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Service Quality and Patient Satisfaction on the Social Health

Insurance (BPJS) At Public & Private Hospitals in Jakarta
Indonesia
Dr. Purwanti Aminingsih¹*; Ali Khatibi¹; S. M. Ferdous Azam¹

[email protected]
¹Post Graduate Centre, Management and Science University, University Drive, Section 13, 40100,
Selangor, Malaysia

Abstract
The purpose of this study is to investigate the function of the Indonesian Social Health Insurance (BPJS) system for
the provision of medical services. The purpose of this study is to examine the differences and similarities between
the public and private hospitals in Jakarta, Indonesia. According to the findings of the study, BPJS is a public service
that can be classified as all different kinds of goods and services as well. This means that the Indonesian government
is responsible for all of the actions that take place within the organisation. As a result, the population of the study
will primarily consist of patients who are treated at Hermina Daan Mogot, a private hospital, and Pasar Minggu
Public Hospital. Path analysis is being used in this study, which is a quantitative descriptive research approach. The
goal of the study is to meet the research objectives by evaluating a set of hypotheses. The data collection is carried
out through the use of a hardcopy questionnaire, and the primary data is gathered from four hundred patients
spread across Jakarta's two hospitals. The outcomes of the research show that there is a favourable association
between the BPJS and the level of satisfaction experienced by patients. In addition, the level of contentment
expressed by patients regarding the quality of the treatment. On the other hand, the findings suggest that Cost does
not influence Service Quality because it possessed a significant value of t-count greater than 0.05 for both Hermina
Daan Mogot Private Hospital and Pasar MInggu Public Hospital.

Keywords: Service Quality, Patient Satisfaction, Social Health Insurance, Public & Private Hospital, Jakarta,
Indonesia

INTRODUCTION
All activities to maintain and improve health with the goal of achieving optimal health degress
to the public are considered health efforts (Siregar, 2017). There are several ways to determine
how the image of patient satisfaction with the services provided by health workers, one of which
is to develop and implement a programme of activities to manage patient complaints in
hospitals. Complaints from patients about various types of services available in hospitals are
collected and managed through the programme. Furthermore, this programme can assess how
patients' satisfaction with the services received compares to the expected service. One indicator
of the quality of the service is the patient's evaluation and assessment of the services received.
The degree of perfection of health services to meet the needs and demands of each patient is
referred to as the quality of health care provided. The higher the correspondence between the
level of expectations and demands by the fact that the patient received in meeting the needs of
health services, the better the quality of health care provided (Anwar, 2017). To create a loyal
patient, hospitals should provide satisfactory service as expected by the patient. Because of the
high cost of hospital operations, efforts are being made to increase the income of health services
from medical, non-medical, and health-related services. As a result, in order to increase traffic
and give the impression of quality and competence in dealing with each patient, the hospital
must provide quality services. According to (Boone and Kurtz, 2017), the quality of service
determines whether a patient is satisfied or dissatisfied. Patient satisfaction and loyalty begin
with excellent service.
Social Health Insurance (BPJS) is a public legal entity established to administer the social
security system. All Indonesian residents, including foreigners who have worked in Indonesia
for at least six months and paid contributions, must be insured by BPJS (MoH RI, 2018). The issue

