Evaluating the Quality of Health Services for BPJS Nasional Indonesia Beneficiaries Using the Servqual Model

Sudirman; Yulia Safitri; Desak Eka Susianawati; Ake Royke Calvin Langingi; Jumain

doi:10.56741/IISTR.jphs.001798

Authors

Sudirman
sudirmandirman549@gmail.com
Indonesia Jaya Institute of Health Science https://orcid.org/0000-0001-5906-383X
Yulia Safitri Indonesia Jaya Institute of Health Science
Desak Eka Susianawati Indonesia Jaya Institute of Health Science https://orcid.org/0000-0002-2218-0511
Ake Royke Calvin Langingi Gunung Maria Tomohon Institute of Health Sciences https://orcid.org/0009-0009-2089-2011
Jumain Indonesia Jaya Institute of Health Science

Keywords:

BPJS patients, Patient satisfaction, Primary health care, Service quality, SERVQUAL

Abstract

Evaluating the quality of health services for BPJS participants is essential to ensure the effectiveness and sustainability of the National Health Insurance program. Although patient visits at the Tinggede Community Health Center have continued to rise, this increase has not been matched by improvements in service quality, highlighting the need for a structured assessment of patient needs. This study aims to evaluate patient perceptions of service quality using the ServQual model, which consists of five key dimensions: Reliability, Responsiveness, Assurance, Empathy, and Tangible. A quantitative cross-sectional design was employed involving 96 BPJS beneficiary respondents. Data were collected through a Likert scale–based questionnaire and analyzed using the Friedman test to compare perceptions across dimensions. Results show that Assurance and Responsiveness received the highest ratings, while Tangible scored the lowest and differed significantly from the top two dimensions. These findings indicate that non-physical elements, particularly competence, trustworthiness, and timely responses from healthcare workers, play a greater role in shaping patient satisfaction than physical facilities. The study contributes empirical evidence on priority areas for improving service quality in primary health care settings. Practical implications include enhancing staff competencies, streamlining service flow to reduce waiting times, and strengthening empathetic communication. The study concludes that efforts to improve service quality should prioritize non-physical dimensions that have the strongest influence on patient experience. Recommendations include ongoing quality evaluations, broader adoption of digital services, and expanding future studies to different regions and populations to deepen understanding of service quality determinants.

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Author Biographies

Sudirman, Indonesia Jaya Institute of Health Science

is a lecturer and researcher in the Department of Public Health at Indonesia Jaya Institute of Health Science. His academic activities include research and community service in public health. He is actively involved in professional organizations, including Persatuan Sarjana Kesehatan Masyarakat Indonesia (PERSAKMI) and Ikatan Ahli Kesehatan Masyarakat Indonesia (IAKMI). His interests focus on public health promotion, community empowerment, and healthcare development in Indonesian society.(email: sudirmandirman549@gmail,com).

Yulia Safitri, Indonesia Jaya Institute of Health Science

is an education practitioner in the field of public health with professional involvement in administrative services under the Directorate of Community Development at the Regional Police level in Indonesia. Her work focuses on supporting public health administration, community engagement, and institutional coordination. She contributes to programs related to public welfare, health awareness, and community development while strengthening collaboration between public institutions and healthcare-related initiatives in local communities. (email: Safitriyulia409@gmail.com).

Desak Eka Susianawati, Indonesia Jaya Institute of Health Science

is a lecturer in the Public Health Study Program at Indonesia Jaya Institute of Health Science. Her academic and research activities focus on community health services, public health promotion, and healthcare education. She actively participates in research and community engagement programs aimed at improving public health awareness and strengthening preventive healthcare practices within Indonesian communities through evidence-based educational and health service initiatives. (email: desak.susianawati@gmail.com).

Ake Royke Calvin Langingi, Gunung Maria Tomohon Institute of Health Sciences

is a lecturer and researcher in the Department of Hospital Administration at Gunung Maria Tomohon Institute of Health Sciences. Her research interests focus on hospital administration, healthcare management, and community health services. She contributes to academic development through research, teaching, and community-based healthcare initiatives, particularly in strengthening healthcare administration systems and improving the quality of health services in Indonesia. (email: ake.langingi2@gmail.com).

