Main Article Content
Abstract
The UN's Sustainable Development Goals (SDGs) target Universal Health Coverage (UHC) to ensure equitable access to health without financial burden. The National Health Insurance Program-Healthy Indonesia Card (JKN-KIS) by BPJS Kesehatan seeks to meet the health needs of the Indonesian people, especially vulnerable groups, including in East Java, which faces many cases of catastrophic diseases. This study aims to analyse the impact of the quality of referral health services and the efficiency of insurance administration on the satisfaction and quality of life of catastrophic patients in East Java. This study uses a positivist quantitative approach with a questionnaire-based Cross-Sectional design to collect data from outpatient catastrophic patients in East Java. Two hundred sixty-three responses were analysed using the PLS-SEM technique through SmartPLS 4.0 software to test hypotheses regarding the quality of referral services, insurance administration, patient satisfaction, and quality of life. The results showed that the ease of JKN-KIS administration significantly affected participant satisfaction, corroborating previous findings regarding the importance of easy access and simple administrative procedures in increasing the positive perception of services. In addition, the quality of referral health facility services also increases satisfaction, especially in meeting the care needs of catastrophic patients. Satisfaction with JKN-KIS also significantly impacts patients' quality of life, improving their physical health, emotional stability, and social satisfaction. These findings encourage optimising JKN-KIS services through digitisation and improving the quality of special services for catastrophic patients to maintain participant satisfaction and trust
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References
- Abu-Salim, T., Onyia, O. P., Harrison, T., & Lindsay, V. (2017). Effects of perceived cost, service quality, and customer satisfaction on health insurance service continuance. Journal of Financial Services Marketing, 22(4), 173–186. https://doi.org/10.1057/s41264-017-0035-4
- Adewole, D. A., Reid, S., Oni, T., & Adebowale, A. S. (2022). Factors Influencing Satisfaction with Service Delivery Among National Health Insurance Scheme Enrollees in Ibadan, Southwest Nigeria. Journal of Patient Experience, 9, 23743735221074184. https://doi.org/10.1177/23743735221074186
- Ardiansah, A., & Silm, S. O. (2020). Politik Hukum Pemenuhan Hak Atas Kesehatan Rakyat Indonesia Berdasarkan UU SJSN dan Undang-Undang BPJS. Jurnal IUS: Kajian Hukum Dan Keadilan, 8(1), 164–179.
- Becker, J.-M., Cheah, J.-H., Gholamzade, R., Ringle, C. M., & Sarstedt, M. (2023). PLS-SEM’s most wanted guidance. International Journal of Contemporary Hospitality Management, 35(1), 321–346. https://doi.org/10.1108/IJCHM-04-2022-0474
- Buselli, R., Corsi, M., Baldanzi, S., Chiumiento, M., Del Lupo, E., Dell’Oste, V., Bertelloni, C. A., Massimetti, G., Dell’Osso, L., & Cristaudo, A. (2020). Professional quality of life and mental health outcomes among health care workers exposed to Sars-Cov-2 (Covid-19)—International Journal of Environmental Research and Public Health, 17(17), 6180.
- Costa, D. S. J., Mercieca-Bebber, R., Rutherford, C., Tait, M.-A., & King, M. T. (2021). How is quality of life defined and assessed in published research? Quality of Life Research, 30, 2109–2121.
- Daramola, O. E., Maduka, W. E., Adeniran, A., & Akande, T. M. (2017). Evaluation of Patients’ Satisfaction with Services Accessed under the National Health Insurance Scheme at a Tertiary Health Facility in North Central, Nigeria. Journal of Community Medicine and Primary Health Care, 29(1), 11–17.