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arises when the government creates health insurance for all people at their own rate and applies
it nationally. The government essentially invites hospitals throughout Indonesia, both public and
private, to participate in the implementation of public health insurance programmes. The
government established the Bureau of Social Health Insurance (BPJS), which is in charge of
running and managing the public health insurance programme. The National Health Insurance
(JKN) programme and the newly launched Health Indonesian Card (KIS), which extend health
insurance coverage to the poor, are not covered by tuition assistance. Patients who use the BPJS
must follow the stages of the treatment flow, which begins with the Provider of First Instance. If
the First Instance Provider was unable, they were referred to a higher level of service in
accordance with their competence. Referrals should be made selectively so that healthy
competition occurs among doctors in order to provide quality health care, health care is
provided to meet or exceed the patient's expectations, and the BPJS to quality health services
received.
Patients' satisfaction (reception upon arrival, during the registration service registration
section, receiving medical care during this process, and receiving the final result (outcome) is
expected, as is the trust that is formed). Interaction between health care providers, hospitals,
workers - professional, and patients or patients is the main focus of the service industry. Such
interactions have a significant impact on patient satisfaction and confidence in the quality of
service. Among the types of health care services in hospitals, among others capable of handling
the patient's illness quickly and accurately, it takes hospitality and the ability of the physician,
the speed of service nurses and staff in the hospital is concerned, which is expected to be formed
satisfaction and user loyalty on hospital services and patients will trust and commitment to the
hospital and end up going back to using the services in hospitals.
Since the implementation of the national health insurance system on January 1, 2014,
complaints from JKN patients about health care related to drug services have remained common.
According to Kompasiana, there are several such complaints such as: drugs given and actions
are not good so they do not feel appreciated, the drug is not available in full, must buy out
because the drug is not available, the wait is very long, and getting a referral is difficult (Yalsis,
2016). The researchers wanted to see how the fact the field directly related to patient
satisfaction JKN participants, especially inpatients at first-level health facilities with pharmacy
services, after seeing the number of complaints from patients that JKN participants. Thus, the
challenge is how to attract Patients in this case the patient is sick who requires health services
and retain them (patients who have recovered) in context for further health care and care. which
will attract Patients / patients and maintain them is level satisfaction Patient satisfaction with a
hospital health service will be a driver of Patient / Patient loyalty, not only when sick, but also
when healthy, for long-term health care. Understanding the needs and desires of consumers, in
this case patients, is critical to patient satisfaction. Patients who are satisfied are very valuable
assets because they will continue to use their chosen services, whereas patients who are
dissatisfied will tell twice as many people about their bad experiences. To create patient
satisfaction, a company or hospital must devise and manage a strategy for acquiring and
retaining patients. Patient dissatisfaction with BPJS can be caused by two factors: external and
internal factors. External factors affecting patients BPJS regards inspection procedures and
patient BPJS tiered administration and validation of membership that requires time as
convoluted or due to internal factors that services provided by health professionals to patients
BPJS is not good, so patients are dissatisfied and hesitant to seek treatment.
Initially, the hospital was a social function institution, but with the presence of Private
Hospitals, this hospital now refers to an industry engaged in the health service by management
based on business entities management. Following hospital development to the present, there
has been a competition between hospitals, whether government or private, all vying to attract

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patients or patients, so that prospective patients will use the hospitals' services. However, the
hospital should strive for patient satisfaction. Patient satisfaction is a situation that a person
perceives after suffering an act or the result of an action that meets the hope-hope. So satisfaction
is the union of a hope and a perception of an action or result of an action. Patient satisfaction is
what will contribute to the formation of a loyal patient. The overall goal of this study is to
determine and comprehend the extent to which cost, facility, trust, and quality of service
influence patient satisfaction of Social Health Insurance (BPJS) in hospital inpatient rooms at
Hermina Daan Mogot Hospital and Pasar Minggu Public Hospital.

LITERATURE REVIEW
Patient Satisfaction
Satisfaction is a happy feeling that someone gets from comparing the impression of goods or
services with their expectations. If the reality matches the hope, the service is said to be
satisfactory; if the reality falls short of the expectations, the service is said to be unsatisfactory
(Kim, et al., 2008, Kotler, 2009). Because there is an empirical relationship between patient
satisfaction and benefit, providing high quality service can enhance the benefits (benefits).
Patients who are satisfied and make a purchase will increase the benefits, forming an image
(image) of the home hospital (Francken, et al., 1981, Anderson, 1994, Cronin, et al., 2000, Kang,
et al., 2004, Alrubaiee, 20118). Relationship commitment is the eternal desire to maintain the
relationship because it is important and appreciated, and you want it to last indefinitely and are
willing to work to keep it. (Morgan, 2019), stating that successful marketing necessitates
relationship commitment and trust, as it can motivate marketers to work for the sake of
preserving relationship investments through collaboration with patients. Commitments made
together form the foundation of relationships. Patient trust and satisfaction with the hospital can
be achieved when doctors and hospitals can develop a relationship that meets the expectations
of the patient in order to support and involve the patient in decision making (Montaglione, 1999;
Kim, et al., 2017).
Patient satisfaction will be met when they get what they want, when they need it, where they
want, and how they want it. The Journal of (Yeni Tri Sari Riswar, 2018: 89). Essentially, patient
satisfaction and dissatisfaction with the product will influence the pattern of subsequent
behaviour. This will be displayed to the Patient following the purchase process (post purchase
action). If the performance of health services obtained meets or exceeds expectations, the new
patient will be satisfied. Based on the description above, the following is an understanding of
patient satisfaction. Patient satisfaction is the level of feeling that a patient has as a result of the
health service performance that they receive after comparing it to what is expected (Pohan,
2018). Patient satisfaction becomes an integral and comprehensive part of health care quality
assurance activity when using a health care quality assurance approach. This means that
measuring patient satisfaction should be an inseparable part of determining the quality of health
care services. As a result of such a mindset, one of the important dimensions of service quality is
patient satisfaction (Pohan, 2018).