Jumain, Indonesia Jaya Institute of Health Science

is a senior lecturer and educational researcher in the Nursing Science Department at Indonesia Jaya Institute of Health Science. He serves as Editor-in-Chief of Pustaka Katulistiwa: Karya Tulis Ilmiah Keperawatan and is actively involved in Persatuan Perawat Nasional Indonesia (PPNI). His interests include nursing education, healthcare research, scientific publication, and professional nursing development in Indonesia. (email: jumainmain55@gmail.com).

References

R. Rindi Antina, “Analisis Kualitas Pelayanan Terhadap Kepuasan Pasien Peserta Bpjs Di Puskesmas Pandian Kabupaten Sumenep,” JPAP: Jurnal Penelitian Administrasi Publik, vol. 2, no. 02, Oct. 2016, doi: 10.30996/jpap.v2i02.1010. DOI: https://doi.org/10.30996/jpap.v2i02.1010

M. Saputra, L. Marlinae, F. Rahman, and D. Rosadi, “Program Jaminan Kesehatan Nasional Dari Aspek Sumber Daya Manusia Pelaksana Pelayanan Kesehatan,” Jurnal Kesehatan Masyarakat, vol. 11, no. 1, p. 32, Sep. 2015, doi: 10.15294/kemas.v11i1.3462. DOI: https://doi.org/10.15294/kemas.v11i1.3462

A. salsha safira siregar, “Tingkat Kepuasan Pasien terhadap Pelayanan Kesehatan pada Proses Keperawatan,” Sep. 25, 2020. doi: 10.31219/osf.io/dbkmp. DOI: https://doi.org/10.31219/osf.io/dbkmp

W. Kurnia Sari, H. Idris, and M. Misnaniarti, “Pengalaman Dan Tingkat Pendidikan Pasien Jkn Terhadap Persepsi Pelayanan Kesehatan,” PREPOTIF : JURNAL KESEHATAN MASYARAKAT, vol. 8, no. 3, pp. 5491–5496, Nov. 2024, doi: 10.31004/prepotif.v8i3.36466. DOI: https://doi.org/10.31004/prepotif.v8i3.36466

A. A. Arnaya and I. W. Niryana, “Tingkat Kepuasan Dan Harapan Pasien Rawat Jalan Terhadap Kualitas Pelayanan Kesehatan Di Puskesmas Mengwi I,” E-Jurnal Medika Udayana, vol. 10, no. 9, p. 82, Sep. 2021, doi: 10.24843/MU.2021.V10.i9.P14. DOI: https://doi.org/10.24843/MU.2021.V10.i9.P14

BPJS, “Data Pengguna pada Program BPJS se-Provinsi Sulawesi Tengah Tahun 2021-2023,” Palu, 2023.

R. Rezapour, J. S. Tabrizi, M. Farahbakhsh, M. Saadati, and H. M. Abdolahi, “Developing Iranian primary health care quality framework: a national study,” BMC Public Health, vol. 19, no. 1, p. 911, Dec. 2019, doi: 10.1186/s12889-019-7237-8. DOI: https://doi.org/10.1186/s12889-019-7237-8

T. P. Lewis et al., “Health service quality in 2929 facilities in six low-income and middle-income countries: a positive deviance analysis,” Lancet Glob. Health, vol. 11, no. 6, pp. e862–e870, Jun. 2023, doi: 10.1016/S2214-109X(23)00163-8. DOI: https://doi.org/10.1016/S2214-109X(23)00163-8

R. Limato et al., “What factors make quality improvement work in primary health care? Experiences of maternal health quality improvement teams in three Puskesmas in Indonesia,” PLoS One, vol. 14, no. 12, p. e0226804, Dec. 2019, doi: 10.1371/journal.pone.0226804. DOI: https://doi.org/10.1371/journal.pone.0226804

A. Chen, S. Feng, L. Zhang, and L. Shi, “Comparison of Patients’ Perceived Quality of Primary Care Between Urban and Rural Community Health Centers in Guangdong, China,” Int. J. Environ. Res. Public Health, vol. 17, no. 13, p. 4898, Jul. 2020, doi: 10.3390/ijerph17134898. DOI: https://doi.org/10.3390/ijerph17134898

