Indonesian Journal of Health Administration (Jurnal Administrasi Kesehatan Indonesia)

DETERMINANTS OF THE NATIONAL HEALTH INSURANCE UPTAKE IN INDONESIA

2022-01-30T18:35:42+00:00

Background: Indonesia introduced a national health insurance program, the so-called Jaminan Kesehatan National (JKN), in 2014 to enhance health access for its citizens. However, unattained universal health coverage (UHC) such as participation target becomes a concern.

Aims: This study aimed to examine the factors influencing JKN participation and propose a possible policy improvement to enhance UHC implementation

Methods: A systematic review was performed based on PRISMA guidelines, and literature was collected from PubMed, Scopus, Web of Science, Cochrane Library, and Google Search.

Results: 21 articles in English and Indonesian language are included in the study after being reviewed using the PRISMA flowchart and quality assessment. The main factors that emerged from the found literature affecting the low enrolment of the NHIS include socio-demographic factors: younger people, low education level, rural location, unstable incomes, and larger family members. Also, health-related, and other factors: lack of health insurance literacy, insufficient healthcare accessibility and services availability, inadequate healthcare service quality, complicated administrative procedure, negative stigma, membership data inaccuracy, and low health status.

Conclusion: Twelve factors have been identified as the most influential determinants for the national health insurance program. Some proposed policies derived from the current results might contribute to the attainment of UHC.

REDUCING INFANT AND UNDER-5 MORTALITY RATE THROUGH GOVERNMENT HEALTH EXPENDITURE: A SYSTEMATIC REVIEW

2022-02-08T12:12:29+00:00

Background: Although it has been globally reported that IMR and U5MR continue to decline every year, the rate disparities between urban and rural areas are still evident in various countries. The government is presumed to carry out efforts to reduce this disparity, such as by allocating the government’s health expenditure.

Objectives: This study systematically identifies the effectiveness, best practices, and positive impacts of government health expenditure allocation for IMR and U5MR, specifically in rural areas.

Methods: This systematic review study was conducted using the PICOS method to analyse data that were obtained from 3 online databases.

Results: The government health expenditure could reduce the gap in mortality rate indicators between urban and rural areas. Programs specifically proposed for rural communities can help decrease the gap between urban-rural IMR and U5MR. The effectiveness of government health expenditure to reduce mortality rates was strongly influenced by various factors, including supporting policies, field implementation in regions, and the collaboration between the central and local governments.

Conclusion: The local government plays a definitely crucial role in the implementation of the health program to ensure that the central government executes the program effectively in order to reduce IMR and U5MR in rural areas.

SRI LANKA OXYGEN READINESS AND STRATEGIES ADAPTED FOR COVID-19 PATIENTS’ MANAGEMENT

2022-02-13T18:19:23+00:00

Background: Shortly after the Covid-19 oxygen crisis in India, the Sri Lanka Ministry of Health started investigating and analyzing gaps in oxygen production, supplies and demands.

Aims: This study aimed to evaluate the preparedness in Covid-19 cases management and recommend strategies to prevent oxygen crisis in healthcare facilities.

Methods: This study used information on oxygen source redundancy and delivery methods to assess whether a healthcare facility is prepared to provide the necessary oxygen demand for patients in need and to estimate the number of patients that can be treated with the currently available oxygen supplies. The predicted oxygen supplies and demands were assessed with a panel of experts using qualitative and quantitative methods. Data were collected using the Health Information Update System.

Results: Sri Lanka had 39,529 designated hospital beds including Intensive Care Unit and High Dependency Unit beds for Covid-19 patients. Even though an average number of patients were reaching 30,000, the actual oxygen demands were around 1,200 which were easily manageable with the current capacity of 80 tons per day.

Conclusions: Sri Lanka has made progress to increase access to oxygen by using novel methods to procure and increase oxygen availability, storing, and carrying capacity.