Health Quality Service

Quality of service or service quality centred on efforts to meet Patient needs and desires, as
well as delivery accuracy to compensate for patient expectations According to (AN Andriana,
2018), the level of excellence expected and control over the level of excellence to meet Patient
desires is the quality of service. If the services received are in line with what is expected, the
quality of services is perceived as good and satisfactory; if the services received exceed Patient
expectations, the quality of services is perceived as ideal. Quality of service provided to patients
although it is a subjective value but there remains an objective basis based on past experience,

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the phycological situation of service time and environmental influences, especially regarding the
assessment of health service provider's performance (Azrul, 2017). This includes explanation
and information, empathy, honesty, sincerity, sensitivity, and trust, as well as consideration for
the patient's privacy (Foster Timothy, R.V. 2018).

Social Health Insurance (BPJS)

Health insurance is a guarantee of health protection for participants to benefit health care and
protection in meeting basic health needs provided by the government to everyone who has paid
their contributions or dues. Health is a legal entity formed to organise a health insurance
programme known as Social Health Insurance (BPJS) (MOH RI, 2018). Community Health
Insurance (Jamkesmas) is a social assistance programme for health services for poor and non-
nationally managed communities, with the goal of achieving a comprehensive health service for
the poor. Jamkesmas implementation efforts are a realisation of the fulfilment of people's right
to health and Law No. 40 of 2004 on the National Social Security System (SJSN) and are one of
the government's commitments in Indonesian health development. However, because the
implementing regulations and institutions required by Law No. 40 of 2004 on National Social
Security System (SJSN) have yet to be formed, the Ministry of Health issues health insurance
programme policies for the poor as a form of fulfilment of people's right to health. The
Jamkesmas policy is stated in the Minister of Health's Decree No. 125 / Menkes / SK / II / 2008
on Guidelines for the Implementation of Community Health Insurance Program.
The responsibility for providing health services to the poor is shared by the Central
Government and the local governments. The obligation of the provincial/regency/municipal
government to contribute to the production of optimal service. Participants receive benefits in
the form of comprehensive (all-inclusive) medical services based on medical needs and in
accordance with "cost-effective" and rational medical service standards, rather than cash (MOH
RI, 2018). The National Social Security System is governed by Law No. 40 of 2004. According to
Articles 2 and 3 of this Act, the purpose of guarantee is to allow participants to benefit from
health care and protection in meeting basic health needs. Article 17 This law establishes the
source of social security programme financing, as specified in point 4, as the government's
contribution to the poor and unpaid. Article 19 states that health insurance for the poor is
organised at the national level on the basis of social insurance. Maintenance of health for the
poor through social insurance mechanisms as the beginning of the development of a social health
insurance system as a whole that is mandatory for the entire society. The poor health-care
guarantee system (Jamkesmas) can encourage fundamental changes such as service
standardisation, standardised tariffs based on correct calculations, formulary arrangements, and
rational drug use, all of which have an impact on quality control and cost control (MOH RI, 2018).

Cost Influence Against Patient Satisfaction on Social Health Insurance (BPJS)

(Kertajaya, 2020) reveals that the Cost assessment indicator can be viewed from the
consumer's willingness to make a sacrifice for the value received after the purchase, and from
there, the consumer's perception of the product or service. A positive perception is the result of
a sense of fulfilment from a purchase, whereas a negative perception is a form of consumer
dissatisfaction with the products or services purchased. If a company's cost does not correspond
to the benefits of the product, it can reduce patient satisfaction; conversely, if a company's cost
corresponds to the benefits received, it can increase patient satisfaction. Patient satisfaction will
be maximised if their perceived value is higher (AD Astono, Suryanto, dkk. 2017)

Influence of Facility to Patient Satisfaction on Social Health Insurance (BPJS)

A facility is a support in the form of service products and physical resources that must be

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present before a service can be provided to customers. Facilities are anything that enables
consumers to meet a variety of needs in terms of the services they provide. In a service-oriented
business, all existing facilities that condition facilities, completeness, interior and exterior
design, and cleanliness of the facility should be considered, particularly those that are closely
related to what is perceived or obtained directly by consumers (Agung, 2015). A facility is
anything that is evaluated as a means of achieving a specific goal or meeting a specific need.
According to Aan Surachlan Damyati, a facility is anything that is purposefully provided for
public use or use and enjoyment and using it does not have to cost anything. Meanwhile,
according to (Wasis Himawanto, 2017), a facility is the provision of physical equipment to make
it easier for consumers to carry out activities and meet their needs.

