Effect of Dimensions of Service Quality on

Satisfaction of BPJS Patiests in Outpatient Health

Abstract--- Health center is the first level health facility in the community, therefore it must pay attention to the
quality of service to patients. This study aims to determine the quality of service to the satisfaction of BPJS patients
in outpatient facilities at the Bungah Gresik Health Center. Variables in this study are dimensions of service quality
with patient satisfaction. The type of research used is quantitative analytical descriptive handled in February-April
2019 with a sample of 89 respondents. Data obtained through questionnaires and interviews, data analysis using a
binary logistic regression statistical test. The results showed that 88.76% of respondents stated that the service
quality of the Bungah health center was good and 77.53% of respondents said they were satisfied with the services
of the Bungah health center. The results of statistical tests show there are influences between the dimensions of
tangible, empathetic, and assurance of patient satisfaction with p-values of 0.022, 0.029, and 0.040. While the
dimensions of reliability and responsiveness have no effect on patient satisfaction with a p-value of 0.389, and
0.316. Suggestions for Bungah health centers need to improve the quality of services by adding supporting facilities,
human resources, and attention to patient complaints to improve patients pain.

Keywords--- Health center, dimensions of service quality, patient satisfaction.

I. INTRODUCTION
Health Services is an effort that is held alone or jointly in an organization to maintain and improve health,
prevent and cure diseases and restore the health of individuals, families, groups, and communities (Nur, 2018).

from detik.com, BPJS services in East Java are still unsatisfactory, from the results of a survey conducted by
BPJS Watch East Java in May 2017. There are seven problems, including the length of time to wait for health
services, the lack of a structured referral system, unfriendly officers in health facilities, partial health checks,
complicated administrative procedures, additional costs taken to patients, and administration of drugs that are still in
installments to patients with chronic illness. According to BPJS data in 2017, there were 134.9 million visits to BPJS
patients who were treated at First Level Health Facilities (Detik News, 2017).

Based on the results of Gusti's research (2014), the index of patient satisfaction at the Kedamean Health Center
in Gresik District in 2014 amounted to 70.82%, which showed that the results were quite satisfied with health


Sakhowi A. Al Awwarij, University of NU Surabaya, Indonesia. E-mail: Achmad.km15@student.unusa.ac.id
Chilyatiz Zahroh, University of NU Surabaya, Indonesia.
Satriya Wijaya., University of NU Surabaya, Indonesia. E-mail: swijaya7@gmail.com
Khamida, University of NU Surabaya, Indonesia.
Agus Aan Adriansyah, University of NU Surabaya, Indonesia.
services, which should be targeted at patient satisfaction reaching 85%. As a frontline provider of public health
services, health center must be able to improve the level of public health optimally by paying attention to the quality
of services to patients, in order to increase patient satisfaction.

From the results of a study conducted by Wira (2014) at Wangya Denpasar Hospital, it shows that one of the
factors that influence patient satisfaction is from the dimensions of service quality consisting of tangible, reliability,
responsiveness, assurance and empathy.

BPJS efforts to increase participant satisfaction and improve Puskesmas performance, BPJS held a Participant
Message Impression After Service program aimed at BPJS participants who were in the health center. Data from
Participant Message the Bungah Health Center experienced a decline in value which initially had a value of 66.5 in
March, then in November, there was a decrease in value of 66. This is still less than the target desired by BPJS to get
an 80 rating per month.

Based on the description above, the researchers are interested in examining the Effect of Dimensions of Service
Quality on Satisfaction of BPJS Patients in Outpatient Services at Bungah Gresik Health Center.

II. METHODOLOGY
The type of research used is descriptive quantitative analytic. The method of sampling by simple random
sampling using lottery method. This study was conducted at Bungah Gresik health center. In this study, all BPJS
patients at the outpatient health center of Bungah Health center were 795 patients with 89 respondents for sample.
Data collection using questionnaires and interviews, data analysis using binary logistic regression statistical test.