IMPLEMENTATION OF STUNTING PROGRAM IN INDONESIA: A NARRATIVE REVIEW

2022-04-20T21:41:08+00:00

Background: Stunting is one of the nutritional problems in the world, especially in Indonesia.

Aims: This study aimed to describe the implementation of stunting programs in Indonesia, Related to specific and sensitive nutrition interventions in particular.

Methods: This narrative review was conducted with a meta-synthetic approach. The literature search was done on Google Scholar, PubMed, Garuda Portal, and DOAJ. The critical appraisal checklist from the Joanna Briggs Institute (JBI) was used to assess the research quality.

Results: Thirteen research articles were analyzed, and some intervention programs most commonly carried out were the provision of iron supplement tablets for pregnant women, supplementary feeding for underweight toddlers, complementary foods for breastfeeding, vitamin A provision, provision of facilities, access to drinking water, and proper sanitation.

Conclusion: The stunting program has not been implemented optimally either inside or outside the health sector. Sufficient numbers of human resources, especially nutritionists, are required to realize stunting programs.

MATERNAL DEATH, QUALITY SERVICES, AND MENTAL HEALTH: A CYCLE OR REPEATED EPISODE ?

2022-06-30T16:09:43+00:00

Maternal issues are classic issues in every edition of the Indonesian Journal of Health Administration. In this issue, our authors, Fatmaningrum et al. (2022), revealed how the COVID-19 pandemic had increased the number of maternal deaths. Research conducted by Ernawaty and Sri (2022) again shows how big the risks Indonesian women must bear during pregnancy and childbirth are. Not only are they risking their lives because they have to give birth to children, but once discharged from treatment, they still have to be faced with high delivery costs. The National Health Insurance does help a lot, but who will help JKN from a deficit if there are many cases of diseases that require huge costs. A systematic review conducted by (Muhlis, 2022) found that the low level of participation in the JKN program was due to various multidimensional factors. This factor is not only related to the ability to pay contributions, but many are due to individual and environmental internal factors.

HEALTH EXPENDITURE ANALYSIS IN PATIENTS WITH PREGNANCY-LABOR COMPLICATIONS IN SURABAYA

2022-01-28T08:23:21+00:00

Background: Healthcare spending has serious social and economic consequences for familie, such as financial constraints and psychological distress. Expenditure caused by obstetrics complications has an impact on total household spending. One person’s health expenditure can influence their family members’ welfare.

Aims: This study analyzed health expenditure of patients experiencing preeclampsia, eclampsia, and postpartum hemorrhages.

Methods: This study utilized a descriptive observational research design with a cross-sectional approach. The research sample consisted of 135 women who gave birth in November to December 2018. Multistage random sampling was used since the respondents were selected from regions of Surabaya.

Results: Respondents of pregnancy and delivery complication with catastrophic health expenditure was eclampsia suffered by 40 respondents, 71 respondents with medium income financing Rp3,800,000.00, 64 respondents with medium household expenditure (monthly income of Rp2,001,000.00 - Rp3,000,000.00). As many as 62 respondents had social security agency for health without contribution beneficiaries, 62 respondents had one employed family member, and 66 respondents had 5-7 family members.

Conclusions: The majority of respondents in Surabaya in 2019 experienced a 10% increase of total household expenditure while undergoing treatment. The government continues to increase subsidies for health service facilities that mostly serve the indigen population.

HEALTH INSTITUTIONAL SUPPORT FOR HEALTH WORKERS AS ROLE MODELS FOR A HEALTHY LIFE

2022-01-24T04:25:06+00:00

Background: Health workers are considered to be credible people in health in the health field; they are often deemed as role models in healthy behavior. Primary healthcare centers (PHCs) and professional health organizations (PHOs) have to support health workers (HWs) in order that they perform their duty according to codes of work ethics.

Aims: This study aimed to investigate the support from PHCs and PHOs for HWs as health role models in the community.

