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Patient satisfaction represents the comparison between expectations before receiving health services and perceptions of the quality of services provided. The assessment of healthcare service quality generally uses the five SERVQUAL dimensions, namely tangibles, reliability, responsiveness, assurance, and empathy. A preliminary survey showed that the reliability dimension obtained the lowest average score compared to other dimensions. This study employed an observational analytic design with a cross-sectional approach. The study population consisted of BPJS (National Health Insurance) patients who received services. A total of 386 respondents were selected using purposive sampling. Data were collected through a SERVQUAL-based questionnaire and analyzed using univariate, bivariate (chi-square test), and multivariate (logistic regression) analyses to identify the dominant factors related to patient satisfaction. The results indicated that the variables of age (p < 0.05) and all five SERVQUAL dimensions (tangible, reliability, responsiveness, assurance, and empathy) were significantly associated with patient satisfaction levels. It can be concluded that most BPJS patients were satisfied with the services provided. The assurance dimension was found to be the most influential factor. Therefore, efforts to improve service quality should focus on strengthening aspects of assurance, trust, and service reliability.

Abstract. The right to health is an integral part of human rights guaranteed by the Constitution and further reinforced by Law Number 17 of 2023 on Health, which places the state as the party responsible for ensuring the provision of safe, high-quality, and non-discriminatory health services for all citizens. However, in practice, the fulfillment of the right to health continues to face various challenges, particularly in the delivery of health services for participants of BPJS Kesehatan. This study aims to analyze the legal protection of the right to health in Indonesia and to examine the refusal of medical services to BPJS patients that resulted in death in Papua from a human rights perspective. The research employs a normative legal research method using statutory, conceptual, and case approaches. The findings indicate that although the national legal framework has clearly regulated the obligations of the state and health care facilities in providing emergency services, its implementation remains weak due to administrative barriers, unequal access to health services, and inconsistent law enforcement. The refusal of medical services to BPJS patients in Papua reflects a tension between hospitals’ administrative compliance and the professional obligation of medical personnel to save human lives. The implications of this study emphasize the need to strengthen supervision, ensure consistent law enforcement, and improve health service governance so that the right to health is truly protected as part of human dignity within the Indonesian rule of law. 

Digital transformation in healthcare services is a strategic approach to improve access, efficiency, and service quality, particularly within Indonesia’s National Health Insurance (JKN) system. BPJS Kesehatan has introduced an online queue feature through the Mobile JKN application to minimize manual queuing and reduce waiting times in outpatient services. However, despite the widespread ownership of the application, its actual utilization for online queuing remains relatively low, including in a regional public hospital (RSUD) in West Bandung. This condition reflects a gap between the availability of digital health technology and patients’ actual usage behavior, highlighting the need to examine factors influencing adoption.This study aims to analyze the effects of perceived ease of use, social influence, and facilitating conditions on the actual use of the Mobile JKN online queue, with behavioral intention as an intervening variable among outpatients. A quantitative cross-sectional design was applied, involving 255 JKN outpatient participants selected through purposive sampling. Data were collected using structured questionnaires and analyzed using Structural Equation Modeling (SEM) with AMOS version 24, based on the Technology Acceptance Model (TAM) and the Unified Theory of Acceptance and Use of Technology (UTAUT). Data analysis included descriptive statistics, validity and reliability testing, normality assessment, goodness-of-fit evaluation, Three Box Method, and hypothesis testing.