- del Pozo-Rubio, R., Mínguez-Salido, R., Pardo-García, I., & Escribano-Sotos, F. (2019). Catastrophic long-term care expenditure: associated socio-demographic and economic factors. The European Journal of Health Economics, 20(5), 691–701. https://doi.org/10.1007/s10198-019-01031-8
- Geng, J., Chen, X., Shi, J., Bao, H., Chen, Q., & Yu, H. (2021). Assessment of the satisfaction with public health insurance programs by patients with chronic diseases in China: a structural equation modelling approach. BMC Public Health, 21(1), 1886. https://doi.org/10.1186/s12889-021-11947-7
- Getaneh, M. M., Bayked, E. M., Workneh, B. D., & Kahissay, M. H. (2023). Satisfaction of beneficiaries with community-based health insurance and associated factors in Legambo District, North-East Ethiopia: a cross-sectional study. Frontiers in Public Health, 11. https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1127755
- Hair, J. F., Astrachan, C. B., Moisescu, O. I., Radomir, L., Sarstedt, M., Vaithilingam, S., & Ringle, C. M. (2021). Executing and interpreting applications of PLS-SEM: Updates for family business researchers. Journal of Family Business Strategy, 12(3). https://doi.org/10.1016/j.jfbs.2020.100392
- Hair, J. F., Matthews, L., Matthews, R. L., & Sarstedt, M. (2017). PLS-SEM or CB-SEM: updated guidelines on which method to use. International Journal of Multivariate Data Analysis, 1(2), 107–123. https://doi.org/10.1504/IJMDA.2017.087624
- Hair, J. F., Risher, J. J., Sarstedt, M., & Ringle, C. M. (2019). When to use and how to report the results of PLS-SEM. European Business Review, 31(1), 2–24. https://doi.org/10.1108/EBR-11-2018-0203
- Hair, J., Hollingsworth, C. L., Randolph, A. B., & Chong, A. Y. L. (2017). An updated and expanded assessment of PLS-SEM in information systems research. Industrial Management & Data Systems, 117(3), 442–458. https://doi.org/10.1108/IMDS-04-2016-0130
- Hildayanti, A. N., Batara, A. S., & Alwi, M. K. (2021). Determinan Ability To Pay dan Willingness To Pay Iuran Peserta Mandiri BPJS Kesehatan di Kecamatan Takabonerate (Studi Kasus di Kabupaten Kepulauan Selayar). Promotif: Jurnal Kesehatan Masyarakat, 11(1), 30–37.
- Hofstetter, S., Zilezinski, M., Wolf, A., Behr, D., Paulicke, D., Stoevesandt, D., Schwarz, K., Schönburg, S., & Jahn, P. (2023). Dfree ultrasonic sensor in supporting quality of life and patient satisfaction with bladder dysfunction. International Journal of Urological Nursing, 17(1), 62–69. https://doi.org/https://doi.org/10.1111/ijun.12334
- Hossain, F., Islam, R., Osugi, T., Shah, F., Mine, T., Nakashima, N., & Ahmed, A. (2024). Concept of Micro Healthcare Entrepreneurship (MHE) to Facilitate Universal Health Coverage (UHC): Prospects and Challenges. Sustainability (Switzerland), 16(6). https://doi.org/10.3390/su16062268
- Jackson, Y., Lozano Becerra, J. C., & Carpentier, M. (2016). Quality of diabetes care and health insurance coverage: a retrospective study in an outpatient academic public hospital in Switzerland. BMC Health Services Research, 16(1), 540. https://doi.org/10.1186/s12913-016-1801-z
- Jürges, H., & Stella, L. (2019). The social dynamics of unmet need, catastrophic healthcare expenses and satisfaction with health insurance coverage. Health and Socio–Economic Status over the Life Course, 269.
- Kaplan, G., Shahar, Y., & Tal, O. (2017). Supplementary Health Insurance from the consumer point of view: Are Israelis consumers doing an informed rational choice when purchasing Supplementary Health Insurance? Health Policy, 121(6), 708–714. https://doi.org/https://doi.org/10.1016/j.healthpol.2017.03.019
- Kustiyanti, S. A. (2023). Smart Hospital: Konsep, Implementasi, dan Tantangan. Transformasi Rumah Sakit Indonesia Menuju Era Masyarakat, 5, 161.