Methods: This study is an exploratory qualitative study conducted in 2017. It involved three heads of PHCs, six clinical practitioners, three PHOs, and three community members from Pontianak.

Results: The health workers had responsibility, awareness, and commitment towards health workers themselves, the community, and colleagues, and thus they became health role models. Although the community never reprimanded HWs directly, they continued having a healthy lifestyle since they had acquired health education that impacts their behavior. Health institutions provided rules for mandatory daily physical activities and healthy diet; also, they established no-smoking areas, but many constraints were found during the execution.

Conclusion: The code of work ethics should be used as standards to support health workers’ role.

DESIGN OF MARKETING PLAN FOR DENTAL HOSPITALS IN THE DIGITAL ERA

2022-01-12T03:41:01+00:00

Background: The development of the digital world has snowballed since the 2000s and has accelerated since the 2010s. Social media is a part of everyday life, and the COVID-19 pandemic has been a significant catalyst for digital life. Despite this, the healthcare industry is lagging compared to other industries in terms of digital marketing.

Aims: The output of this research is a design of a digital marketing plan for a dental hospital based on a robust theoretical foundation and ongoing practical research in dental hospitals.

Methods: This study utilized a qualitative approach and descriptive method to describe the existing condition related to the challenges and the use of digital marketing in dental hospitals. The focus of this study was the development of a digital marketing plan for a dental hospital.

Results: The study obtained several data related to digital marketing activities that have been carried out, challenges in digital marketing, and the preparation of digital marketing development plans at dental hospitals.

Conclusion: The proposed model includes situation analysis, goal analysis, strategy planning, action, and control based on the existing marketing plan. A novelty in this model emphasizes technology components including technoware, hardware, software, infoware, humanware, and organiware.

A QUALITATIVE STUDY: HOSPITAL PATIENT COMPLAINT MANAGEMENT

2022-01-06T17:57:42+00:00

Background: Complaint management is vital for hospitals as patient complaints can be used to advance the quality of health services provided.

Aims: This study analyzed patient complaint management at an X government hospital in Yogyakarta.

Methods: The research used a descriptive-qualitative method and phenomenology, which was carried out through in-depth interviews, observation, and document review. It involved the head of the legal and public relations department, the head of the public relations sub-division, two staff of the legal and public relations department, two officers to outpatient and inpatient units, and two patients. This study used purposive sampling to select the samples. Data analysis referred to was from the concept of Miles and Huberman, which consists of data reduction, display, and verification. The accuracy of all data was checked using a triangulation method.

Results: The hospital followed the patient complaint management procedures. Providing complaint reporting platforms is required to lodge patient complaints to the hospital. Moreover, the suggestion box should be managed properly, and thus the complaints on the box can be managed promptly.

Conclusion: Overall, patient complaint management at the hospital has been carried out well and followed the standard operating procedures (SOP).

PARENTS’ SATISFACTION WITH MEASLES RUBELLA IMMUNIZATION SERVICES FOR SCHOOLERS DURING THE COVID-19 PANDEMIC

2022-01-25T04:12:51+00:00

Background: Measles Rubella (MR) immunization coverage for schoolers in Semarang City decreased to 92.7% in 2020 due to the COVID-19 pandemic. However, in practice, many parents still complain about MR immunization services for schoolers.

Aims: This study aimed to determine parental satisfaction with MR immunization services during the COVID-19 pandemic.

Methods: This quantitative study used a cross-sectional approach. Purposive and proportional sampling was used to select 102 samples. Data collection was done through questionnaire, and data were analyzed using the chi-square test and importance-performance analysis test.

Results: The lowest suitability dimension level was tangibility (81.52%), followed by responsiveness (86.6%). The reliability dimension had the highest average conformity level (92.87%). The priority items for improvement were related to health workers’ compliance with the use of complete personal protective equipment (PPE), spacious immunization service rooms, registration officers’ responsiveness in giving directions, punctual immunizations distribution, polite and friendly registration services officers, as well as health workers’ initiative to remind parents about health protocols. Bivariate analysis showed there was no relationship between respondents’ characteristics and their satisfaction level.

