e-ISSN: 2549-0281 Publisher: Masters Program in Public Health, Universitas Sebelas Maret, Indonesia Editor in Chief: Dr. Rossi Sanusi, Universitas Gadjah Mada, Indonesia Aim and Scope The Journal of Health Policy and Management (JHPM) is a peer-reviewed, open-access international journal that publishes original research articles, systematic reviews, and meta-analyses on a four-monthly basis. Since its establishment on October 21, 2015, JHPM has served as a critical platform for disseminating high-quality, policy-relevant research that informs and influences health care systems and public health governance worldwide. JHPM provides a forum for researchers, policy-makers, health care managers, public health professionals, and academics to engage with evidence-based insights into the formulation, implementation, and evaluation of health policy and management practices. The journal embraces multidisciplinary and integrative approaches to better understand complex health challenges and generate innovative, actionable solutions. The scope of JHPM spans a wide array of topics, including but not limited to: Health policy development and analysis Health systems management and governance Health economics and financing Epidemiological research with policy implications Public and social policy in health Strategic health planning and administration Equity and access in health care delivery Ethical and philosophical dimensions of health policy Global health policy and comparative health systems JHPM welcomes rigorous research from scholars and practitioners across the globe, with a strong emphasis on contributions from low- and middle-income countries (LMICs). We especially encourage submissions that address urgent health system issues, propose innovative models of care, or evaluate health policy impacts in diverse settings. By promoting dialogue across disciplines and geographies, the Journal of Health Policy and Management aims to foster practical knowledge, inform policy decisions, and support the advancement of efficient, equitable, and sustainable health systems worldwide.
Masters Program in Public Health, Universitas Sebelas Maret, Indonesia
Evaluation of Anesthesia Management Care in the Central Surgical Installation
Background: Effective anesthesia management is essential to ensure patient safety, minimize perioperative complications, and promote optimal recovery. Comprehensive planning across the pre-, intra-, and postoperative phases allows anesthesiologists to deliver systematic and high-quality care. Evaluating each component of anesthesia services context, input, process, product, and outcome is crucial for maintaining professional standards and improving patient satisfaction. Therefore, this study aimed to evaluate anesthesia care arrangements (pre-, intra-, and postoperative) at the Central Surgical Installation of dr. Soepraoen Kesdam V/Brawijaya Malang Hospital using the CIPP evaluation model. Subjects and Method: This qualitative evaluative study was conducted from June 1 to July 1, 2024, employing the Context, Input, Process, and Product (CIPP) framework. Five anesthesiologists were selected through probability sampling. Data were collected through in-depth interviews, direct observations, document reviews, and Focus Group Discussions, and analyzed through data reduction, classifica­tion, and interpretation. Results: Evaluation of the context and input components showed that anesthesia services complied with professional standards and ASKAN guidelines, supported by adequate human resources, infrastructure, and standard operating procedures. The process component including assessment, diagnosis, intervention, implementation, evaluation, and documentation was implemented adequately but not fully aligned with the ASKAN guidelines. Product evaluation indicated satisfactory documentation quality with partial conformity to the 2023 ASKAN edition. The outcome showed stable patient hemodynamics and high satisfaction levels. Conclusion: Context and input components were well-implemented, while process and product evaluations were adequate but require improved documentation to align with the latest ASKAN standards.
