD Dr. Moewardi, how- contrast someone with low income will be ever it is statistically insignificant. The re- passive and will not question much and sult of the study is in accordance with tends to accept well whatever treatment to Bakar et al., (2008) in Dengjuin et al., be implemented. Anjaryani (2009) states (2009) that patients with high level of edu- that the demand for additional treatment cation possess higher expectation and in- will influence patients‘s satisfaction so that tention compared to those with low income. someone with high income is likely to be High expectation tends to make patient unsatisfied with condition of care and type unsatisfied with healthcare service. Some- of service given by the hospital. one with higher education level can not The result of the study is supported by adjust their expectation with the condition Khuong dan Anh (2013) that someone with of hospital so that they need higher quality high income is likely to have higher needs of service to make them feel satisfied. for services. Healthcare service provider Patients with lower level of education have needs to effectively improve the service ca- lower expectation so that they can adjust pacity which is needed and meets the pa- their expectation in accordance with the tients‘ expectation to improve patients‘ sa- condition of hospital as well as accept tisfaction. A good and integrated service is whatever service given (Fraihi et al., 2016). expected to give output in a form of The study is supported by Fletcher patients‘ satisfaction for the performance of and Frisvol (2012) that higher education in- healthcare service providers in this term is fluence a variety of medical treatments con- hospitals. In reality, the fulfillment of ser- ducted. The higher the education of a pa- vice for the sake of patients‘ recovery is not tient is, the higher intention, expectation met by the hospital thus leads to dissatis- and confidence of the patient will be toward faction out of patients‘ expectation (Deng et any medical treatment conducted. Patients al., 2009). with higher education will be more critical The result of the study showed in- and having higher demand. Being critical direct negative association between family generates high expectation in term of ob- income by means of quality of service to- tained healthcare service and is likely to be ward the patients satisfaction of inpatient incapable to accept services below the ex- care in RSUD Dr. Moewardi, Surakarta and pectation thus decreases patients‘ level of statistically significant. It is in accordance satisfaction toward the services provided by with Kawachi et al., (2010) who states that hospital. On the contrary, low educated income, wealth is used to attain better patients are likely to accept any treatment health or for health improvement. People to be given to recover. Thus, patients with

8 e-ISSN: 2549-0257 (Online) Akbar et al./ The Influence of Personal Factors of the Patient, Doctor, Payment Method low education are more satisfied than positive correlation between length of stay patients with high education. by means of quality of service toward pa- C. The influence of patients‘ length of tients‘ satisfaction of inpatient care in stay toward patients‘ satisfaction. RSUD Dr Moewardi, and statistically signi- The result of path analysis showed that ficant. A study by Anjaryani (2009) states there was a directly positive association bet- that there is a correlation between length of ween the length of stay toward patients‘ stay and patients‘ satisfaction. Patients with satisfaction of inpatient care in RSUD Dr. longer range of care time are likely to be Moewardi, Surakarta and statistically ap- more familiar with medical personnel, both proaching to significant. It is in accordance doctor and nurses. Familiarity influences with the study conducted by Borghans et patients‘ psychological condition, in which al., (2012) that states there is no correlation patients feel well cared for and listened for between length of stay and patients‘ satis- their problems. It makes patients feel satis- faction. Borghans et al., (2012) in his study fied with the quality of healthcare service. does not find any evidence that hospital Strong personal and emotional connection with relative shorter length of stay (LOS) between service providers and customers in owns higher level of satisfaction. Length of this terms is patients has been proven to stay by considering physicall condition, positively influence the level of patients‘ type of diseases being suffered as well as satisfaction toward type of service obtained the improvement in medication, is deter- (Boer et al., 2010). mined by hospital‘s medical team or doctor. Based on the description above, psy- Length of stay does not only depend on chological relationship between medical type of diseases but is also influenced by personnel and patients is greatly needed in other factors, such as patients‘ emotional giving care to generate proper commu- and psychological condition in facing the nication. In addition, to improve the quality disease, thus, patients with similar type of of service, hospitals need to make an infor- disease will not necessarily have similar mative approach by describing health deve- length of stay. lopment by using simple language which is The study is supported by Oroh et al., easy to understand to patients and family (2014) that length of stay for each patients member (Mulyawan, 2015). is different since patient is influenced D. The influence of doctors‘ salary emotionally in enduring the disease being toward patients‘ satisfaction. suffered, so that proper emotional approach The result of path analysis of the study will make patients finds their psychological showed that there was a directly positive and social needs which is not fulfilled association between doctors‘ salary