The Influence of Trust on Patient Satisfaction of Social Health Insurance (BPJS)

When one person in an interpersonal relationship trusts the other, he or she relies on the
other person and then expresses his or her intention to maintain the relationship in the form of
purchasing loyalty. According to (Usman, 2017), trust is an important factor that influences the
quality of a relationship. Consumer trust in service providers will increase the value of existing
relationships with service providers. According to Agung (2018), "the Patient's commitment to
stay in touch with the company because of the belief or trust in the company so that it will
repurchase the company's product." 28 (D Cyr, McKnight, 2018) adds that high confidence will
reduce the possibility of transferring to other service providers.

Effect of Service Quality Against Patient Satisfaction on Social Health Insurance (BPJS)
The relationship between service quality and patient satisfaction has been extensively
documented in the literature, particularly in marketing, where the relationship is both
theoretically and empirically positive (AD Astono, 2017). In theory, the Patient will be satisfied
if the service provided meets or exceeds his or her expectations (AD Astono 2017). As a result,
patient satisfaction is frequently defined as a gap paradigm between patient perceptions of
service quality and patient expectations of the services provided. As a result, it is possible to
explain that the quality of service has a significant relationship with patient satisfaction, with
increased quality of service resulting in increased patient satisfaction (AD Astono 2017). Many
empirical studies with diverse sample backgrounds and objects have demonstrated that service
quality has a positive effect on patient satisfaction. According to the findings of (N Hijrah, 2017),
the quality of patient service is related to patient satisfaction.
According to the findings of (AD Astono 2017), the higher the quality of service, the higher
the consumer satisfaction. Further research from (Zawawi 2015) revealed that the quality of
service has an impact on patient satisfaction. According to research (N Hijrah, AD Astono 2017),
service quality has an effect on consumer satisfaction. The Patient's evaluation of the perfection
of service performance is referred to as service quality. Furthermore, (Zawawi 2018) contends
that if the service meets the Patient's expectations, the Patient will be satisfied. (Zawawi, 2018)
demonstrates that the quality of service as perceived by the patient influences satisfaction,

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which in turn influences loyalty.

Conceptual Framework

Figure 1 Conceptual Framework

RESEARCH METHODOLOGY
This section will describe the methodology that will be employed in this study. A study
contains a method that must be passed as a condition in research; thus, several procedures for
conducting research will be described in this chapter by presenting the methods to be used as
well as analytical techniques to answer the research problem. (2018 Formulation) demonstrates
that the patient's perception of service quality influences satisfaction, and that patient
satisfaction influences loyalty. The goal of the positivism philosophical approach to research is
to explain, which ultimately allows for the prediction and control of phenomena, physical
objects, or humans. The ability of "scientists" to predict and control (phenomena) should
develop over time as the criterion for peak progress in this paradigm. The research was carried
out at two Jakarta hospitals, Hermina Daan Mogot Hospital and Pasar Minggu Public Hospital.
This hospital was chosen based on its performance as well as the location of the BPJS
programme. Hermina Daan Mogot Hospital represents the private sector, while Pasar Minggu
Public Hospital represents the public sector.
The study's conclusion is a description of the causal relationship. This study will look into the
factors that influence patient satisfaction of Social Health Insurance (BPJS) users based on cost,
facilities, trust, and service quality, so that they can get an idea of the level of satisfaction of
patients with Social Health Insurance (BPJS) users in the two hospitals studied. This study used
Social Health Insurance (BPJS) patients in the Inpatient Rooms of Hermina Daan Mogot Hospital
and Pasar Minggu Public Hospital in Jakarta as the unit of analysis. Descriptive analysis and
inferential statistics are among the data analysis techniques employed. Descriptive statistical
analysis seeks to provide a high-level overview of each research variable. The Slovin technique
is used to calculate sample size. As a result, the number of samples examined was 400
questionnaire respondents.