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The Influence of Servqual Indicators in Measuring Health Service Quality and Patient Satisfaction
Background: Health services are organized efforts by individuals or institutions to prevent and treat diseases, restore health, and improve community well-being. Both government and private healthcare institutions play a crucial role in ensuring accessible and high-quality services. The quality of health services is a key determinant of patient satisfaction. This study aimed to assess the SERVQUAL indicators in measuring the quality of health services and patient satisfaction at Diponegoro National Hospital. Subjects and Method: A cross-sectional study was conducted at Diponegoro National Hospital, Semarang, in July 2024. A total of 200 patients were recruited using accidental sampling. The dependent variables were service quality and patient satisfaction, while the independent variables included age, education, gender, and financing method. Data were collected using structured questionnaires and analyzed through path analysis. Results: The concept of service quality was represented by SERVQUAL indicators: reliability (b= 0.61; 95% CI= 0.46–0.76; p<0.001), assurance (b= 0.50; 95% CI= 0.35–0.64; p<0.001), tangibles (b= 0.67; 95% CI= 0.56–0.78; p<0.001), and responsiveness (b= 0.66; 95% CI= 0.46–0.76; p<0.001). Patient satisfaction showed a positive structural relationship with service quality (b= 0.31; 95% CI= 0.07–0.55; p= 0.012). The financing method also affected satisfaction, with insured (BPJS) patients reporting higher satisfaction than general patients (b= 0.15; 95% CI= 0.02–0.27; p= 0.015). Conclusion: Health service quality is defined by multiple SERVQUAL indicators, including reliability, assurance, tangibles, empathy, and responsiveness. Patient satisfaction is positively associated with service quality and influenced by the financing method, indicating the importance of equitable and high-quality healthcare delivery
Associations between Reliability, Assurance, Physical Evidence, Responsiveness, Empathy, Gender, and Income with Inpatient Satisfaction in Yos Sudarso Hospital, Padang, Indonesia
Background: Patient satisfaction refers to the patient's perception and assessment of the quality of health services he receives. There are many factors that affect patient satisfaction. This study aims to analyze variables that affect patient satisfaction. Subjects and Method: This study is an observational analytical study with a cross-sectional design. This research was conducted on Yos Sudarso Hospital, Padang City, in March-May 2024. A sample of 200 patients was selected by simple random sampling. The dependent variable in this study is patient satisfaction. The independent variables in the study were reliability, guarantee, physical evidence, responsiveness, empathy, gender, and income. Data collection was carried out using a questionnaire and analyzed by path analysis. Results: Patient satisfaction in the health center was influenced by reliability ((b= 0.51; 95% CI= 0.39 to 0.62; p<0.001)), assurance (b= 0.62; 95% CI= 0.52 to 0.72; p<0.001), physical evidence (b= 0.52; 95% CI= 0.41 to 0.64; p<0.001), responsiveness (b= 0.69; 95% CI= 0.60 to 0.78; p<0.001), empathy (b= 0.69; 95% CI= 0.60 to 0.78; p<0.001), gender (b = 0.15; 95% CI = <0.01 to 0.30; p = 0.047), and income (b = -0.31; 95% CI = -0.45 to -0.17; p<0.001). Conclusion: Patient satisfaction is positively influenced by reliability, assurance, physical evidence, responsiveness, empathy, gender, and income.
The Influence of Social Capital, Commitment, Justice, Employee Status, Age, Gender, and Community Health Center Strata on Performance at the Metro, Lampung, Indonesia
Background: The performance of health workers is one of the biggest reasons for the good health services. Various factors affect employee performance such as commitment, employee status, justice and social capital. This study aims to see the influence of social capital along with other accompanying factors such as justice, organizational commitment, employee status, and strata of the Health Center on the performance of Health Center employees. Subjects and Method: This study is an observational analytical study with a cross-sectional design. This research was conducted on 11 health centers in Metro City, Lampung, Indonesia in April - May 2024. A sample of 200 health center employees was selected by simple random sampling. The dependent variable in this study is the performance of health center employees. The independent variables in the study were social capital, fairness, organizational commitment, employee status, health center strata, age, and gender. Data collection was carried out using a questionnaire and analyzed by multiple linear regression. Results: Social capital (b= 0.07; CI 95%= 0.06 to 0.14; p= 0.048), justice (b= 0.13; CI 95%= 0.06 to 0.20; p= <0.001), organizational commitment (b= 0.10; CI 95%= 0.02 to 0.17; p= 0.012), and the strata of the Health Center (b= 1.01; CI 95%= 0.62 to 1.41; p= <0.001) has an influence on improving performance and is statistically significant. Officer status (b= -0.28; CI 95%= -0.56 to -0.01; p= 0.038) had a degrading effect and was statistically significant. Age (b= -0.13; CI 95%= -0.39 to 0.11; p= 0.284) and gender (b= 0.06; CI 95%= -0.35 to 0.11; p= 0.750) has no significant effect on performance. Conclusion: The performance of health center employees is influenced by social capital, justice, organizational commitment, strata, and employee status. Age and gender are not factors that affect performance.
