1. Kamaluddin Latief - 47th APACPH Conference

PUSKA-FKM UI
Hospital Accreditation Process Impact Evaluation
(HAPIE):
Patient satisfaction at the early stage of National Health
Insurance (NHI) implementation: A comparative study before
and after NHI implementation
p
at nine class A public
p
hospitals
p
in Indonesia
Latief, K.*, Nandiaty, F.*, Pawestri, E.A.*, Wahyuni, S.*, Rianty, T.*, Achadi, A.*
*Center for Family Welfare, Faculty of Public Health, Universitas Indonesia
Presented in the APACPH 2015 Conference
Bandung, October 22, 2015
USAID Applying Science to Strengthen and Improve Systems Project
CFW - UI1
BACKGROUND
In 2011
2011, USAID supported URC and Center for Family Welfare Faculty of Public Health
Universitas Indonesia to begin a study in nine Class A government-owned hospitals 
Hospital Accreditation Process Impact Evaluation (HAPIE) study
Three Phases of HAPIE Study
BASELINE
Completed
in August
2013
MID-LINE
Completed
in July
2014
END LINE
USAID Applying Science to Strengthen and Improve Systems Project
Planned
for January
2016
CFW - UI
BACKGROUND
The implementation of the National Health Insurance (NHI)/Jaminan
Kesehatan Nasional at January 2014 signals an enormous change for the
health system in Indonesia.
NHI is compulsory for all Indonesians and will be the largest single-payer
health insurance system in the world, covering approximately 250 million
people when it is fully implemented in 2019.
NHI encompasses all government insurance programs managed by the
Social Insurance Board (BPJS)
(i e Jamkesmas/Jampersal Askes,
Askes Jamsostek,
Jamsostek TNI/ Polri,
Polri and some of
(i.e.Jamkesmas/Jampersal,
Jamkesda).
The impact of NHI implementation is already seen by the increasing
number of BPJS patients in hospitals.
USAID Applying Science to Strengthen and Improve Systems Project
CFW - UI
GOAL
1
2
• To examine whether there was any
difference in p
patient satisfaction
before and after NHI implementation
• To examine whether there were
differences among the nine hospitals
USAID Applying Science to Strengthen and Improve Systems Project
CFW - UI
RESEARCH METHODOLOGY
Interviews in each phase
Patient exit interviews conducted in four inpatient wards 
obstetric, pediatric, internal medicine and surgery
in each wards  n = 30
in all hospitals  n = 1.080
Patients were randomly selected
Patients were discharged
USAID Applying Science to Strengthen and Improve Systems Project
CFW - UI
RESULT
1
• Patient satisfaction is measured on several components 
doctor’s competence, doctor’s communication, nurse/midwive’s competence, nursing
care, patient involvement in the process of treatment, information received, and
appearance of hospital facilities.
2
• After controlling for other factors, including method of payment, patient satisfaction in
all nine hospitals was lower in the period after NHI implementation as compared to
before its implementation.
3
• The difference varied among hospitals. When analyzed by component within the
patient satisfaction categories, differences were observed in the magnitude of
decrease in patient satisfaction
USAID Applying Science to Strengthen and Improve Systems Project
CFW - UI
1. Percentage Change in Patients’ Perception of
Medical Services
20
15
10
95% CI Upper
5
2
95% CI L
Lower
2
0
A -3
-5
B*
C
D
E*
F*
-6
G*
H -3
I -3 All*
-6
-4
Percentage
Difference
-9
-10
-14
-15
-20
* Statistically Significant
Composite variable: doctor talk clearly, confidence in doctors’ competence
7
USAID Applying Science to Strengthen and Improve Systems Project
CFW - UI
Percentage Change in Patients’ Perception of
Doctors’ Competence
20
15
10
95% CI Upper
5
3
95% CI Lower
0
A*
-5
B*
C
-2
D
E*
F*
G*
I -2 All*
H*
-5
-6
-7
6
-6
Percentage
Difference
-9
-10
-12
-15
15
-14
-20
* Statistically Significant
8
USAID Applying Science to Strengthen and Improve Systems Project