FINDING AND DISCUSSION

Respondent Profile
Before presenting the research data results for each variable investigated in this study,
describe the characteristics of the respondents. The total number of respondents for this study
is 200, with 85 male and 115 female respondents for Hermina Dan Mogot Hospital. Pasar Minggu
Public Hospital received 200 responses, or 50%, with 92 male respondents and 108 female

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respondents. According to the data above, the respondents in this study for Hermina Daan Mogot
Hospital aged 20 numbered 10, 20-30 years totaled 34 people, 31-40 years totaled 57 people,
41-50 years totaled 83 people, and age> 50 years totaled 16. While Pasar Minggu Public
Hospitals had 8 people under the age of 20, 40 people under the age of 30, 50 people under the
age of 31, 87 people under the age of 50, and 15 people over the age of 50. This demonstrates
that in this study, there were more respondents aged 41-50 years, and the percentage of Pasar
Minggu Public Hospital and Hermina Daan Mogot Hospital each amounted to 200 people, or
50%.

Table 1: Demographics
Gender Age (year)
20 - 31 – 41 –
Hospital < 20 > 50 Total %
Male Female 30 40 50
Year Year
Year Year Year
Hospital
Daan 85 115 10 34 57 83 16 200 50%
Mogot
Pasar
Minggu
92 108 8 40 50 87 15 200 50%
Public
Hospital
Total 400 100%

Reliability Test
In reference to the Table 2 below one can observe that the value attained for Cronbach’s alpha
is .819, indicating that there is an adequate level of consistency among the items that are in the
research instrument.

Table 2 Reliability Test

Cronbach’s Alpha
Cronbach’s Alpha
Variable Pasar Minggu N of Items
Hermina Daan Mogot Hospital
Public Hospital
Cost 0.79 0.870 3
Facilities 0.873 0.912 5
Trust 0.856 0.901 3
Service Quality 0.955 0.959 6
Patient Satisfaction 0.961 0.970 6
Overall 0.887 0.922 23

Path Analysis of Hermina Daan Mogot Hospital

Path analysis was used to answer the research hypothesis. Path analysis is split into two sub-
structure analyses. Sub-structure analysis I describes the impact of Cost, Facility, and Trust on
service quality at the same time and in part. The effect of Cost, Facility, Trust, and Service Quality
on Patient Satisfaction BPJS is explained in Sub-structure Analysis II. Whereas mediation testing
was used to determine the significance of the effect of Cost, Facility, and Trust on Patient
Satisfaction BPJS through Service Quality.

The structural equations for path analysis are as follows:

Y = ρyX1 + ρyX2 + ρyX3 + ε1

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Z = ρzX1 + ρzX2 + ρzX3 + ρzY + ε2

The following is an overall picture in the path analysis

Figure 2 Path Analysis Testing

Table 3 Overall Path Analysis Results

Influence
Inter-Variable Path Not Directly
Sig Decision
Influences coefficient Directly Through Total
Service Quality
Facility to Service
0.198 0.198 - 0.003 .001 Significant
Quality
Trust to Service
0.512 0.512 - 0.000 .000 Significant
Quality
Cost to Patient
0.156 0.156 - 0.156 .003 Significant
Satisfaction BPJS
Trust to Patient
0.502 0.502 - 0.502 .000 Significant
Satisfaction BPJS
Service Qualityto
Patient Satisfaction 0.247 0.247 - 0.247 .000 Significant
BPJS
Trust to Patient
- - 0.126 0.628 .000 Significant
Satisfaction BPJS
ε1 0.762 0.762 - 0.762 - -
ε2 0.644 0.644 - 0.644 - -

Conclusions can be drawn from the table above to provide objective information directly and
a total Facility influence on Service Quality of 0.198. The ratio of direct influence to total trust in
service quality is 0.512. Directly Cost and Total have a 0.156 effect on Patient Satisfaction BPJS.
The effect of Trust on Patient SatisfactionBPJS is 0.502, and the effect of Trust on Patient
SatisfactionBPJS through Service Quality is 0.126, for a total influence of Trust on Patient
SatisfactionBPJS through Service Quality of 0.628. The overall Quality Satisfaction Service BPJS
is 0.247. The influence of other factors on Service Quality from the influence of Facility and Trust