- Meidayanti, R. W., & Nurwahyuni, A. (2023). Hubungan Faktor Sosial Geografis Terhadap Pemanfaatan Pelayanan Kesehatan Pada Pasien Hipertensi Di FKTRL Tahun 2021: Analisis Data Sampel BPJS Kesehatan Tahun 2022. Jurnal Cahaya Mandalika ISSN 2721-4796 (Online), 4(3), 1882–1895.
- Merlis, M. (2014). Simplifying administration of health insurance. In Expanding Access to Health Care (pp. 279–298). Routledge.
- Mz, M. Q., Pane, M., Hutajulu, J., Tarigan, F. L., & Ginting, D. (2023). ANALISIS KESIAPAN RUMAH SAKIT BHAYANGKARA TK II MEDAN TERHADAP PELAKSANAAN KELAS RAWAT INAP STANDAR (KRIS). Jurnal Kesehatan Tambusai, 4(2), 1893–1911.
- Pahlevan Sharif, S., Naghavi, N., Ong, F. S., Sharif Nia, H., & Waheed, H. (2021). Health insurance satisfaction, financial burden, locus of control and quality of life of cancer patients: a moderated mediation model. International Journal of Social Economics, 48(4), 513–530. https://doi.org/10.1108/IJSE-10-2019-0629
- Ridiarsih, R., Nugroho, T. A., Ahsani, M. N., & Pasaribu, P. N. (2024). SOCIAL HEALTH INSURANCE ADMINISTRATION BODY PARTICIPANTS’SATISFACTION ON DECISION TO USE MOBILE JKN APPLICATION. Riset: Jurnal Aplikasi Ekonomi Akuntansi Dan Bisnis, 6(1), 104–119.
- Salim, D. L. F. (2020). Aksesibilitas Pembiayaan Kesehatan Dalam Program Jaminan Kesehatan Nasional. Lex Et Societatis, 8(4).
- Sandi, M. R., Martini, S., Artanti, K. D., & Widati, S. (2019). The description of modifiable risk factors in coronary heart disease at dr. Soetomo regional public hospital. THE DESCRIPTION OF MODIFIABLE RISK FACTORS IN CORONARY HEART DISEASE AT DR. SOETOMO REGIONAL PUBLIC HOSPITAL, 7(2).
- Sarker, A. R., Sultana, M., Ahmed, S., Mahumud, R. A., Morton, A., & Khan, J. A. M. (2018). Clients’ experience and satisfaction of utilizing healthcare services in a community based health insurance program in Bangladesh. International Journal of Environmental Research and Public Health, 15(8), 1637.
- Situmeang, L. E., & Hidayat, B. (2018). Pengaruh Kepemilikan Jaminan Kesehatan terhadap Belanja Kesehatan Katastropik Rumah Tangga di Indonesia Tahun 2012. Jurnal Kebijakan Kesehatan Indonesia: JKKI, 7(1), 1–9.
- Solida, A., Mekarisce, A. A., & Wisudariani, E. (2023). Peran Prolanis Memberikan Perlindungan Biaya Kesehatan Mencegah Pengeluaran Katastropik di Kota Jambi. Jurnal Ilmiah Universitas Batanghari Jambi, 23(3), 3117–3124.
- Streukens, S., & Leroi-Werelds, S. (2016). Bootstrapping and PLS-SEM: A step-by-step guide to get more out of your bootstrap results. European Management Journal, 34(6), 618–632. https://doi.org/10.1016/j.emj.2016.06.003
- Tefera, B. B., Kibret, M. A., Molla, Y. B., Kassie, G., Hailemichael, A., Abate, T., Zelelew, H., Desta, B. F., Futrell, E., & Kebede, Z. (2021). The interaction of healthcare service quality and community-based health insurance in Ethiopia. PLoS One, 16(8), e0256132.