The Relationship between The Use of Mobile JKN Application and Health Services at Majene Regency Hospital
Background: This study is motivated by the digital transformation of BPJS Kesehatan services through the Mobile JKN application to improve the accessibility and efficiency of health services. The purpose of this study is to determine the relationship between the use of the Mobile JKN application and health services at the Majene Regency Hospital. Subjects and Method: This study is a cross sectional study design using a quantitative approach and data collection through a questionnaire conducted at the Majene Regency Hospital, in August-September 2024. The total sample is 100 respondents with a sampling technique, namely purposive sampling. The study subjects were patients who used the JKN mobile application. The independent variable is health services. The intermediate variable is the Mobile JKN application. The dependent variable is satisfaction. The data was analyzed using the Wilcoxon test to see the difference in the level of satisfaction and service quality before and after the use of the Mobile JKN application. Results: The results of the study showed that 91.6% of respondents used the Mobile JKN application, with a significant increase in satisfaction with health services, from an average score of 3,010 to 3,972 after using the application. The use of applications also has an impact on time efficiency and ease of access to health services. The average score of health services (Queue) was higher after the use of the Mobile JKN Application (Mean=4,209; SD=0.645) compared to before (Mean=3.484; SD=0.688), and this result is statistically significant (p=0.000). The health service satisfaction score was higher after using the JKN mobile application (Mean=3,972; SD=0.524) compared to before (Mean=3.010 ; SD=0.522), and this result was statistically significant (p=0.000). Conclusion: There is a positive relationship between the use of the Mobile JKN application and the improvement of the quality and satisfaction of health services at the Majene Regency Hospital.
Analysis of BPJS Mandiri Participant Contribution Payment Compliance Inpatient Service Fines at Dr Mohamad Saleh Probolinggo Regional Hospital
Background: The National Health Insurance Program (JKN) through BPJS Kesehatan is an initiative to equalize the quality of health services for all levels of society. Contributions are an essential factor in the success of a national social security system. The importance of paying BPJS contributions regularly is so that participants get adequate health service guarantees. The study aims to analyze the compliance of BPJS Mandiri participant contribution payments who are subject to inpatient service fines at Dr. Mohamad Saleh Probolinggo Regional Hospital. Subjects and Method: An observational study with a cross-sectional approach was conducted in the inpatient unit of Dr. Mohamad Saleh Hospital, Probolinggo, in May and June 2023. A total of 100 patients were selected for this study. The dependent variable was compliance. The independent variables were knowledge, income, number of family members, perception of illness, access to health services. Data were collected using a questionnaire and analyzed using factor analysis, t-test, f-test and multiple linear regression. Results: The regression coefficient of knowledge variable is 0.018, income is 0.823, number of family members is 0.375, perception of illness is -0.021, access to health services is -0.128. Compliance of contribution payments is influenced by income variable with sig 0.002, number of family members with sig (0.000) and access to health services with sig (0.007). Conclusion: Compliance in payment of BPJS Mandiri participants who are subject to inpatient service fines is influenced by income, number of family members, access to health services. The most dominant factor is income.
Policy Response to Substance Abuse in Selected Higher and Tertiary Education Institutions: A Comparative Review
Background: Substance abuse in Higher and Tertiary Education Institutions (HTEIs) poses a serious threat to students’ academic achievement, mental well-being, and campus safety. Although various interventions have been introduced, the effectiveness of existing policies remains inconsistent. This study compared global literature on school-related substance abuse policies with policy responses in selected Copperbelt HTEIs in Zambia to inform the development of contextually appropriate strategies for substance abuse reduction. Subjects and Method: The study applied the Protocol, Search, Appraisal, Synthesis, and Reporting (PSALAR) framework, guided by the Population, Interest, and Context (PICo) approach. Two colleges and one university in Zambia’s Copperbelt Province were purposively selected, and an exhaustive online search was conducted to identify institutional policies addressing substance abuse. Peer-reviewed English articles (2013–2023) focusing on punitive and remedial school-based policies were reviewed. Inclusion criteria for HTEIs were adapted to align with the PSALAR framework. Results: Three major themes emerged: (1) policy deficiencies and implementation gaps, (2) punitive versus remedial interventions, and (3) limited monitoring and evaluation mechanisms. The dominant issue was finding an effective balance between punitive and supportive policy approaches. The integration of substance abuse education within institutional frameworks was weak, and evidence on the relative effectiveness of punitive versus remedial measures remained inconclusive. Conclusion: Substance abuse policies in Zambian HTEIs predominantly emphasize punitive responses, with insufficient attention to remedial or preventive efforts. Strengthening evidence-based, context-specific, and student-centered policies is essential to reduce substance abuse and advance Zambia’s progress toward Sustainable Development Goal 3.5 by 2030.