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is 0.507. and the influence of other factors from Cost, Trust, and Service Quality on Patient
Satisfaction BPJS is 0.644. The following is the final model of the influence of Cost, Facility, and
Trust on Service quality and its impact on Patient Satisfaction BPJS are as follows:

Figure 3 Overall Quality Service

The direct effect of trust toward patient satisfaction is 0.502 (50.2%). The undirect effect of
trust through service quality toward patient satisfaction is 0.512 x 0.247 = 0.1265 (12.65%). So
the total influence trust toward patient satisfaction is = direct effect + undirect effect = 0.02 +
0.1265 = 0.6285 (62.85%). Can be concluded that service quality is not be able to be the
moderating variable because the value of direct effect is greater than undirect effect (0.502 >
0.126)

Analysis of Pasar Minggu Public Hospital

Table 4 Normality Test use One-Sample Kolmogorov-Smirnov Test
Patient
Facility Service SatisfactionBPJS
Cost (X1) (X2) Trust (X3) Quality(X4) (Y)
N 200 200 200 200 200
Normal Mean 25,7200 45,3800 33,7600 71,0250 93,5050
Parametersa,b Std. 5,44609 6,36302 4,50933 9,75552 12,27614
Deviation
Most ExtremeAbsolute ,161 ,124 ,148 ,128 ,137
Differences Positive ,068 ,065 ,083 ,076 ,090
Negative -,161 -,124 -,148 -,128 -,137
Test Statistic ,161 ,124 ,148 ,128 ,137
Asymp. Sig. (2-tailed) ,000 c ,000 c ,000 c ,000c ,000c
Based on the table above, the value of the Test-Statistic Cost variable (X1) is 0.161, the Facility
(X2) variable is 0.124, the Trust variable (X3) is 0.148, the Service Quality variable (X4) is 0.128,
while the Patient SatisfactionBPJS variable (Y) equal to 0.137, meaning residual data is normally
distributed.

Path Analysis of Pasar Minggu Public Hospital

In answering the research hypothesis used path analysis. In path analysis, it is divided into
two sub-structure analyzes. Sub-structure analysis I describes the influence of Cost, Facility and
Trust simultaneously and partially on service quality. Sub-structure analysis II explains the

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effect of Cost, Facility, Trust, Service Quality on Patient Satisfaction BPJS. Whereas to find out the
significance of the effect of Cost, Facility and Trust on Patient Satisfaction BPJS through Service
Quality using mediation testing.

The structural equations for path analysis are as follow

Y = ρyX1 + ρyX2 + ρyX3 + ε1
Z = ρzX1 + ρzX2 + ρzX3 + ρzY + ε2

The following is an overall picture in the path analysis test:

Figure 4 Path Analysis Testing

The overall influence of Facility, Trust and Service Quality on Patient Satisfaction can be illustrated
in the following table:

Table 5 Overall Path Analysis Results

Influence
Inter-Variable Path Not Directly
Sig Decision
Influences coefficient Directly Through Total
Service Quality
Facility to Service
0.178 0.178 - 0.178 .001 Significant
Quality
Trust to Service
0.723 0.723 - 0.723 .000 Significant
Quality
Facility to Patient
0.144 0.144 - 0.144 .005 Significant
Satisfaction BPJS
Trust to Patient
0.315 0.315 - 0.315 .000 Significant
Satisfaction BPJS
Service Qualityto
Patient Satisfaction 0.485 0.485 - 0.485 .000 Significant
BPJS
Facility to Patient
- - 0.086 0.264 .002 Significant
Satisfaction BPJS
Trust to Patient
- - 0.350 1.073 .000 Significant
Satisfaction BPJS

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ε1 0.507 0.507 - 0.507 - -

ε2 0.469 0.469 - 0.469 - -

Conclusions can be drawn from the table above to provide objective information directly and
a total facility influence on service quality of 0.178. 0.723 direct influence and total trust in
service quality The direct effect of the BPJS Facility to Patient Satisfaction is 0.315, and the
indirect effect is 0.086, for a total effect of the BPJS Facility to Patient Satisfaction through Service
Quality of 0.264. The effect of BPJS Trust to Patient Satisfaction is 0.315, and the indirect effect
of Directly is 0.350, for a total effect of BPJS Trust to Patient Satisfaction through Service Quality
of 1.073. and has a direct influence on total Quality Quality Satisfaction PBJS of 0.485. The
influence of other factors on Service Quality from the influence of Facility and Trust is 0.507.
Finally, the influence of other factors from the influence of Facility, Trust, and Service Quality on
BPJS is 0.469. The final model of the Facility and Trust's influence on Service Quality and the
impact on BPJS Patient Satisfaction is as follows:

Figure 5 Final model

The direct effect of facility on patient satisfaction is equal to 0.144. (14,4 percent ). The
indirect effect of the facility on patient satisfaction through service quality is = 0,178 x 0,485 =
0,08633. (8,633 percent ). As a result, the total effect of the facility on patient satisfaction is =
direct effect + indirect effect = 0,144 + 0,08633 = 0,23033. (23,033 percent ). It is possible to
conclude that service quality cannot be a moderating variable in the effect of facility on patient
satisfaction because the amount of direct effect is greater than the amount of indirect effect
(0,144 > 0,0863). Trust has a direct effect on patient satisfaction of 0.315%. (31,5 percent ). The
indirect effect of trust on patient satisfaction through service quality is 0.723/0.485 = 0.351.
(35,1 percent ). As a result, the total effect of trust on patient satisfaction is 0.315 + 0.351 = 0.66.
(66,6 percent ). It is possible to conclude that there is a significant effect of trust toward patient
satisfaction as a moderating variable because the direct effect is less than the indirect effect
(0,315 0,351).

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Table 6 Comparison between Hermina Daan Mogot Hospital and Pasar Minggu Public Hospital

Hermina Daan Mogot Hospital Pasar Minggu Public Hospital

Path
Relationship t- Path
coefficie Sig Ket t-count Sig Ket
count coefficient
nt
Facility to Service
0.198 2.985 0.003 Sig. 0.178 3.363 0.001 Sig.
Quality
Trust to Service
0.512 7.702 0.000 Sig. 0.723 13.684 0.000 Sig.
Quality
Cost to Patient
0.156 3.053 0.003 Sig. - - - -
Satisfaction BPJS
Facility to Patient
- - - - 0.144 2.865 0.005 Sig.
Satisfaction BPJS
Trust to Patient
0.502 8.247 0.000 Sig. 0.315 4.597 0.000 Sig.
Satisfaction BPJS
Service Quality to
Patient Satisfaction 0.247 4.138 0.000 Sig. 0.485 7.340 0.000 Sig.
BPJS
Facility toward
patient satisfaction
- - - - 0.086 3.063 0.002 Sig.
through service
quality
Trust toward
patient satisfaction
0.126 3.648 0.000 Sig. 0.350 6.479 0.000 Sig.
through service
quality

The difference in the results of the survey of 400 respondents conducted in the Hermina Daan
Mogot hospital and the Pasar Minggu public hospital can be explained using the table above.
Accounting for path analysis results in Hermina Daan Mogot hospitals revealed that the facility
had no effect on patient satisfaction, either directly or indirectly through service quality. At Pasar
Minggu Public Hospital, the cost has no direct impact on patient satisfaction, either directly or
indirectly through service quality.

CONCLUSION
The consumer's level of comfort indicates whether the consumer's expectations are met or
exceeded. Patient satisfaction is an evaluation after purchase in which the chosen alternative at
least meets or exceeds the patient's expectations, whereas dissatisfaction occurs when the
results obtained do not meet the patient's expectations. So, a facility is anything that is
purposefully provided by a service provider for consumers to use and enjoy in order to provide
the highest level of satisfaction. This means that if the facilities are good, patients' satisfaction as
consumers will rise, and vice versa. If services deteriorate, so will consumer satisfaction. The fact
that the correlation coefficient is positive indicates that the relationship between facilities and
patient satisfaction is strong, which means that any minor change, either increased or decreased,
on the facilities would result in a significant increase or decrease in patient satisfaction.
As a public health service, the Pasar Minggu Public Hospital has a major problem, which is
whether the services provided are already in line with patient expectations. As a result, the
hospital is required to always maintain patients' trust by improving the quality of services,

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where quality health services are defined as health services that can satisfy every user of health
services in accordance with the average population's level of satisfaction, as well as
implementation in accordance with the standards and code of ethics that have been established.
Pasar Minggu Public Hospitals is a government hospital in terms of service implementation,
which is entirely supported by the government, both in terms of financing, facility procurement
of medical and non-medical, the source of the workforce, and the quality standard of the service,
which is already regulated and established by the government, so that almost all dimensions of
service can meet the desire and satisfaction of patients.

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