- Wallengren, E., Guthold, R., Newby, H., Moller, A.-B., Marsh, A. D., Fagan, L., Azzopardi, P., Ba, M. G., & Kågesten, A. E. (2024). Relevance of the Sustainable Development Goals (SDGs) to Adolescent Health Measurement: A Systematic Mapping of the SDG Framework and Global Adolescent Health Indicators. Journal of Adolescent Health, 74(6), S47–S55. https://doi.org/10.1016/j.jadohealth.2024.01.004
- Williams, S. J., & Radnor, Z. J. (2022). Moving from service to sustainable services: a healthcare case study. International Journal of Productivity and Performance Management, 71(4), 1126–1148. https://doi.org/10.1108/IJPPM-12-2019-0583
References
Abu-Salim, T., Onyia, O. P., Harrison, T., & Lindsay, V. (2017). Effects of perceived cost, service quality, and customer satisfaction on health insurance service continuance. Journal of Financial Services Marketing, 22(4), 173–186. https://doi.org/10.1057/s41264-017-0035-4
Adewole, D. A., Reid, S., Oni, T., & Adebowale, A. S. (2022). Factors Influencing Satisfaction with Service Delivery Among National Health Insurance Scheme Enrollees in Ibadan, Southwest Nigeria. Journal of Patient Experience, 9, 23743735221074184. https://doi.org/10.1177/23743735221074186
Ardiansah, A., & Silm, S. O. (2020). Politik Hukum Pemenuhan Hak Atas Kesehatan Rakyat Indonesia Berdasarkan UU SJSN dan Undang-Undang BPJS. Jurnal IUS: Kajian Hukum Dan Keadilan, 8(1), 164–179.
Becker, J.-M., Cheah, J.-H., Gholamzade, R., Ringle, C. M., & Sarstedt, M. (2023). PLS-SEM’s most wanted guidance. International Journal of Contemporary Hospitality Management, 35(1), 321–346. https://doi.org/10.1108/IJCHM-04-2022-0474
Buselli, R., Corsi, M., Baldanzi, S., Chiumiento, M., Del Lupo, E., Dell’Oste, V., Bertelloni, C. A., Massimetti, G., Dell’Osso, L., & Cristaudo, A. (2020). Professional quality of life and mental health outcomes among health care workers exposed to Sars-Cov-2 (Covid-19)—International Journal of Environmental Research and Public Health, 17(17), 6180.
Costa, D. S. J., Mercieca-Bebber, R., Rutherford, C., Tait, M.-A., & King, M. T. (2021). How is quality of life defined and assessed in published research? Quality of Life Research, 30, 2109–2121.
Daramola, O. E., Maduka, W. E., Adeniran, A., & Akande, T. M. (2017). Evaluation of Patients’ Satisfaction with Services Accessed under the National Health Insurance Scheme at a Tertiary Health Facility in North Central, Nigeria. Journal of Community Medicine and Primary Health Care, 29(1), 11–17.