M. A. Bustamante U., M. Tello, M. Carvache-Franco, O. Carvache-Franco, and W. Carvache-Franco, “Statistical determination of service quality gaps in primary health care in Guayas, Ecuador,” PLoS One, vol. 19, no. 3, p. e0299994, Mar. 2024, doi: 10.1371/journal.pone.0299994. DOI: https://doi.org/10.1371/journal.pone.0299994

J. S. Souza et al., “Users’ Perceptions of Access to and Quality of Unified Health System Services in Brazil: A Cross-Sectional Study and Implications to Healthcare Management Challenges,” Int. J. Environ. Res. Public Health, vol. 21, no. 6, p. 721, May 2024, doi: 10.3390/ijerph21060721. DOI: https://doi.org/10.3390/ijerph21060721

A. Riaz and U. Sughra, “Measurement of Service Quality Gaps in Dental Services using SERVQUAL in Public Hospitals of Rawalpindi,” Pak. J. Med. Sci., vol. 37, no. 3, Mar. 2021, doi: 10.12669/pjms.37.3.3436. DOI: https://doi.org/10.12669/pjms.37.3.3436

H. Shahnazi, M. Araban, M. Karimy, M. Basiri, A. Ghazvini, and L. Stein, “A quasi-experimental study to improve health service quality: implementing communication and self-efficacy skills training to primary healthcare workers in two counties in Iran,” BMC Med. Educ., vol. 21, no. 1, p. 369, Dec. 2021, doi: 10.1186/s12909-021-02796-4. DOI: https://doi.org/10.1186/s12909-021-02796-4

Y. Huo, X. Kang, C. Zhong, L. Shi, R. Liu, and R. Hu, “The quality of migrant patients’ primary healthcare experiences and patient-centered medical home achievement by community health centers: results from the China Greater Bay Area study,” Int. J. Equity Health, vol. 22, no. 1, p. 114, Jun. 2023, doi: 10.1186/s12939-023-01929-z. DOI: https://doi.org/10.1186/s12939-023-01929-z

D. G. Kassa et al., “Patients’ perception of the outpatient pharmaceutical service quality in hospital pharmacies with auditable pharmaceutical transactions and services in Ethiopia: a cross-sectional study,” BMJ Open, vol. 11, no. 5, p. e042853, May 2021, doi: 10.1136/bmjopen-2020-042853. DOI: https://doi.org/10.1136/bmjopen-2020-042853

A. Vanichchinchai, “Priority nonconformity and service quality analysis of hospitals in Thailand: a care provider perspective,” The TQM Journal, vol. 33, no. 6, pp. 1395–1410, Oct. 2021, doi: 10.1108/TQM-08-2020-0179. DOI: https://doi.org/10.1108/TQM-08-2020-0179

M. Z. Abdullah, A. K. Othman, M. I. Hamzah, A. Anuar, S. N. M. Tobi, and N. Solat, “The Influence of Healthcare Service Quality on Public University Students’ Satisfaction and Behavioural Intention: Moderating Role of Trust,” J. Health Manag., vol. 25, no. 3, pp. 489–498, Sep. 2023, doi: 10.1177/09720634221076886. DOI: https://doi.org/10.1177/09720634221076886

J. Chen et al., “Exploring factors affecting patient satisfaction in online healthcare: A machine learning approach grounded in empathy theory,” Digit. Health, vol. 10, Jan. 2024, doi: 10.1177/20552076241309223. DOI: https://doi.org/10.1177/20552076241309223

M. Umoke et al., “Patients’ satisfaction with quality of care in general hospitals in Ebonyi State, Nigeria, using SERVQUAL theory,” SAGE Open Med., vol. 8, Jan. 2020, doi: 10.1177/2050312120945129. DOI: https://doi.org/10.1177/2050312120945129

Y. Mei, X. Xu, and X. Li, “Encouraging Patient Engagement Behaviors from the Perspective of Functional Quality,” Int. J. Environ. Res. Public Health, vol. 17, no. 22, p. 8613, Nov. 2020, doi: 10.3390/ijerph17228613. DOI: https://doi.org/10.3390/ijerph17228613

S. Renggli et al., “Towards improved health service quality in Tanzania: contribution of a supportive supervision approach to increased quality of primary healthcare,” BMC Health Serv. Res., vol. 19, no. 1, p. 848, Dec. 2019, doi: 10.1186/s12913-019-4648-2. DOI: https://doi.org/10.1186/s12913-019-4648-2