III.RESULTS
1. Dimensions of service quality
Assessment of service quality there is five dimensions of service quality, the dimensions that get the most ratings
are good, namely dimensions of reliability, responsiveness, assurance, and empathy. While the dimensions that get
the lowest good rating are tangible dimensions. This shows that overall the dimensions of service quality are good.

The quality of service in the outpatient installation at Bungah Gresik health center is good. This can be seen from
the results of respondents' evaluations of the quality of services available at the outpatient installation at Bungah
health center. The thing that causes BPJS patients in the Outpatient Installation of Satisfied the service of good
health workers, close to home and complete facilities in poly, while the causes of BPJS patients are not satisfied
with the services available at the outpatient installation at Bungah health center specifically the length of waiting
time, lack of parking area, and lack of seats to wait.

Service quality emphasizes the level of perfection of health services in generating satisfaction in patients
(Herlambang, 2016). Whereas according to Kotler (2007), Quality of service is a whole characteristic and nature of
a product or service that influences its ability to satisfy expressed or implied needs.

The first dimension of service quality that gets the best rating is the reliability dimension. Almost all respondents
(89.89%) stated that the reliability dimension was good. So that it can be concluded that in general, the majority of
patients believe in the reliability and accuracy of services provided by health workers quickly, and with the
reliability that health workers have is able to be fair in providing services to patients without distinguishing social
status or other factors (not being discriminatory). According to Tjitono (2016), the reliability dimension shows the
company's ability to provide services or services that are expected to be convincing, fast, precise, accurate, reliable,
and consistent.

The second dimension of service quality that gets the most ratings is the responsiveness dimension. Almost all
respondents (80.90%) stated that the dimensions of responsiveness were good. Thus, it can be said that most patients
believe in the readiness of officers in helping patients if there are difficulties, responsiveness, and ability of officers
to help patients solve problems faced, and the responsiveness of officers in providing information on services
provided clearly at the outpatient installation at Bungah health center. Responsibility is pleased with the willingness
and ability of employees to help customers and process their requests, and inform when services will be provided
and then provide services quickly. This dimension emphasizes the attitude of service providers who are attentive and
responsive in providing services (Tjiptono, 2016).

The third dimension of service quality that gets the most ratings is the assurance dimension. Almost all
respondents (80.90%) stated that the assurance dimension was good. Thus, it can be said that most patients believe
in the ability of health workers to provide treatment to patients, and the creation of a safe and family atmosphere
between health workers and patients who seek treatment. the assurance dimension, which is the behavior of
employees who are able to foster customer trust in companies and companies, can create a sense of security for their
customers. Security also means that employees are always polite and master the knowledge and skills needed to
handle each customer's question or problem.

The fourth dimension of service quality that gets the best rating is the empathy dimension (attention), almost all
respondents (78.65%) suggest good. The empathy dimension shows the ability of service providers to provide
genuine and individual attention given to consumers by understanding their desires, and health workers being polite
and using language that is easily understood by patients. The empathy dimension is pleasing to facilitate
communication, good communication and understanding customers' problems and acting in the interest of, as well
as providing personal attention and understanding of the individual needs of customers (Tjiptono, 2016).
Communication means keeping every customer getting information in accordance with a language that they
understand and based on their wishes (Herlambang, 2016).

The last dimension of service quality that gets the lowest good rating is the tangible dimension. Although getting
the lowest score, almost most of the respondents (71.91%) stated that the service was in a good tangible dimension.
This was found in the respondent's answer to the questionnaire which complained that there were still inadequate
facilities such as lack of cleanliness of the room and lack of parking space. The tangible dimension is the physical
appearance of the services offered, equipment, personnel, and communication facilities. Physical evidence is
pleasing to the physical appearance of service facilities, equipment, human resources, and communication. Thus
direct evidence to realize is one of the most concrete indicators, its form in the form of all facilities that can be
clearly seen (Tjiptono, 2016).
2. Patient satisfaction
The results of this study indicate that BPJS patients at the outpatient installation at Bungah health center were
almost entirely respondents (77.53%) were satisfied with the existing services, but there were still BPJS patients
who felt dissatisfied. Patient satisfaction includes good health care services, the information obtained is complete,
close to home, does not differentiate services between general patients and BPJS patients, the availability of
complete drugs, the suitability of the days and hours of practice on the bulletin board and no additional fees that is
applied to BPJS patients when seeking treatment.