del Pozo-Rubio, R., Mínguez-Salido, R., Pardo-García, I., & Escribano-Sotos, F. (2019). Catastrophic long-term care expenditure: associated socio-demographic and economic factors. The European Journal of Health Economics, 20(5), 691–701. https://doi.org/10.1007/s10198-019-01031-8
Geng, J., Chen, X., Shi, J., Bao, H., Chen, Q., & Yu, H. (2021). Assessment of the satisfaction with public health insurance programs by patients with chronic diseases in China: a structural equation modelling approach. BMC Public Health, 21(1), 1886. https://doi.org/10.1186/s12889-021-11947-7
Getaneh, M. M., Bayked, E. M., Workneh, B. D., & Kahissay, M. H. (2023). Satisfaction of beneficiaries with community-based health insurance and associated factors in Legambo District, North-East Ethiopia: a cross-sectional study. Frontiers in Public Health, 11. https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1127755
Hair, J. F., Astrachan, C. B., Moisescu, O. I., Radomir, L., Sarstedt, M., Vaithilingam, S., & Ringle, C. M. (2021). Executing and interpreting applications of PLS-SEM: Updates for family business researchers. Journal of Family Business Strategy, 12(3). https://doi.org/10.1016/j.jfbs.2020.100392
Hair, J. F., Matthews, L., Matthews, R. L., & Sarstedt, M. (2017). PLS-SEM or CB-SEM: updated guidelines on which method to use. International Journal of Multivariate Data Analysis, 1(2), 107–123. https://doi.org/10.1504/IJMDA.2017.087624
Hair, J. F., Risher, J. J., Sarstedt, M., & Ringle, C. M. (2019). When to use and how to report the results of PLS-SEM. European Business Review, 31(1), 2–24. https://doi.org/10.1108/EBR-11-2018-0203
Hair, J., Hollingsworth, C. L., Randolph, A. B., & Chong, A. Y. L. (2017). An updated and expanded assessment of PLS-SEM in information systems research. Industrial Management & Data Systems, 117(3), 442–458. https://doi.org/10.1108/IMDS-04-2016-0130
Hildayanti, A. N., Batara, A. S., & Alwi, M. K. (2021). Determinan Ability To Pay dan Willingness To Pay Iuran Peserta Mandiri BPJS Kesehatan di Kecamatan Takabonerate (Studi Kasus di Kabupaten Kepulauan Selayar). Promotif: Jurnal Kesehatan Masyarakat, 11(1), 30–37.
Hofstetter, S., Zilezinski, M., Wolf, A., Behr, D., Paulicke, D., Stoevesandt, D., Schwarz, K., Schönburg, S., & Jahn, P. (2023). Dfree ultrasonic sensor in supporting quality of life and patient satisfaction with bladder dysfunction. International Journal of Urological Nursing, 17(1), 62–69. https://doi.org/https://doi.org/10.1111/ijun.12334
Hossain, F., Islam, R., Osugi, T., Shah, F., Mine, T., Nakashima, N., & Ahmed, A. (2024). Concept of Micro Healthcare Entrepreneurship (MHE) to Facilitate Universal Health Coverage (UHC): Prospects and Challenges. Sustainability (Switzerland), 16(6). https://doi.org/10.3390/su16062268
Jackson, Y., Lozano Becerra, J. C., & Carpentier, M. (2016). Quality of diabetes care and health insurance coverage: a retrospective study in an outpatient academic public hospital in Switzerland. BMC Health Services Research, 16(1), 540. https://doi.org/10.1186/s12913-016-1801-z
Jürges, H., & Stella, L. (2019). The social dynamics of unmet need, catastrophic healthcare expenses and satisfaction with health insurance coverage. Health and Socio–Economic Status over the Life Course, 269.
Kaplan, G., Shahar, Y., & Tal, O. (2017). Supplementary Health Insurance from the consumer point of view: Are Israelis consumers doing an informed rational choice when purchasing Supplementary Health Insurance? Health Policy, 121(6), 708–714. https://doi.org/https://doi.org/10.1016/j.healthpol.2017.03.019
Kustiyanti, S. A. (2023). Smart Hospital: Konsep, Implementasi, dan Tantangan. Transformasi Rumah Sakit Indonesia Menuju Era Masyarakat, 5, 161.
Meidayanti, R. W., & Nurwahyuni, A. (2023). Hubungan Faktor Sosial Geografis Terhadap Pemanfaatan Pelayanan Kesehatan Pada Pasien Hipertensi Di FKTRL Tahun 2021: Analisis Data Sampel BPJS Kesehatan Tahun 2022. Jurnal Cahaya Mandalika ISSN 2721-4796 (Online), 4(3), 1882–1895.
Merlis, M. (2014). Simplifying administration of health insurance. In Expanding Access to Health Care (pp. 279–298). Routledge.