toward during their sickness, and patient will feel patients‘ satisfaction of inpatient care and better with their condition and it leads to statistically approaching to significant. It is patients‘ satisfaction (Krishnasamy et al., in accordance with the study conducted by 2001). The finding shows that the main Bardach et al., (2014) that states doctors‘ focus of care does not only depend on phy- salary is very effective in maximally im- sical care however on how healthcare ser- proving the quality of doctors‘ performance. vice providers are able to recognize pa- Excellent doctors‘ performance actively tients‘ psychological condition. play important role in improving the result The result of path analysis in this of patients‘ recovery, thus, it will increase study also shows that there was a indirect patients‘ satisfaction. Performance impro- e-ISSN: 2549-0281 (Online) 9 Journal of Health Policy and Management (2017), 2(1): 1-15 https://doi.org/10.26911/thejhpm.2017.02.01.01 vement based on the salary received or Pay tients and their family are absolutely con- for Performance (P4P) is also supported by vinced about the procedure to be conducted Roland dan Dudley (2015) who state that as well as the result obtained. Doctors‘ incentive extension will improve doctors‘ capacity along with doctors‘ working period working quality in providing service. will reduce fear or anxiety toward problems Patients will feel satisfied whenever that may not occur (Kim et al., 2017). doctors perform maximal performance and The result of path analysis of the stu- capacity during recovery phase. Economy dy showed that there was an indirect posi- factor (doctors‘ welfare) plays an important tive association between doctors‘ working role in improving doctors working satisfac- period by means of quality of service to- tion and the impact can be perceived by ward patients‘ satisfaction of inpatient care patients in a form of good and satisfying in RSUD Dr Moewardi and statistically ap- service. proaching to significant. The study is in ac- E. The influence of doctors‘ working cordance with Kurtz (2005) who states that period toward patients‘ satisfac- working period is a factor that greatly de- tion. termines a doctor‘s experience and capaci- The result of path analysis showed that ty. Doctor‘ working period is total number there was a directly positive association bet- of annual working hours, in which the ween doctors‘ working period and patients‘ longer doctors‘ working period, the more satisfaction of inpatient care in RSUD Dr. experience in using treatment mechanism Moewardi, Surakarta and statistically signi- well and properly, as well as coordinating ficant. It is in accordance with Kim et al., and creating good communication with (2017) that the longer doctors‘ working other healthcare professionals in improving period, the more increasing capacity and the quality of service. Good coordination knowledge they have. Patients will feel sa- and communication between doctors and tisfied if they are handled by doctors with patients is also established based on the sufficient capacity and knowledge. The long- length of working period thus it is needed er doctors‘ working period will increase the in improving service quality. The intended capacity in therapeutic communication that communication is communication using la- can explore patients‘ needs and desire. The nguage and terminology which are easy to opinion is supported by Krishnasamy et al., understand so that patients understand (2001) that capacity in communicating and prior and post the administration of pro- delivering information is very important for cedure (Herqutanto et al., 2011). all parties, both doctors and patients. Calnan dan Rowe (2006) show that Good communication is needed bet- level of trust given by patients to healthcare ween doctors and patients about the pro- service is greatly influenced by the quality cedure used in the treatment so that pa- of relationship between doctors and pa- tients and their family understand the con- tients. The trust is obtained through good dition of health problems. Patients who communication, in which the communica- obtained information on treatment and tion is not only conducted to patients but prevention which meets the expectation in also to colleagues as well as other medical patients recovery, will feel satisfied. In team. The purpose is to gain an under- addition, patients‘ ailment and questions standing and agreement, to be able to give should be responded as well as answered in satisfaction to healthcare service recipients. complete and proper manner so that pa- Good communication can be established by

10 e-ISSN: 2549-0257 (Online) Akbar et al./ The Influence of Personal Factors of the Patient, Doctor, Payment Method means of doctors‘ experience and working providers should not give different services period. based on the payment methods of the pa- F. The influence of health insurance tients either insurance users, BPJS or Jam- toward patients‘ satisfaction. kesmas. Patients of Jamkesmas or Aid Re- The result of path analysis showed that cipient have similar opportunity to use there is a directly positive association bet- healthcare service without making a dis- ween type of insurance toward patients‘ tinction of the healthcare service. In addi- satisfaction of inpatient care in RSUD Dr tion, patients who do not have any insuran- Moewardi, Surakarta and statistically signi- ce however they get similar service, treat- ficant. ment and procedure with the insurance The use of health insurance in Indo- users, are likely to feel less satisfied with nesia is still controversial. It is generated by the healthcare service. the status of insurance users which is not The result of path analysis also show- clear especially state-own insurance, that ed that there was an indirectly positive leads to the