A. Barańska et al., “Assessment of the Level of Satisfaction with Medical Care of Patients Treated in Osteoporosis Clinics as an Indicator of the Quality of Medical Care,” Int. J. Environ. Res. Public Health, vol. 19, no. 12, p. 7343, Jun. 2022, doi: 10.3390/ijerph19127343. DOI: https://doi.org/10.3390/ijerph19127343

X. Hu et al., “Exploring association between certified EHRs adoption and patient experience in U.S. psychiatric hospitals,” PLoS One, vol. 15, no. 6, p. e0234607, Jun. 2020, doi: 10.1371/journal.pone.0234607. DOI: https://doi.org/10.1371/journal.pone.0234607

S. Joseph, “Relationship Quality in Geriatric Healthcare Delivery: A sustainable model,” Asia Pacific Journal of Health Management, vol. 16, no. 2, pp. 65–74, Jun. 2021, doi: 10.24083/apjhm.v16i2.675. DOI: https://doi.org/10.24083/apjhm.v16i2.675

P. K. Leszczyński, P. Sobolewska, B. Muraczyńska, P. Gryz, and A. Kwapisz, “Impact of COVID-19 Pandemic on Quality of Health Services Provided by Emergency Medical Services and Emergency Departments in the Opinion of Patients: Pilot Study,” Int. J. Environ. Res. Public Health, vol. 19, no. 3, p. 1232, Jan. 2022, doi: 10.3390/ijerph19031232. DOI: https://doi.org/10.3390/ijerph19031232

S. Orangi, T. Orangi, K. M. Kabubei, and A. Honda, “Understanding factors influencing the use of clinical guidelines in low-income and middle-income settings: a scoping review,” BMJ Open, vol. 13, no. 6, p. e070399, Jun. 2023, doi: 10.1136/bmjopen-2022-070399. DOI: https://doi.org/10.1136/bmjopen-2022-070399

Z.-Y. Wang, X. Zhang, and L. Ma, “How to Maintain a Sustainable Doctor-Patient Relationship in Healthcare in China: A Structural Equation Modeling Approach,” J. Healthc. Eng., vol. 2022, pp. 1–10, Jul. 2022, doi: 10.1155/2022/8251220. DOI: https://doi.org/10.1155/2022/8251220

S. K. Opoku Duku, E. Nketiah‐Amponsah, C. J. Fenenga, W. Janssens, and M. Pradhan, “The effect of community engagement on healthcare utilization and health insurance enrollment in Ghana: Results from a randomized experiment,” Health Econ., vol. 31, no. 10, pp. 2120–2141, Oct. 2022, doi: 10.1002/hec.4556. DOI: https://doi.org/10.1002/hec.4556

S. Wolka, M. D. Alemu, M. Gobana, G. T. Bati, H. Gerawork, and Z. Abebaw, “Mobile Health and Nutrition Team Service Implementation in Somali and Afar Regions of Ethiopia: A Qualitative Implementation Science Study,” J. Multidiscip. Healthc., vol. Volume 15, pp. 2881–2889, Dec. 2022, doi: 10.2147/JMDH.S388104. DOI: https://doi.org/10.2147/JMDH.S388104

R. Armita Arman et al., “The Effect of Service Quality and Patient Satisfaction Toward Patient Loyalty in Special Regional Hospitals of South Sulawesi,” Pharmacognosy Journal, vol. 15, no. 3, pp. 443–449, Jun. 2023, doi: 10.5530/pj.2023.15.99. DOI: https://doi.org/10.5530/pj.2023.15.99

G. A. Tessema et al., “Structural Quality of Services and Use of Family Planning Services in Primary Health Care Facilities in Ethiopia. How Do Public and Private Facilities Compare?” Int. J. Environ. Res. Public Health, vol. 17, no. 12, p. 4201, Jun. 2020, doi: 10.3390/ijerph17124201. DOI: https://doi.org/10.3390/ijerph17124201