Factors Influencing the Health Workers Performance in Community Health Center in Metro, Lampung
Background: Performance is the result of a person's ability to complete tasks and responsibilities competitively. There are many factors that affect a person's performance, each of which affects their own performance. This study aims to analyze the variables that affect the performance of health center employees. Subjects and Method: This study is an observational analytical study with a cross-sectional design. This research was conducted on 11 health centers in Metro City, Lampung in March-April 2024. A sample of 200 health center employees was selected by simple random sampling. The dependent variable in this study is the performance of health center employees. The independent variables in the study were age, training, incentives, motivation, leadership perceptions, and the strata of the health center. Data collection was carried out using a questionnaire and analyzed by multiple linear regression. Results: Employee performance in service at the health center was influenced by age (b= -0.01; CI 95%= -0.01 to -0.02; p= 0.008), training (b=1.08; CI 95%= 1.03 to 1.13; p< 0.001), incentives (b= 1.02; CI 95%= 0.98 to 1.05; p< 0.001), motivation (b= 1.16; CI 95%= 1.08 to 1.22; p<0.001), leadership perception (b= 0.98; CI 95%= 0.93 to 1.03; p<0.001), and the strata of the health center (b= 0.33; CI 95%= 0.10 to 0.54; p=0.003). Conclusion: The performance of health center employees is positively influenced by age, training, incentives, motivation, leadership perception, and strata of the health center.
Determinants of Health Worker Performance in Health Care Facilities: Meta-Analysis
Background: Performance is the result of a certain process carried out by all components of the organization on certain resources used. In addition, performance affects organizational goals. This study aims to analyze the influence of training, education level, and gender on performance in health workers. Subject and Method: This study is a systematic study and meta-analysis, with the following PICO : Population = Health workers, Intervention = Training, Higher education level, Female, Comparison = No training, Low education level, Male, Outcome = Performance. The articles used in this study were obtained from several databases, including Google Scholar, PubMed, and ScienceDirect which were published from 2014 to 2024. These articles were collected over a period of 4 weeks. The keywords used by the researcher in searching the database include Community Health Workers OR CHW AND Job Performance OR Work Performance AND Training AND Education Level AND Gender OR Sex. The articles included in this study are full-text articles with a cross sectional study design. Articles are collected using PRISMA flow diagrams. Articles are analyzed using the Review Manager 5.3 application. Results: A total of 14 articles were reviewed in this meta-analysis study from Malaysia, China, India, Ethiopia, Uganda, Cameroon and Ghana. Studies show that healthcare workers with training (aOR=2.94; CI 95%= 1.33 to 6.46; p= 0.007), higher education level (aOR=2.16; CI 95%= 1.62 to 2.88; p<0.001) had a significant influence on performance. Meanwhile, women (aOR=0.92; CI 95%= 0.57 to 1.49; p=0.75) had an insignificant effect on performance. Conclusion: Training and higher education levels can significantly improve performance in health workers, and statistically insignificant performance differences between men and women, women have the possibility of performing well.
Meta-Analysis: Effects of Computer Skill and Management Support on Readiness to Use Electronic Medical Record in Health Workers
Background: Electronic Medical Record (EMR) is an information technology that has proven its benefits in improving service quality. This study aims to analyze the effect of computer skills and management support on health workers' willingness to use EMR. Subjects and Method: This research is a systematic review and meta-analysis study using the PRISMA diagram and PICO model. Population: health workers, Intervention: computer skills and management support, Comparison: low computer skills and no management support, Outcome: willingness to use EMR. The articles used came from Google Scholar, Pubmed, and Elsevier which were published from 2013 - 2023. The keywords used in the search were (computer skills OR Management support) AND (“willingness to use” OR “willingness to utilize” OR “readiness to implement”) AND (EMR OR electronic medical record) AND “odds ratio” AND “cross-sectional study” AND (“health personnel” OR “health workers” OR “health professionals”). The inclusion criteria for this study were full paper articles with cross-sectional studies. The analysis used was multivariate with adjusted Odds Ratio. Eligible articles were analyzed using the Revman 5.3 application. Results: Meta-analysis was conducted on 11 articles with a cross-sectional research design. Health workers who have high computer skills were 2.62 times more likely to use EMR than health workers who have low computer skills (aOR= 2.62; 95% CI= 1.92 to 3.57; p= 0.050). Health workers who received Management support were 1.87 times more likely to use EMR than health workers who did not have Management support (aOR= 1.87; 95% CI= 1.40 to 2.51; p= 0.030). Conclusion: Computer skills and management support influence the willingness to use EMR among health workers.