Whereas the causes of BPJS patients are not satisfied with the services available at the outpatient installation at
Bungah health center according to the results of respondents' answers in the questionnaire that they lack parking
space, they complain that it is difficult to get a parking space for their vehicles so patients park their motorbikes
outside the Bungah Health Center it is not safe for the vehicles they park, the lack of seats to wait for causes patients
to stand while waiting for service. Then the length of the waiting time, more than 60 minutes the patients waited to
get service at the Bungah health center. And other dissatisfied statements such as lack of friendliness of health
workers with patients, information obtained, lack of hygiene, and diagnostic errors by doctors.

This is because there is still a lack of improvement in terms of patient complaints, even though there has been a
suggestion box used to convey patient complaints to the health center, and there is still no minimum standard of
patient satisfaction at the Bungah Gresik Health Center. Customer satisfaction is a response to the level of interest or
expectations of customers before they receive services after the service they receive. The satisfaction of the use of
health services can be concluded as the difference in the performance of health service institutions with the
expectations of customers (patients or community groups) Muninjaya, 2013).

factors that influence patient satisfaction are an approach to employee behavior, quality of the information
received, agreement procedures, waiting time, public facilities provided and outcomes (Dhiyanto, 2014). Whereas
according to Arifin and Prasetya (2006). The factors that influence patient satisfaction and decision to visit (medical
treatment) to a health facility are doctor services, safety, location, cleanliness, food menu, waiting for time, parking,
emergency services, drug availability and opening hours.

3. The influence of service quality dimensions on patient satisfaction

The results showed that there was a significant effect between the tangible dimension on the satisfaction of BPJS
patients in the outpatient installation at Bungah health center and the first strongest dimension affecting patient
satisfaction, with a p-value < α (0.10). This happens because physical evidence is one of the determinants of
customer satisfaction. Patients assess the quality of health service from existing physical evidence, especially for the
cleanliness of the room and inadequate waiting room facilities. So that the better the dimensions of physical
evidence given, the more patient satisfaction will be increased.

This research is in line with Yessi's research (2018) at Seringin Health Center, Medan Tembung Subdistrict
which states that physical evidence has a direct and not significant effect on satisfaction with a significance value of
0.131> 0.005 and Thitung <T table (1.524 < 1.1985)[11]. In addition, it is also in line with Indra's (2014) research that
there is a significantly positive effect between the tangible dimension on Patient Satisfaction in Muara Taweh
Hospital.

Patients use their sense of sight to assess the quality of health services. A health service organization such as a
health center must have a service room and comfortable, regular and clean environmental conditions in order to
provide satisfaction to patients. in general, patients treated are also somewhat satisfied if the health care provider has
prepared a complete and appropriate examination and treatment tool (Novita, 2016).

The results of this study indicate that there is a significant influence between the empathy dimension on the
satisfaction of BPJS patients in the outpatient installation at Bungah health center and the second strongest
dimension affecting patient satisfaction. With a p-value < α (0.10). This happens because empathy is one of the
determinants of customer satisfaction. Patients assess the quality of health service from the attention of existing
employees especially for the hospitality of health workers, the language used impartiality and applying smiles,
greetings, and greetings. the better the empathy dimension is given, the more it will increase patient satisfaction.

This research is in line with Yessi's research (2018) at Seringin Health Center, Medan Tembung Subdistrict
which states that the empathy dimension has a positive and not significant effect on satisfaction with a significance
value of 0.293> 0.005 and Thitung <T table (1.985 < 1.1985). Besides that, it is also in line with Indra's (2014)
research that there is a significantly positive effect between the empathy dimensions of Patient Satisfaction in Muara
Taweh Hospital. the empathy that is giving a sincere and individual or personal attitude that is given to customers by
understanding consumer desires (Khasanah, 2010).