Conclusion: Parental satisfaction with MR immunization services for schoolers did not match their expectations; therefore, it is necessary to improve future immunization services.

THE EFFECT OF SERVICE QUALITY DIMENSIONS ON HEMODIALYSIS PATIENT SATISFACTION IN INDONESIA

2022-02-03T08:52:14+00:00

Background: Chronic kidney disease is a catastrophic disease ranked second in Indonesia for high health costs. The number of renal units in Indonesia has rapidly increased since the launch of the National Health Insurance program in 2014. Its increase was accompanied by the increased number of patients.

Aim: This study analyzed the effect of service quality dimensions on patient satisfaction with hemodialysis care.

Methods: This study used a cross-sectional design and a quantitative method. It retrieved data from respondents who had undergone hemodialysis care at hospitals and clinics in Jakarta and surroundings. The PLS-SEM approach was used to analyze the data.

Results: Eight service dimensions were proven to influence the overall service quality and directly impact patient satisfaction. The influential dimensions included facilities and organization of the service, care by attending nurses and assistants, attention to psychological and administrative issues, medical attention and care, nutrition attention and care, medication supply and quality, features and administration process, attention and care given by the head nurse. All of these dimensions affected patient satisfaction as a dependent variable. This study has strong predictive accuracy, and thus it can be replicable in future research with different populations.

Conclusion: This study demonstrated eight service quality dimensions that affect service quality and directly impact satisfaction of hemodialysis patients both with hospital and clinic services.

PREVALENCE OF BURNOUT SYMPTOMS IN NURSES HOSPITAL ASSIGNED TO COVID-19 ISOLATION ROOMS

2022-03-08T08:11:13+00:00

Background: Burnout is a health problem that may happen to nurses and may impact patient safety and organization in any situations, especially during the second wave of COVID-19 pandemic.

Aims: This study aimed to identify the prevalence of burnout among nurses in charge of isolation rooms and its relationship to their demographics factor.

Methods: This research design is descriptive-analytic quantitative and cross-sectional. It involved 124 nurses assigned to isolation rooms for COVID-19 patients admitted to the first referral hospital in Bali. Data were collected using a questionnaire adopted from the Maslach Burnout Inventory to identify burnout symptoms. Demographic questionnaire was administered to garner respondents' demographics.

Results: High category of burnout was related to emotional exhaustion found in 66.1% of the respondents, depersonalization in 33.1%, and reduced personal accomplishment in 0.8%. Age, marital status, education, and gender were not related to burnout. Nurses who worked in non-ICU experienced higher burnout than ICU (p < 0.05).

Conclusions: The prevalence of burnout symptoms in the nurses who were in charge in COVID-19 isolation rooms is in the high category. Hospital management must consider demographic factors to improve the work environment, recruit new employees, conduct routine health checks, and provide mental health treatments consistently.

THE IMPACT OF THE COVID-19 PANDEMIC ON MATERNAL MORTALITY ATTRIBUTES

2022-03-25T01:28:06+00:00

Background: The COVID-19 pandemic is a challenge for mothers to access health services in Indonesia. Patient management, referral processes, and maternal screening protocols are the reasons for this issue.

Aims: This study aimed to analyze maternal mortality trends in East Java Province before and during the COVID-19 pandemic.

Methods: This study was conducted using retrospective observation with a cross-sectional design, and samples were selected using a total sampling technique. The number of maternal deaths in East Java was 520 in 2019 and 565 in 2020. The independent variable in this study is the number of maternal deaths, and the dependent variables include age, gravida, place of death, rescue relay, time of death, and maternal complications. The variables of age, place of death, rescue relay, and gravida were assessed using the Chi-square test.

Results: Statistical tests showed a ρ value of 0.195 for age; 0.916 for place of death; 0.646 for rescue relay; and 0.048 for gravida.