Meta-Analysis: The Impact of Product, Price, Place, and Promotion on Patient Satisfaction
Background: A component of effective health care is measuring patient satisfaction. Satisfaction helps in the evaluation of health services from the patient's perspective. In order to compete globally, hospitals need to consider marketing strategies that emphasize understanding customer needs, wants and demands. One of the most common and widely applied marketing concepts in this context is the marketing mix, which includes four main elements, namely product, place, promotion and price. This research aims to estimate the magnitude of the influence of the marketing mix (4P) which includes product, price, place and promotion on patient satisfaction. Subjects and Method: Meta-analysis studies with PICO research questions. Population = general patients. Intervention = high product quality, high promotion, long distance and high price. Comparison = low product quality, lack of promotion, close distance to facilities, and low price. Out­come= Patient satisfaction. Data obtained from Google Scholar, Pubmed, Scopus and ScienceDirect, with the keywords "Product for patient satisfaction" OR "Promotion for patient satisfaction" OR "Price for patient satisfaction" OR "Place for patient satisfaction" AND "Marketing patient satisfaction" OR "Marketing mix patient satisfaction” AND aOR. The effect size used was the Adjusted Odds Ratio (aOR) from multivariate analysis. Data analysis using the Review Manager 5.3 application. Results: This meta-analysis was carried out on 20 primary studies with a cross-sectional design, originating from Turkey, Israel, Saudi Arabia, Ethiopia and Ghana. The sample size was 14,388 people. The meta-analysis results show that patient satisfaction increases with high product quality and is statistically significant (aOR= 2.23; CI 95%= 1.54 to 3.23; p<0.001) and good promotion, although not statistically significant (aOR= 1.42; CI 95 %= 0.75 to 2.71; p= 0.280). Patient satisfaction decreases with distance to a health facility (aOR= 0.55; 95% CI= 0.35 to 0.86; p= 0.009) and high price (aOR= 0.56; 95% CI= 0.38 to 0.81; p= 0.002). Conclusion: Patient satisfaction increases with high product quality and good promotions. Patient satisfaction decreases with distance to the facility and high prices.
Meta Analysis: Factors Affecting Health Care Service on Outpatient’s Satisfaction in Hospital
Background: Patient satisfaction with health services is very important to measure the level of health services offered to patients and the implementation of health services in hospitals. Patient expectations about service quality are also related to service perceptions and when patients have a good impression, patients' clinical experiences and outcomes are more likely to have positive responses. The aim of this study is to analyze the influence of health service factors on the level of satisfaction of outpatients in hospitals based on the results of several previous studies using meta-analysis. Subjects and Method: This research is a systematic review and meta-analysis based on data obtained through various databases including Google Scholar, PubMed, ResearchGate and Science Direct. This study used articles that were published from 2014 to 2022. The article search was carried out by considering the eligibility criteria defined using the PICO model. Population: outpatients. Intervention: comfortable waiting room, short waiting time, drug availability and payment status (free). Comparation: uncomfortable waiting room, long waiting time, no medicine available and payment status (Out of Pocket). Outcome: patient satisfaction. This article was collected within 1 month with the following keywords used: "Waiting Room" AND "Waiting Time" AND "Drug" AND "Payment Status" AND "Outpatient Health Services" OR "Satisfaction" AND "Cross Sectional Study". The articles included in this research are full text articles with a cross-sectional study design. This article was collected using a PRISMA flow diagram and analyzed using the Review Manager 5.3 application. Results: Meta-analysis of 16 articles using a cross-sectional research design from the countries of Ethiopia and Fiji. Total sample 15,453. Patient satisfaction increases with a comfortable waiting room (aOR= 2.54; 95% CI= 2.01 to 3.21; p < 0.001), short waiting time (aOR= 2.97; 95% CI= 1.62 to 5.47; p < 0.001), good availability of medicines. complete (aOR= 2.01; 95% CI= 1.55 to 2.60; p <0.001), and payment status (free) (aOR= 1.99; 95% CI= 1.34 to 2.95; p <0.001). Conclusion: Outpatient satisfaction in hospitals increases with the comfort of the waiting room, short waiting time, availability of medicines, and payment status (free).