reluctance of service providers association between type of insurance in giving the rights of insurance holders. through quality of service toward patients‘ Different result is conveyed by McMichael satisfaction of inpatient care in RSUD Dr and Healy (2017) in the literature review in Moewardi and statistically significant. The some South East Asia Countries (Cambo- study is in accordance with Zarei et al., dia, Laos, Myanmar, Thailand, Vietnam) (2012) that states patients without insu- that states there is no difference of insu- rance coverage have low perceived quality. rance use in using quality healthcare ser- Patients without insurance pay the hospital vice neither difference in the equality of bill out-of-pocket, they expect hospitals are healthcare service, both for insurance users able to fulfill their expectation. Lestari et and self-reliance or out- of pocket. al., (2016) states that non insurance pa- In order to fulfill public healthcare tients have higher level of satisfaction com- service in , government launched pared to patients with health insurance. It a healthcare programs one of them is Social is because of the difference of treatment in Health Insurance (Jamkesmas), however which patients who self pay or out-of- according to Dwiyanto (2010), the existence pocket is likely to be noticed about their of Jamkesmas is still covered with pro- needs and ailment. blems in terms of service delivery. It is be- G. The influence of type of class of in- cause of the status of health insurance patient care toward patients‘ satis- which still becomes a consideration in deli- faction. vering healthcare service thus people who The result of path analysis showed that are registered in Jamkesmas do not use there was a direct association between type their rights properly. They prefer to use of class of inpatient ward toward patients‘ healthcare service as general users than satisfaction. The association is positive and using their right as Jamkesmas members to statistically significant. It means that health- get equal treatment in using healthcare ser- care service quality delivered to class III vice. patients is in the lowest level. On the other The difference of opinion between the side inpatient care in class I deliver the best two researchers is generated by the dif- service compared to class II and class III. ference of treatment by health workers to Patients are relatively less satisfied with patients. Hospitals as healthcare service healthcare service in class III since their e-ISSN: 2549-0281 (Online) 11 Journal of Health Policy and Management (2017), 2(1): 1-15 https://doi.org/10.26911/thejhpm.2017.02.01.01 expectations toward healthcare service are (2017) states that quality of service is pro- not fulfilled. In general, the difference of ven to have positive effect toward patients‘ class in hospitals is distinguished by faci- satisfaction. Quality of service will make lities as well as type and price of medicines patients feel satisfied. In addition, comfort- given. In addition, there is a missed per- able environment, extensive facilities, and ception which has been entrenched within pleasant service for the treatment in hos- the healthcare service providers‘ mindset pitals are the aspects of service quality that prioritizing more the patients in class I which are important within satisfaction. ward than patients in class II and III. The (Zarei et al., 2012). type of class III of inpatient ward is gene- Some studies show doctors‘ and nur- rally patients with relatively low level of ses‘ performance are other important fac- income and education, thus it certainly tors within patients‘ satisfaction (Butt and needs more skillful service especially in Run, 2010). The emergence of trust enables communicating anything related to pa- patients to feel satisfied with the conve- tients‘ right and responsibility (Nurrizka nience given. Professional and timely ser- dan Saputra, 2011). Therefore it can be con- vices as well as appropriate information cluded that the influence of type of class is given are what patients expect from hos- directly and positively associated with pa- pitals. Quality of service delivered by hos- tients‘ satisfaction accordingly the result of pital is especially determined by factors the study can be affirmed as in accordance related with process such as scheduling, with the study above. delivery of care, and accuracy of infor- The study also showed that in path mation given (Kim et al., 2017). analysis there was indirectly positive asso- RSUD Dr Moewardi is one of the re- ciation and statistically significant between ferral hospitals, there are numerous pa- type of class of inpatient ward though qua- tients who are severely ill, therefore fast lity of service toward patients‘ satisfaction respond of the personnel in delivering ser- of inpatients care in RSUD Dr Moewardi. It vices leads to the increasing of satisfaction is in accordance with Asshidin et al, (2016) level. Increasing patients‘ satisfaction RSUD who states that quality is influenced by Dr. Moewardi should maintain the quality value of product characteristics. In health- of healthcare service so that patients will care terms, one of them is type of class of feel very satisfied with the delivered health- inpatient ward. Every type of class of inpa- care service quality. tient ward offers different facilities, proce- Based on the result of the study it can dures and convenience, so that every class be concluded that patients‘ satisfaction is has distinguished quality. influenced by family income, level of edu- H. The influence of quality of service cation, length of stay, doctors‘ salary, doctors‘ toward patients satisfaction. working period, type of insurance, type of The result of path analysis showed that class and healthcare service quality. 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