The results of this study indicate that there is a significant influence between the assurance dimension of BPJS
patient satisfaction in the outpatient installation at Bungah health center and the third strongest dimension affecting
patient satisfaction. With a p-value < α (0.10). This happens because the guarantee dimension is one of the
determinants of customer satisfaction. Patients can assess the quality of health service from the existing guarantee
dimension specifically for the creation of a sense of security, comfort, and family life in the health center and
diagnosis by health workers. So that the better the guarantee dimension is given, the more it will increase patient
satisfaction.

This research is in line with Yessi's research (2018) at Seringin Health Center, Medan Tembung Subdistrict
which states that the guarantee dimension has a positive and significant effect on satisfaction with a significance
value of 0.003 <0.05 and Calculate <T table (3.085 < 1.1985). Besides that, it is also in line with Indra's (2014)
research that there is a significantly positive effect between the dimensions of assurance for Patient Satisfaction in
Muara Taweh Hospital.

The assurance dimension, which is the behavior of health workers, can foster trust in patients in health facilities
and health facilities can create a sense of security for patients. According to Purwoastuti (2015), the guarantee of
employee behavior is able to foster patient trust in health facilities and can create a sense of comfort for the part.
Guarantees also mean employees are polite and master the knowledge and skills needed to handle each customer's
questions and problems. Guarantees to consumers include capabilities, politeness, and trustworthiness that are
owned by staff, free of danger or risk of doubt, the behavior of employees is expected to foster trust and the
company is expected to foster a sense of security for customers (Parasuraman, 1998).

The results of this study indicate that there is no significant effect between the reliability dimension on the
satisfaction of BPJS patients in the outpatient installation at Bungah health center, with a p-value > α (0.10). This is
because the reliability in Bungah Health Center has been considered good, patients assess the quality of a health care
provider from the reliability of health workers who handle the disease explanation and skills in treating the disease.

The results of this study are not in line with Lesmana's (2014) research that the dimensions of reliability
positively influence patient satisfaction at Muara Taweh Hospital [17]. As well as Yessi's research (2018) in the
Puskesmas Seringin Subdistrict Tembung, which stated that reliability has a significant and significant effect on
patient satisfaction with a significance value of 0.0054 < 0.05 and Thitung > T table (2.852 > 1.985). reliability
relates to the ability to provide accurate services for the first time without making any mistakes in delivering
services in accordance with the agreed time. A health facility is said to be reliable if the patient admission process is
carried out quickly and the administrative procedures are not complicated (Novita, 2016).

The results of this study indicate that there is no significant effect between the dimensions of responsiveness to
the satisfaction of BPJS patients at the Outpatient Installation of the Bungah Gresik Health Center. With p-value > α
(0.10). This is because the responsiveness at Bungah Health Center has been considered good. Patients assess the
quality of service from the responsiveness of health workers from the patient to come, the registration section, to
listening to patient complaints. So that the better the responsiveness dimension is given, the more it will increase
patient satisfaction.

Responsiveness shows the desire to help consumers and provide services quickly and precisely, letting
consumers wait without any reason that causes negative perceptions in service quality (Lupiyoadi, 2006). The
implementation of quality health care relations between health workers and patients must be good. The quick
attitude and responsiveness of the staff in handling patient complaints are explained and done well and make the
patient understand every action taken. The doctor explains each question and explains what to do and what not to do
(Azwar, 2006).

IV. CONCLUSION
The results of this study were that BPJS patients almost all expressed satisfaction with the quality of services at
the Bungah Gresik health center, almost all BPJS patients said they were satisfied with the services at the outpatient
installation at Bungah health center.

from the five dimensions of service quality that have a significant influence on the satisfaction of BPJS patients
in the outpatient installation at Bungah Gresik health center, only the dimensions are tangible, empathetic, and
assurance. While the dimensions of reliability and responsiveness do not have a significant effect on the satisfaction
of BPJS patients in the outpatient installation at Bungah health center.
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