Unit Cost Analysis In Heart Failure Inpatients Using The Time Driven Activity Based Costing Method At Type D Hospital In Sragen
Background: Heart failure is one of the most common non-communicable diseases in adults. The number of cases of patients admitted to hospitals due to heart failure is quite large, resulting in a high frequency of hospitalizations and high patient treatment costs. Cost calculation is very important for health care providers in order to conduct financial evaluations. One way to calculate costs in hospitals is to use unit cost analysis. The purpose of the study was to determine the unit cost of treatment for heart failure patients in inpatient settings, especially in Type D hospitals in Sragen. Subjects and Method: This study is a qualitative type study using a case study approach to unit cost to calculate the inpatient treatment rate of patients with chronic heart failure using the Time Driven Activity Based Costing method. Furthermore, the difference with the INA CBGs rate is seen. There are two sources of data in this study, namely primary data from interview results from sources directly in the field and secondary data from financial report data and clinical pathway data for inpatient services for patients with chronic heart failure in hospitals. Results: The unit cost of treatment of heart failure patients in the inpatient installation using the Time Driven Activity Based Costing method at type D hospitals in Sragen amounted to Rp 2,186,089. The difference in heart failure treatment costs in the type D hospital inpatient installation in Sragen using the Time Driven Activity Based Costing method with the patient treatment rate based on INA-CBG'S is Rp 250,211 (10%). Conclusion: The unit cost of treatment of heart failure patients in the inpatient installation using the Time Driven Activity Based Costing method is Rp 2,186,089
Determinants of Work Performance among Employee in Dr. Soediran Mangun Sumarso Hospital, Wonogiri, Central Java
Background: Good performance is the dream of every hospital which aims to achieve the predeter¬mined vision, mission and goals. Achieving the vision, mission and goals requires human resources who are capable of handling these matters. This study aimed to determine and analyze the deter¬mi¬nants of the performance of health and non-health workers. Subjects and Method: Cross-sectional study was conducted at Dr. Soediran Mangun Suwarso Hospital, Wonogiri, Central Java, from November to December. 200 hospital workers were selected using stratified random sampling. The dependent variable was work performance. The independent variables were work motivation, job satisfaction, job training, work environment, and job suitability. Data was collected using a questionnaire and analyzed using a path analysis model. Results: Performance of hospital employers was directly and positively influenced by job satisfaction (b= 0.15; 95% CI= 0.01 to 0.28; p = 0.033), work motivation (b= 0.17; 95% CI = 0.04 to 0.31; p= 0.009), and training (b= 0.16; 95% CI= 0.03 to 0.29; p= 0.017). Satisfaction increased motivation (b= 0.83; CI 95%= 0.54 to 1.12; p <0.001). Job satisfaction was influenced by the work environment (b= 0.13; CI 95%= 0.02 to 0.23; p= 0.016) and job suitability (b = 0.41; 95% CI= 0.30 to 0.51; p <0.001). Conclusion: Performance of hospital employers is directly and positively influenced by job satisfaction, work motivation, and training. Satisfaction increases motivation. Job satisfaction is influenced by the work environment and job suitability.
Multilevel Analysis: Factors Related to Work Performance in Health Workers at Community Health Centers
Background: Patient satisfaction is a very valuable asset because if patients are satisfied they will continue to use the services of their choice. The level of patient satisfaction arises as a result of the performance of health services obtained after the patient compares it with the quality of health services. The aim of this research is to analyze the performance of health workers at community health centers. Subjects and Method: Cross-sectional research was conducted at community health centers in Karanganyar, Central Java, from November to December 2023. A total of 210 health workers were selected using stratified random sampling. The dependent variable was work performance. The independent variables were age, length of work, employment status, income and work environment. Data were collected using questionnaires and analyzed using multiple multilevel linear regression. Results: Age decreased the performance but was not statistically significant (b= -0.33; CI 95%= -1.63 to 0.97; p = 0.623). Length of work (b= -1.19; CI 95%= -2.30 to -0.08; p= 0.035) and income (b= -1.43; CI 95%= -2.78 to -0.07; p = 0.039) significantly degraded the performance. Employment status decreased performance but it was statistically close to significant (b= -1.44; CI 95%= -3.04 to 0.16; p = 0.078). A comfortable work environment significantly increased performance (b= 0.16; 95% CI= 0.02 to 0.30; p = 0.029). There was a contextual influence of community health center factors on work performance (ICC= 9.62%). Conclusion: Age decreases performance but is not statistically significant. Length of work and income significantly decrease performance. Employment status decreases performance but is statistically close to significant. A comfortable work environment significantly improves performance. There is a contextual effect of community health center factors on work performance.