CFW - UI
2. Percentage Change in Patients’ Perception of
Nursing Services
10
5
2
0
95% CI Upper
A
-3
B
-3
C
D -2 E*
F*
-5
5
G*
H*
I*
-5
5
-6
-5
5
95% CI L
Lower
-8
-9
-10
All*
-13
Percentage
Diff
Difference
-15
-20
* Statistically Significant
Composite
p
variable: nurses’ competence,
p
, caringness,
g
, attentiveness,, communication nurse to inform
the test and examination, patient satisfaction, timely manner, and good services
9
USAID Applying Science to Strengthen and Improve Systems Project
CFW - UI
Percentage Change in Patients’ Perception of
Nurse/ Midwife’s Competence
20
15
10
5
4
95% CI Upper
4
0
A -2
B -2 C*
-1
D*
E*
F
G*
H -4
-5
-8
95% CI Lower
-1
I
All*
-2
Percentage
Difference
-8
-10
-15
-20
* Statistically Significant
10
USAID Applying Science to Strengthen and Improve Systems Project
CFW - UI
Percentage Change in Patients’ Perception of
Nursing Services
20
15
10
5
3
1
0
A
-5
95% CI Upper
1
B
-4
C
0
D
E*
F
G*
I -3 All* -2
H*
-4
-7
-10
95% CI Lower
Percentage
g
Difference
-9
-15
-20
* Statistically Significant
11
USAID Applying Science to Strengthen and Improve Systems Project
CFW - UI
Percentage Changes in Patients’ Perception of
Satisfaction
20
15
10
95% CI Upper
5
95% CI Lower
3
1
0
A
-5
0
B -4 C -3 D
-10
E
F*
G*
H*
I
-5
-4
All* -4
Percentage
Difference
-9
-10
-15
-20
* Statistically Significant
12
USAID Applying Science to Strengthen and Improve Systems Project
CFW - UI
Percentage Change in Patients’ Perception of
Timeliness of Services
20
15
10
95% CI Upper
7
5
95% CI Lower
4
0
A
B -2 C*
D*
E*
F*
G*
H*
-5
-8
-10
I*
-6
6
-6
-7
Percentage
Difference
All*
-12
-15
15
-15
-13
-20
* Statistically Significant
13
USAID Applying Science to Strengthen and Improve Systems Project
CFW - UI
Percentage Change in Patient Perception’s of
treatment by hospital staff
25
15
95% CI Upper
5
-5
95% CI Lower
A*
B*
-7
-10
C*
-7
D*
E*
F*
G*
H*
I*
-11
-14
-15
-13
13
-13
-16
Percentage
Difference
All*
-13
-25
-29
-35
* Statistically Significant
14
USAID Applying Science to Strengthen and Improve Systems Project
CFW - UI
3. Percentage change in Patients’ Perceptions of
Medical Decisions and Discharge Instructions
20
15
11
10
7
5
95% CI Upper
3
2
0
0
A
B
-5
C*
D*
E* -3
F*
G*
H*
I
0
All
-6
-9
9
-10
10
95% CI Lower
-9
9
Percentage
Difference
-15
-20
* Statistically Significant
Composite
p
variable: p
patient involvement in decision's making,
g, clear discharged
g instruction,,
recommend hospital
15
USAID Applying Science to Strengthen and Improve Systems Project
CFW - UI
Percentage Change in Patients’ Perception of
Services’ Involvement
20
17
15
10
9
95% CI Upper
5
5
95% CI Lower
3
1
0
A
0
B
C*
D*
E*
F*
G*
H
-5
I
All
Percentage
Difference
-5
-8
-10
-15
-11
-15
15
-20
* Statistically Significant
16
USAID Applying Science to Strengthen and Improve Systems Project
CFW - UI
Percentage Changes in Patients who would
Recommend Hospital to others
20
15
11
10
5
8
8
8
95% CI Upper
4
95% CI Lower
2
0
A
B*
C*
D*
E*
F*
G -4
-5
H -4
I -3 All*
Percentage
Difference
-10
-12
-15
-20
* Statistically Significant
17
USAID Applying Science to Strengthen and Improve Systems Project
CFW - UI
4. Percentage Change in Patients’ Perceptions of
Hospital Facilities
20
15
10
95% CI Upper
5
3
2
0
0
A
-5
2
-4
B
10
-10
C
95% CI Lower
0
D
E
F*
G
-10
10
-4
H*
I
All* -2
Percentage
Difference
9
-9
-15
-20
* Statistically Significant
18
USAID Applying Science to Strengthen and Improve Systems Project
CFW - UI
CONCLUSION
• Implementation of the NHI scheme has not been
accompanied by needed measures to strengthen the
service delivery system
system.
• Achieving the full promise of Universal Health
Coverage in Indonesia will require efforts to
strengthen delivery systems.
USAID Applying Science to Strengthen and Improve Systems Project
CFW - UI
20
USAID Applying Science to Strengthen and Improve Systems Project
CFW - UI