In response to the evolving landscape of public healthcare services, hospitals are expected not only to maintain operational efficiency but also to adapt to the shifting needs and expectations of patients as healthcare consumers. The presence of non-BPJS patients in regional public hospitals plays a strategic role not only contributing to revenue diversification but also reflecting service quality, institutional competitiveness, and shaping public perception. The declining trend in outpatient visits by general patients at RSUD Balaraja over the past three years highlights the need to understand the factors influencing consumer behavior in determining revisit intentions. This study examines the effect of co-creation and hospital image on the revisit intention of outpatient general patients at RSUD Balaraja, with patient experience as a mediating variable. The research employed a quantitative explanatory design involving 278 outpatient general patients selected through purposive sampling. Data were collected via structured questionnaires and analyzed using Structural Equation Modeling–Partial Least Squares (SEM-PLS). The results indicate that patient experience plays a significant mediating role in shaping revisit intention among general outpatients at RSUD Balaraja. These findings confirm that patient experience serves as a central factor in post-service evaluation processes, which ultimately drive patients’ intention to return. Therefore, hospitals need to enhance patient involvement in service processes (co-creation), improve public perception of institutional image (hospital image), and develop patient-centered service systems as a key strategy to increase revisit intention among general outpatients.

The digital transformation of health services through the Mobile JKN application was introduced by BPJS Kesehatan to provide easier access for the public in obtaining information, managing membership administration, and receiving health services more quickly and efficiently. This study aims to measure the readiness level of patients at Abdul Manap Regional Hospital, Jambi City, in adopting the Mobile JKN application using the HOT-Fit method, which covers three main components: Human, Organization, and Technology. Data were collected from 360 respondents through questionnaires and analyzed using Partial Least Square Structural Equation Modeling (PLS-SEM). The results indicate that technology factors—including system quality, information quality, and service quality— along with organizational support have a significant effect on system use and user satisfaction, which in turn positively influence the net benefits. The outer loading values of all indicators exceeded 0.7, with Composite Reliability above 0.8 and AVE above 0.6, confirming that the research instruments are valid and reliable. Overall, patients at Abdul Manap Hospital are categorized as ready to adopt Mobile JKN, although improvements in digital literacy and stronger organizational support are still required to optimize its utilization.

The Outpatient Unit is an important service unit that contributes to the hospital's revenue. However, at Adam Talib Cikunir Hospital, the number of patient visits has not yet reached the target, thus it is necessary to formulate a strategy to enhance competitiveness. This research aims to develop a strategic plan for the Outpatient Unit to improve service quality and increase its contribution to the hospital's revenue. The research uses a qualitative descriptive approach. Analysis is conducted through Internal Factor Evaluation (IFE), External Factor Evaluation (EFE), SWOT analysis, and Quantitative Strategic Planning Matrix (QSPM). The IFE score of 2.44 and the EFE score of 2.41 place RS DAT Cikunir in Quadrant V of the IE Matrix, which means RS DAT Cikunir is in a Hold and Maintain position. The SWOT analysis generates several alternative strategies, and the QSPM prioritizes three strategies: enhancing specialized services (score 5,84), expanding services and digital promotion (score 5,66), and optimizing cooperation with BPJS and private insurance (score 5,38). The research concludes that improving specialized services, expanding services and digital promotions, as well as optimizing cooperation between BPJS and private insurance are the right strategies to enhance service quality, attract more patients, and strengthen the competitiveness of RS Dokter Adam Talib Cikunir amid competition in the healthcare sector.  

The high cost of colloid fluids and the large number of patients are concerns in determining which treatment standard should be chosen from several treatment alternative, where the total cost for 43 cases with a combination of crystalloid colloid fluids is IDR 209.370.993 while the total cost for 45 cases of crystalloid fluids is only UDR 146.492.268 which causes hospital losses. This study aims to determine the difference in the cost-effectiveness between crystalloid fluids and crystalloid-colloid combinations in hospitalized dengue fever patients without shock at Tangerang City Hospital. The research design used was cross-sectional with a comparative quantitative analysis method, where cost effectiveness was analyzed using the Average Cost Effectiveness Ratios (ACER) method. There were two groups of study samples: the first group, 25 patients who received crystalloid fluids, and the second group, 23 patients who received crystalloid-colloid combination fluids. This study showed a difference in the average hospitalization costs for dengue patients between crystalloid fluid therapy and crystalloid-colloid combination therapy. Hospitalization costs for dengue patients were lower in the crystalloid fluid group, with a significant difference (p=0.000). It was also found that crystalloid fluids were more cost-effective than the crystalloid-colloid combination. The implications of the study results consist of theoretical implications and practical implications. Based on the results of the analysis carried out, the crystalloid solutions are more cost-effective than crystalloid-colloid combinations. This finding can be used as a consideration in making decisions and policies that are in accordance with quality control and cost control for patients covered by the National Health Insurance (BPJS Health insurance).