Meta-Analysis: Effects of Gender, Waiting Time, Visits, and Insurance on Outpatient Satisfaction with Health Services
Background: Patient satisfaction is the result of the service process felt by the patient, overall satisfaction arises from the patient's evaluation of the experience or as an interaction, including the availability of health services provided by officers (health workers), so that patient satisfaction can be used to assess the quality of services received by the patient. This study aims to estimate the magnitude of the influence of gender, waiting time, visits, and insurance on health service satisfaction. Subjects and Method: Systematic review and meta-analysis using PRISMA flow charts and PICO models. Population: outpatients. Intervention: Female, long waiting time, already visited, using insurance. Comparison: Male, short waiting time, first time visit, and not using insurance. Outcome: Outpatient satisfaction with health services. The online databases used were Google Scholar, Biomedcentral, Taylor & Francis and Plos with the keywords gender, waiting time, visits, insurance, outpatient satisfaction, cross-sectional and aOR. Inclusion criteria were full text articles with cross-sectional use of multivariate analysis that included aOR and were published from 2014-2024. Data analysis using the RevMan 5.3 application. Result: Twelve primary studies were used to analyze gender and patient satisfaction with health services. Women had satisfaction with health services 1.19 times compared to men (aOR= 1.19; 95% CI=1.11 to 1.28; p<0.001). Ten primary studies were used to analyze insurance and patient satisfaction with health services. Patients who have insurance are 1.23 times more satisfied with health services than those who do not have insurance (aOR= 1.23; 95% CI=1.09 to 1.40; p<0.001). Seven primary studies were used to analyze waiting times and patient satisfaction with health services. Patients who experienced short waiting times were 0.30 times more satisfied with health services compared to those with long waiting times (aOR=0.30; 95% CI=0.21 to 0.44; p<0.001). Seven primary studies were used to analyze visit frequency and patient satisfaction with health services. Patients who have visited are 2.96 times more satisfied with health services than patients who are visiting for the first time (aOR=2.96; 95% CI=2.60 to 3.37; p<0.001). Conclusion: Female gender, short waiting times, repeat visits and insurance in increasing outpatient satisfaction with health services.
Meta-Analysis: Factors Reducing Health Workers' Willingness to Leave Work
Background: Employees are the most important human resource in a company because they have a direct influence on institutional operations in achieving organizational goals. The main problem in health service management is a shortage of health workers due to turnover or intention to leave work. This research aims to analyze the factors that reduce the desire to leave among health personnel. Subjects and Method: This research uses a meta-analysis based on PICO as follows; population: health workers; intervention: satisfied autonomy, good working environment, length of service > 5 years, low workload; comparison: autonomy not satisfied, poor working environment, length of service < 5 years, high workload; outcome: intention to leave work. Data was obtained from the PubMed, Google Scholar, Science Direct databases published from 2013-2022. The keywords in the article search are "Autonomy", "Work Environment", "Work Experience", "Workload", "Intention to Out", "Turnover Intention". "Cross Sectional". Article selection used PRISMA Flowchart and results were analyzed using Review Manager 5.4 software. Results: This study was conducted on 14 articles from Ethiopia, Ghana, California, Peru with a sample size of 9,555 professional health workers. Meta-analysis results concluded that satisfied work autonomy (aOR=0.22; CI 95%=0.06 to 0.85; p=0.030), low workload (aOR=0.60; CI 95%=0.46 to 0.78; p<0.001), had the desire out of work low. The meta-analysis results of the work environment were good (aOR=0.51; CI 95%=0.23 to 1.14; p=0.100), work experience >5 years (aOR=0.51; CI 95%=0.23 to 1.14; p=0.100) was not significantly influenced. Conclusion: Satisfied job autonomy and low workload reduce the intention to leave work among health workers. Health workers' desire to leave work is not significantly influenced by work experience or work environment.