Mz, M. Q., Pane, M., Hutajulu, J., Tarigan, F. L., & Ginting, D. (2023). ANALISIS KESIAPAN RUMAH SAKIT BHAYANGKARA TK II MEDAN TERHADAP PELAKSANAAN KELAS RAWAT INAP STANDAR (KRIS). Jurnal Kesehatan Tambusai, 4(2), 1893–1911.
Pahlevan Sharif, S., Naghavi, N., Ong, F. S., Sharif Nia, H., & Waheed, H. (2021). Health insurance satisfaction, financial burden, locus of control and quality of life of cancer patients: a moderated mediation model. International Journal of Social Economics, 48(4), 513–530. https://doi.org/10.1108/IJSE-10-2019-0629
Ridiarsih, R., Nugroho, T. A., Ahsani, M. N., & Pasaribu, P. N. (2024). SOCIAL HEALTH INSURANCE ADMINISTRATION BODY PARTICIPANTS’SATISFACTION ON DECISION TO USE MOBILE JKN APPLICATION. Riset: Jurnal Aplikasi Ekonomi Akuntansi Dan Bisnis, 6(1), 104–119.
Salim, D. L. F. (2020). Aksesibilitas Pembiayaan Kesehatan Dalam Program Jaminan Kesehatan Nasional. Lex Et Societatis, 8(4).
Sandi, M. R., Martini, S., Artanti, K. D., & Widati, S. (2019). The description of modifiable risk factors in coronary heart disease at dr. Soetomo regional public hospital. THE DESCRIPTION OF MODIFIABLE RISK FACTORS IN CORONARY HEART DISEASE AT DR. SOETOMO REGIONAL PUBLIC HOSPITAL, 7(2).
Sarker, A. R., Sultana, M., Ahmed, S., Mahumud, R. A., Morton, A., & Khan, J. A. M. (2018). Clients’ experience and satisfaction of utilizing healthcare services in a community based health insurance program in Bangladesh. International Journal of Environmental Research and Public Health, 15(8), 1637.
Situmeang, L. E., & Hidayat, B. (2018). Pengaruh Kepemilikan Jaminan Kesehatan terhadap Belanja Kesehatan Katastropik Rumah Tangga di Indonesia Tahun 2012. Jurnal Kebijakan Kesehatan Indonesia: JKKI, 7(1), 1–9.
Solida, A., Mekarisce, A. A., & Wisudariani, E. (2023). Peran Prolanis Memberikan Perlindungan Biaya Kesehatan Mencegah Pengeluaran Katastropik di Kota Jambi. Jurnal Ilmiah Universitas Batanghari Jambi, 23(3), 3117–3124.
Streukens, S., & Leroi-Werelds, S. (2016). Bootstrapping and PLS-SEM: A step-by-step guide to get more out of your bootstrap results. European Management Journal, 34(6), 618–632. https://doi.org/10.1016/j.emj.2016.06.003
Tefera, B. B., Kibret, M. A., Molla, Y. B., Kassie, G., Hailemichael, A., Abate, T., Zelelew, H., Desta, B. F., Futrell, E., & Kebede, Z. (2021). The interaction of healthcare service quality and community-based health insurance in Ethiopia. PLoS One, 16(8), e0256132.
Wallengren, E., Guthold, R., Newby, H., Moller, A.-B., Marsh, A. D., Fagan, L., Azzopardi, P., Ba, M. G., & Kågesten, A. E. (2024). Relevance of the Sustainable Development Goals (SDGs) to Adolescent Health Measurement: A Systematic Mapping of the SDG Framework and Global Adolescent Health Indicators. Journal of Adolescent Health, 74(6), S47–S55. https://doi.org/10.1016/j.jadohealth.2024.01.004
Williams, S. J., & Radnor, Z. J. (2022). Moving from service to sustainable services: a healthcare case study. International Journal of Productivity and Performance Management, 71(4), 1126–1148. https://doi.org/10.1108/IJPPM-12-2019-0583