The JKN Mobile application is an electronic-based service innovation introduced by BPJS Health to facilitate JKN participants in accessing healthcare services and managing their membership information. This study aims to explore the experiences and perspectives of outpatient patients regarding the effectiveness of the JKN Mobile online registration system at Baubau City Regional General Hospital. A qualitative phenomenological approach was employed, with informants selected through purposive sampling. Data were collected to capture the meanings of patients’ experiences in using the application. The findings show that most patients are satisfied with the practicality, speed, and flexibility of the online registration system. However, technical problems, particularly unstable internet connectivity, remain a major challenge. Furthermore, the online registration system has contributed to improved service efficiency and patient satisfaction. These findings indicate the importance of continuous evaluation and improvement of the JKN Mobile online registration system to enhance service quality and health information system development at Baubau City Regional General Hospital.

Electronic Medical Record (EMR) is an essential component of hospital digital transformation aimed at improving administrative efficiency and service quality. This study aims to analyze the factors influencing the implementation of EMR in outpatient registration at a private hospital in North Jakarta. A mixed-methods design was employed, combining quantitative data collected from questionnaires completed by 30 registration staff with qualitative data obtained through structured interviews and direct observation. The logistic regression analysis revealed that Training and Staff Competence (X2) had a significant positive effect on outpatient registration (OR 30.663; p=0.040), while System Integration and Data Security (X4) also showed a significant effect (OR 15.121; p=0.047). In contrast, Technological Infrastructure Readiness (X1) was positive but not significant (p=0.112), and Organizational Culture and Managerial Support (X3) was negative and not significant (p=0.954). Simultaneously, the model explained 72.1% of the variation in registration effectiveness (Nagelkerke R²=0.721) with a classification accuracy of 93.3%. Qualitative findings supported the quantitative results, highlighting insufficient staff training, persistent technical issues in BPJS system bridging, and difficulties faced by elderly patients in adapting to digital registration. Elderly patients still required staff assistance and simple educational media such as tutorial videos displayed in hospital waiting areas. This study concludes that staff competence and system integration are the key determinants of successful EMR implementation in outpatient registration. It is recommended that hospitals strengthen continuous training programs, improve network and server stability, and expand patient education initiatives to ensure effective, efficient, and patient-friendly digital services.

In the healthcare sector, patient revisit intention serves as an important measure of hospital success, influencing financial stability, operational effectiveness, and long-term patient retention. With increasing competition, hospitals must strengthen trust, improve service quality, and maintain a positive institutional image to retain patients. This study focuses on the declining number of non-BPJS (non-insured) patients at Cinta Kasih Tzu Chi Hospital, Cengkareng, which impacts revenue sustainability. The research aims to assess how trust and customer perceived value affect revisit intention, and whether hospital image moderates these relationships. A quantitative approach was applied using a structured questionnaire distributed to 95 non-BPJS outpatients who had previously sought treatment more than once. Data were analyzed through Structural Equation Modeling (SEM) using the Partial Least Squares (PLS) method via SmartPLS software. The findings reveal that both trust and perceived value significantly and positively influence revisit intention, implying that patients with strong trust and satisfaction tend to return. Although hospital image directly influences revisit intention, it does not significantly moderate the link between perceived value and revisit intention. Therefore, hospitals are advised to enhance patient trust and perceived value while sustaining a credible institutional image to strengthen loyalty among non-BPJS patients