Adapting to Transformations in Hospital Structure: A Case Study at Manguharjo Lung Specialist Hospital, Madiun
Background: Manguharjo Lung Specialist Hospital is a type C hospital in Madiun. Along with global health trends, health needs are increasing and varying. So the Management of Manguharjo Lung Hospital innovated to improve more diverse services by changing the form to a general hospital with a Man, Money, Method, Material, Market approach. The aim of this study was to examine the preparation of a non-pulmonary disease treatment program at the Manguharjo Lung Specialist Hospital, East Java, Indonesia. Subjects and Method: This qualitative study uses a case study approach, involving 4 hospital staff, 3 patients, 3 East Java Health Office officials, and 3 local community leaders. Data sources include interviews and a review of the hospital's strategic development plans and supporting documents. Results: Five themes emerged: (1) Opportunities for conversion, supported by strategic location, adequate resources, and community demand for non-pulmonary services; (2) Supporting factors, including skilled human resources and the potential for increased hospital income; (3) Public perception, where the hospital is still viewed primarily as a lung service facility, deterring broader usage; (4) Obstacles, particularly lack of approval from the East Java Health Office; (5) Efforts, such as opening non-lung services and preparing human resources and facilities. Conclusion: Manguharjo Lung Specialist Hospital has significant potential to transition into a general hospital due to strong supporting factors like skilled personnel. However, challenges like public perception and institutional approval must be addressed.
Multilevel Analysis of Nurse’s Performance Predictors at Dr. Moewardi Hospital, Surakarta
Background: Nurse Performance plays a role as a determinant of patient satisfaction when providing nursing care. Nursing services in hospitals are one of the determining factors for good or bad service, quality and image of a hospital. Factors that influence nurse performance are gender, working time arrangements, education, work experience and job satisfaction. The aim of this study was to analyze the performance of inpatient and outpatient ward nurses at Dr. Moewardi Hospital. Subject and Method: This research uses an observational analytic design with a cross-sectional approach. This research is intended to find the relationship between the independent variables, namely gender, working time arrangements, education, work experience and job satisfaction, with the dependent variable, namely the performance of nurses in the inpatient and outpatient wards at Dr. Moewardi. This research was conducted in October-November 2023. A sample of 200 posyandu cadres was selected using random sampling. Data collection was carried out using questionnaires/interviews and data was analyzed using a multiple linear regression analysis model with a multilevel approach. Results: Gender has an influence and is significant between gender and nurse performance (b = -1.79; 95% CI = -3.13 to -0.45; p = 0.009). Working time arrangements have an influence on nurse performance, and this influence is statistically significant (b = 1.96: 95% CI = 0.39 to 3.54; p = 0.014). Job satisfaction has a positive and significant influence on nurse performance (b = 0.32 CI 95% = 0.10 to 0.4). The results of education and work experience did not show a statistically significant difference in nursing performance between nurses with DIII education and the nursing profession (b = 0.32; 95% CI = -0.86 to 1.51) and work experience of more than 12 years and less than 12 years (b = 0.71; 95% CI = -0.75 to 2.17). The results of this multilevel analysis also found that there was a contextual influence of the ward on nurse performance (ICC= 15.09%). Conclusion: Nurse performance is directly influenced by gender, working time arrangements and job satisfaction. Variations at level 2 wards have a contextual influence on nurse performance.
Assessing Inequality in Health Service Accessibility Based on Hospital Distribution in Indonesia
Background: The distribution of health facilities is an essential indicator to improve public health services in Indonesia. However, the country’s archipelagic geography and uneven population density create challenges in ensuring equal access. This study aimed to analyze hospital distribution in Indonesia based on provinces and main islands to evaluate inequality in health service accessibility. Subjects and Method: A comparative descriptive study was conducted using secondary data. Hospital data were obtained from the Hospital Information System (SIRS) of the Ministry of Health (2024), and population data were retrieved from the Central Statistics Agency (BPS) report (2023). A total of 3,209 hospitals were identified across 38 provinces and grouped into seven island clusters: Java, Sumatra, Sulawesi, Kalimantan, Papua, Maluku, and Bali–Nusa Tenggara. The population-to-hospital ratio was calculated, and hospital distribution was further analyzed by province, island, and hospital class. Results: Java accounted for the largest number of hospitals (1,622) due to its high population and better infrastructure. In contrast, Eastern regions such as Papua (73) and Maluku (53) showed limited availability. Inequalities were also found in hospital classes, where advanced hospitals (Class A and B) were concentrated in Java, while peripheral regions were dominated by Class C and D facilities. This disparity forces residents in remote areas to travel long distances for adequate care. Conclusion: Unequal hospital distribution highlights the urgent need for equitable health infrastructure development and strategic resource allocation policies to ensure fair access to health services across Indonesia.