Conclusion: Maternal mortality showed different trends before and after the pandemic in East Java. Significant differences in maternal mortality rate are influenced by gravida status.

THE INTERNET AS A HEALTH INFORMATION IN DECISION MAKING OF PREGNANT WOMEN

2022-03-09T19:16:29+00:00

Background: Maternal and Child Health (MCH) is still becoming a health problem in Indonesia. One of the causes of maternal mortality is the speed of decision making in the family. Decision making is influenced by knowledge, awareness, family shape and culture in the neighborhood.

Aims: the study aimed to identify and analyze the relationship between the use of the internet as a health information and maternal decision-making regarding emergency help

Methods: This study used a mixed-method approach. The sample of 175 respondents. Data analysis performed in this study was frequency analysis, cross tabulation and chi-square.

Results: There were 40% of respondents used the internet as a source of pregnancy information. Pregnant women had the information about pregnancy from google, instagram and whatsApp group. There were 45.70% of them have made decisions independently regarding the emergency relief. Chi-square analysis showed a p-value = “0,000” with a contingency coefficient of 0,368 indicating the use of the internet as a health information related to decision making of pregnant women regarding emergency relief.

Conclusion: The conclusion of this study is that there were pregnant women who were using the internet for health information and the majority of pregnant women had made decisions regarding emergency relief independently.

THE ACCEPTANCE OF MEDICAL RECORD OFFICER TOWARDS MRMIS IN X HOSPITAL MATARAM

2022-03-03T22:54:45+00:00

Background: MRMIS needs to be evaluated to know the actual conditions of implementing the system . One of the evaluations that can be done is user acceptance of MRMIS.

Aims: The study aims to determine MRMIS acceptance in X hospital Mataram City based on the variables in the UTAUT model.

Methods: This is a quantitative study with a correlational approach. The sample size was 70 medical record officers using total sampling. Data processing used Partial Least Square (PLS) methodd.

Results: The test results showed the t-statistic of effort expectancy was 2.507, facilitating conditions 3.787 behavioural intention 4.928, however the performance expectancy, social influence and moderate variables like age and gender variables had t-statistic values below 1.96.

Conclusion: The variables of effort expectancy, enabling conditions, and behavioural intentions all have a significant impact on respondent acceptance of MRMIS, whereas the variables of performance expectancy, social influence, and moderate variables of age and gender do not.

PATTERNS OF MEDICINE USE FOR COVID-19 PATIENTS AT UNDATA HOSPITAL PALU

2022-03-29T00:14:08+00:00

Background: Covid-19 cases had drastically increased. Little therapy has been formulated to respond to the situation. Covid-19 symptoms in Indonesia are divided into four classes: asymptomatic, mild, moderate, and severe.

Aims: This study aims to illustrate the pattern of drug use in Covid-19 patients at Undata Palu Hospital.

Methods: This study is a type of cross-sectional descriptive study using a cross-sectional design and collecting data retrospectively from medical records at Undata Hospital Palu in 2020.

Results: In 2020, 186 patients were confirmed positive for Covid-19. There were 95 female patients (51.9%) and 50 patients at the age of 46-55 years (27.3%). The severe symptoms happened to 109 patients (59.6%). The most common clinical manifestation was cough in 127 patients (23.3%). The most common comorbidity was pneumonia (30.8%). The most widely used primary therapy was the antibiotic azithromycin applied to 155 patients (30.0%), and the most widely used supportive therapy was vitamin C among 141 patients (20.1%). Oseltamivir antiviral therapy was administered to 132 patients (25.6%) and remdesivir to 34 patients (6.6%).

Conclusion: Covid-19 patients were mostly treated with antibiotic therapy (41.5%), antiviral therapy (32.2%), antimalarial therapy (15.7%), and corticosteroid therapy (10.7%). As many as 132 patients took oseltamivir, and 34 patients took remdesivir. However, for now, oseltamivir is no longer used.