Advances in information technology in the health sector encourage the use of digital applications to improve service efficiency. One of them is the Primary Care (P-Care) application developed by BPJS Kesehatan to support the implementation of National Health Insurance (JKN) in first-level health facilities. This study aims to evaluate the implementation of P-Care at the Blangkejeren City Treatment Center using the Task Technology Fit (TTF) approach. This study uses a descriptive qualitative method with a narrative approach. Data was collected through in-depth interviews with the heads of health centers, medical personnel, and patients, and analyzed interactively through the stages of reduction, presentation, and drawing conclusions. The results of the study show that the perception of health workers on the ease of use and benefits of P-Care is quite positive, although it is still constrained by system disruptions and infrastructure limitations. Attitudes and interest in use remain high, but actual usage is not fully optimal because there is still a combination of digital and manual processes. The conclusion of this study states that although P-Care has supported service improvement, optimization of application features and infrastructure improvements are urgently needed. Training support and strengthening internal management at health centers are important factors to ensure the sustainability of the implementation of the application as a whole.

The Maternal Mortality Rate (MMR) is closely related to the low number of pregnant women visiting the Community Health Center (Puskesmas). This situation can occur due to patient dissatisfaction with the quality of services provided by health facilities, which can lead to patients deciding not to undergo check-ups at the Puskesmas or going to non-medical personnel, which can lead to complications in pregnant women. The purpose of this study was to analyze the effect of health service quality on patient satisfaction among third-trimester pregnant women at Pucakwangi 2 Pati Community Health Center. This study adopted a quantitative, observational, analytical, cross-sectional approach. This study was conducted at Pucakwangi 2 Pati Community Health Center in October 2023. The sample size was 42 third-trimester pregnant women using BPJS services. The sampling method used was total sampling, and the results were analyzed using the Mann-Whitney statistical test. The results showed that the dimensions of tangible, reliability, responsiveness, and empathy were related to patient satisfaction with a p-value of 0.000. Meanwhile, the assurance dimension was not related to patient satisfaction because the p-value was 0.356. Four quality dimensions were found to be related to patient satisfaction, namely tangible, reliability, responsiveness, and empathy dimensions on the satisfaction of pregnant women in the third trimester at Pucakwangi 2 Community Health Center, Pati. Meanwhile, no relationship was found between the assurance dimension and the satisfaction of pregnant women in the third trimester at Pucakwangi 2 Community Health Center, Pati. This finding indicates that improving the quality of health services, especially in the aspects of tangible, reliability, responsiveness, and empathy, is very important to increase the satisfaction of pregnant women. The Community Health Center needs to conduct continuous evaluation and improvement in maternal health services to encourage regular visits by pregnant women, reduce the risk of complications, and contribute to reducing maternal mortality in the Pucakwangi 2 Community Health Center's working area.

The implementation of the Enhanced Recovery After Cesarean Surgery (ERACS) method as an innovation in the Sectio Cesarea (SC) surgical procedure aims to accelerate recovery, minimize pain, and improve patient comfort. Although it has been clinically proven, there is still limited research exploring patients' subjective experiences with this method, particularly in eastern Indonesia. This study aims to explore in depth the physical, emotional, psychological experiences, as well as perceptions of service and patient expectations after undergoing SC with the ERACS method at Banggai Laut General Hospital. The study employs a qualitative approach with a phenomenological study design. Data were collected through in-depth interviews with purposively selected informants and analyzed using Braun & Clarke's thematic analysis technique. The results showed that patients experienced rapid physical recovery, minimal pain, and were able to mobilize early. Emotionally, patients felt calm and stable, supported by good communication with medical staff and family support. However, information about the ERACS procedure before surgery was still perceived as lacking detail. Patients also hope that this method continues to be implemented with improvements in educational aspects and financial support from BPJS. Patients' experiences with the ERACS method are generally very positive and reflect the success of this approach not only clinically but also in creating a more comfortable, efficient, and humane childbirth experience. This study recommends enhancing preoperative education, postoperative monitoring, and more inclusive financial support systems.