M. Kadović, Š. Mikšić, and R. Lovrić, “Ability of Emotional Regulation and Control as a Stress Predictor in Healthcare Professionals,” Int. J. Environ. Res. Public Health, vol. 20, no. 1, p. 541, Dec. 2022, doi: 10.3390/ijerph20010541. DOI: https://doi.org/10.3390/ijerph20010541

E. Nketiah-Amponsah, R. K. Alhassan, S. Ampaw, and A. Abuosi, “Subscribers’ perception of quality of services provided by Ghana’s National Health Insurance Scheme - what are the correlates?” BMC Health Serv. Res., vol. 19, no. 1, p. 196, Dec. 2019, doi: 10.1186/s12913-019-4023-3. DOI: https://doi.org/10.1186/s12913-019-4023-3

Y. Nakano et al., “Nurses’ perception regarding patient safety climate and quality of health care in general hospitals in Japan,” J. Nurs. Manag., vol. 29, no. 4, pp. 749–758, May 2021, doi: 10.1111/jonm.13215. DOI: https://doi.org/10.1111/jonm.13215

A. Goula, T. Rizopoulos, M.-A. Stamouli, M. Kelesi, E. Kaba, and S. Soulis, “Internal Quality and Job Satisfaction in Health Care Services,” Int. J. Environ. Res. Public Health, vol. 19, no. 3, p. 1496, Jan. 2022, doi: 10.3390/ijerph19031496. DOI: https://doi.org/10.3390/ijerph19031496

S. C. Budi et al., “Outpatient Registration Staff Performance Assessment Model Using Ongoing Professional Practice Evaluation Method,” Window of Health : Jurnal Kesehatan, pp. 362–371, Oct. 2024, doi: 10.33096/woh.v7i4.1252. DOI: https://doi.org/10.33096/woh.v7i4.1252

Salesika, R. J. Sitorus, and R. A. Syakurah, “Utilization of Telemedicine Services for National Health Insurance Participants at Primary Health Facilities,” Window of Health : Jurnal Kesehatan, pp. 279–292, Jul. 2023, doi: 10.33096/woh.vi.92.

D. Agustina, A. R. Kusuma, and P. A. Siregar, “Analisis Kemampuan dan Kemauan Pasien PBPU Membayar Iuran Jaminan Kesehatan Nasional,” Window of Health : Jurnal Kesehatan, pp. 238–247, Jul. 2021, doi: 10.33096/woh.v4i03.235. DOI: https://doi.org/10.33096/woh.v4i03.235

Setyoadi et al., “The Relationship Between Health Service Support at Community Health Centers and Family Caregiver Coping for Patients with Type 2 Diabetes Mellitus,” Window of Health : Jurnal Kesehatan, pp. 439–450, Oct. 2024, doi: 10.33096/woh.v7i4.1350. DOI: https://doi.org/10.33096/woh.v7i4.1350

S. Wenang et al., “Availability and Accessibility of Primary Care for the Remote, Rural, and Poor Population of Indonesia,” Front. Public Health, vol. 9, Sep. 2021, doi: 10.3389/fpubh.2021.721886. DOI: https://doi.org/10.3389/fpubh.2021.721886

Syarief Makhya, “Health Insurance and Access Policy for the Lower-Class Community in Obtaining Healthcare Services in Bandar Lampung City, Indonesia,” Journal of Information Systems Engineering and Management, vol. 10, no. 35s, pp. 24–35, Apr. 2025, doi: 10.52783/jisem.v10i35s.5919. DOI: https://doi.org/10.52783/jisem.v10i35s.5919

N. P. Sambodo, I. Bonfrer, R. Sparrow, M. Pradhan, and E. van Doorslaer, “Effects of performance-based capitation payment on the use of public primary health care services in Indonesia,” Soc. Sci. Med., vol. 327, p. 115921, Jun. 2023, doi: 10.1016/j.socscimed.2023.115921. DOI: https://doi.org/10.1016/j.socscimed.2023.115921

A. D. Aryani, A. Bachtiar, and C. Candi, “The Structural Equation Modelling of First Level Health Facilities’ Performance-Based Capitation Payment in National Health Service,” Kesmas: Jurnal Kesehatan Masyarakat Nasional, vol. 19, no. 1, p. 35, Feb. 2024, doi: 10.21109/kesmas.v19i1.7340. DOI: https://doi.org/10.21109/kesmas.v19i1.7340