Pending BPJS Health claims are claim returns where there is no agreement between BPJS Health and FKRTL regarding coding or medical principles (claim disputes), but resolution is carried out in accordance with BPJS Law Number 7 of 2018. The purpose of this research is to identify the factors causing pending claims using the Fishbone diagram approach, which includes the aspects of Man, Money, Method, Machine, and Material. The type of this research is a qualitative descriptive method using interviews and observations. The population of this study consists of all inpatient and outpatient insurance officers at Al-Hikmah Clinic. The sampling techniques used are total sampling and purposive sampling. Data were analyzed descriptively. Based on the research results at Al-Hikmah Sukorejo Clinic, the factors causing pending claims include the absence of staff with a background in medical records, incomplete claim documents, system errors in the P-Care application, and internet network issues. Continuous training, improvement of the digital system, and adjustment of SOPs are needed to minimize pending claim cases and enhance service efficiency. The researchers' recommendation is to always check the completeness of claim documents for the BPJS insurance claim process and to conduct regular training for claim officers at the clinic.  

The incidence of chronic diseases is not comparable to the ratio of chronic disease service utilization in Jambi City. Data from BPJS Kesehatan Jambi states that Talang Banjar Health Center is a health center with the lowest achievement of the Controlled Chronic Disease Management Program Participant Ratio (RPPT) of 0.55% from ≥ 5%. It is suspected that the behavior of chronic disease sufferers influences this figure. The study aims to analyze the behavior of health service utilization by chronic disease patients in the work area of Talang Banjar Health Center, Jambi City. Quantitative research with a cross-sectional study design. The research sample was selected through the Total Sampling Technique, namely all prolanis participants who have been registered at Talang Banjar Health Center, Jambi City, totaling 75 respondents. Data analysis using the chi square test. The results of the study showed that there was a relationship between Education (p = 0.049), knowledge (p = 0.000), accessibility (p = 0.043), and perception of disease (0.020) with prolanis utilization. There is no relationship between age (p = 0.254), gender (p = 0.383), occupation (p = 1.000), and health worker attitudes (p = 0.320) with the utilization of prolanis health services. It is concluded that education, knowledge, accessibility and perception of disease factors influence patient behavior in utilizing Prolanis services.

Tritya Eye Clinic Surabaya, as one of the developing eye health service providers today, faces a major challenge in providing optimal services for various patient segments, including BPJS Kesehatan participants, private insurance users, and general patients. Problems that occur with employees at the Tritya Eye Clinic, based on the results of a psychological test on September 9, 2024 on 24 employees, it was found that 22 employees had low/lacking emotional stability, in addition, based on personnel data in 2024, it was found that there were employees who committed violations with one of the causes being emotional stability based on the results of counseling conducted by the Head of HR. From the counseling, it was also found that employees have a desire for their well-being in the workplace, which is a trigger for expectations related to employee well-being and digitalization requires Tritya Eye Clinic to make changes that are expected to simplify work and minimize errors in work. The purpose of this study was to determine the effect of employee well being , emotional intelligence and job simplification on employee performance with employee achievement as an intervening variable on employees of Tritya Eye Clinic Surabaya. This study uses a quantitative method with primary data sources obtained from distributing questionnaires. The population of the study was employees of Tritya Eye Clinic Surabaya. The selection of respondents was carried out using the saturated non-probability sampling method with a total of 67 respondents . The data analysis method used descriptive analysis and SEM-PLS analysis. The results showed that the variables employee well being , emotional intelligence and job simplification had a positive and significant effect on employee performance through employee achievement on employees of Tritya Eye Clinic Surabaya.

Healthcare financing for patients covered by BPJS Kesehatan in hospitals is carried out through a claims mechanism. Delayed BPJS Kesehatan claims represent a critical issue within the healthcare service context in Indonesia. The aim of this study is to identify management strategies that can expedite the eligibility of BPJS Kesehatan claims at Restu Ibu Hospital in Balikpapan. This research is conducted using a descriptive qualitative approach, with data collection through interviews and Focus Group Discussions (FGD). The informants consisted of one doctor, three coders, and one verifier. The study begins by identifying the claim service system situation, focusing on both internal aspects (Strengths and Weaknesses) and external aspects (opportunities and Threats), also known as SWOT analysis. This study identifies several strategies, including: 1) Enhancing the competence of staff and medical personnel through regular training; 2) Developing a more advanced and integrated information system; 3) Improving communication with BPJS Kesehatan; 4) Improving documentation and data verification; and 5) Strengthening coordination with relevant units.

Non-formulary drug utilization in Harapan Kita Children’s and Mother’s Hospital presents a substantial challenge in healthcare cost management, especially for patients enrolled in the BPJS health insurance program. Given its status as a national referral hospital, Harapan Kita Children’s and Mother’s Hospital encounters a high prevalence of complex maternal and child health cases requiring the use of medications beyond the scope of the national formulary. This research endeavor seeks to examine the patterns and consequences of non-formulary drug use within this context. This study adopted a quasi-experimental design, incorporating both quantitative and qualitative methods, to evaluate the impact of an sosialisation intervention and audit clinic on physician compliance with formulary drug use. A pre-test and post-test design was employed to measure changes in non-formulary drug utilization. Findings indicated a statistically significant decrease in non-formulary drug use from 18% to 13% post-intervention. The integration of a clinical pathway and tailored physician training was instrumental in achieving improved formulary adherence. Given these results, it is recommended to broaden training and surveillance programs, strengthen technological support through the implementation of formulary information systems, and undertake longitudinal research to assess the long-term sustainability of the intervention's effects..

This study aims to determine and evaluate the BPJS Health Service Policy in the VIP Room of Edelweiss, Dr. M. M. Dunda Limboto Regional General Hospital, Gorontalo Regency. The research method used is qualitative descriptive. The results of the study indicate that several indicators of the effectiveness of the BPJS Health service policy in the VIP Room of Edelweiss, Dr. M. M. Dunda Limboto Regional General Hospital have not been running optimally. In terms of effectiveness, the administrative procedures are still considered unclear and not easy by patients and families, especially with the time limit for processing BPJS only 3 x 24 hours. The adequacy indicator is running quite well, but administrative information is only delivered verbally without written support, so patients or their families often have to ask again for the information needed. In terms of equality, although there are differences in facilities and comfort between the VIP room and the general care room, equality in processing BPJS administration is maintained. Responsiveness is considered good; administrative officers are considered fast and precise in providing solutions to obstacles faced by patients. However, in the accuracy indicator, some informants felt that the time given for administrative management was not yet in accordance with needs, especially for patient families who live far away or have other activities. This indicates the need for a re-evaluation of the time provisions and the delivery of more complete and written information.

This study aims to identify forms of violations of the right to health services in the implementation of BPJS Kesehatan, analyze the factors that cause them, and formulate preventive and limiting solutions. The research used a descriptive qualitative approach with in-depth interviews with six informants who were active BPJS Health participants in Tanjung Sari, East Jambi. The results showed that there was service discrimination in the form of different treatment between BPJS patients and general patients, patient rejection, administrative obstacles in emergency situations, and unavailability of drugs and medical facilities. Contributing factors include unequal distribution of health facilities, limited human resources, and a weak monitoring system. The experiences of BPJS participants confirm the gap between the program's objectives and the reality on the ground, reflecting a denial of the state's obligation to guarantee citizens' health rights. Comprehensive efforts are needed, including public education, administrative simplification, equitable distribution of health facilities, enforcement of strict sanctions, and active community involvement to realize quality and equitable health services.