Fitriana Murriya Ekawati, Mora Claramita, Krishna Hort, John Furler, Sharon Licqurish, Jane Gunn
{"title":"在印度尼西亚全民健康覆盖改革背景下患者使用初级保健服务的经验。","authors":"Fitriana Murriya Ekawati, Mora Claramita, Krishna Hort, John Furler, Sharon Licqurish, Jane Gunn","doi":"10.1186/s12930-017-0034-6","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The World Health Organization (WHO) recommendation on universal coverage has been implemented in Indonesia as <i>Jaminan Kesehatan Nasional</i> (JKN). It was designed to provide people with equitable and high-quality health care by strengthening primary care as the gate-keeper to hospitals. However, during its first year of implementation, recruitment of JKN members was slow, and the referral rates from primary to secondary care remained high. Little is known about how the public views the introduction of JKN or the factors that influence their decision to enroll in JKN.</p><p><strong>Aim: </strong>This research aimed to explore patients' views on the implementation of JKN and factors that influence a person's decision to enroll in the JKN scheme.</p><p><strong>Methods: </strong>This study was informed by interpretative phenomenological analysis (IPA) methodology to understand patients' views. The interview participants were purposively recruited using maximum variation criteria. The data were gathered using in-depth interviews and was conducted in Yogyakarta from October to December 2014. The interviews were transcribed, translated and analyzed using IPA analysis.</p><p><strong>Result: </strong>Twenty three participants were interviewed from eight primary care clinics. Three superordinate themes: access, trust, and separation anxiety were identified which impacted on the uptake of JKN. Participants acknowledged that whilst primary care clinics were conveniently located, access was often complicated by long waiting times and short opening hours. Participants also expressed lower levels of trust with primary care doctors compared to hospital and specialist care. They also reported a sense of anxiety that the current JKN regulation might limit their ability to access the hospital service guaranteed in the past.</p><p><strong>Discussion: </strong>This study identified patients' views that could challenge the implementation of the gate-keeper role of primary care in Indonesia. While the patients valued the availability of medical care close to home, their lack of trust in primary care doctors and fear that they might lost the hospital care in the future appears to have impacted on the uptake of JKN. Unless targeted efforts are made to address these views through sustained public education and further capacity building in primary care, it is unlikely that the full potential of the JKN scheme in primary care will be realized.</p>","PeriodicalId":39050,"journal":{"name":"Asia Pacific Family Medicine","volume":"16 ","pages":"4"},"PeriodicalIF":0.0000,"publicationDate":"2017-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s12930-017-0034-6","citationCount":"33","resultStr":"{\"title\":\"Patients' experience of using primary care services in the context of Indonesian universal health coverage reforms.\",\"authors\":\"Fitriana Murriya Ekawati, Mora Claramita, Krishna Hort, John Furler, Sharon Licqurish, Jane Gunn\",\"doi\":\"10.1186/s12930-017-0034-6\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The World Health Organization (WHO) recommendation on universal coverage has been implemented in Indonesia as <i>Jaminan Kesehatan Nasional</i> (JKN). It was designed to provide people with equitable and high-quality health care by strengthening primary care as the gate-keeper to hospitals. However, during its first year of implementation, recruitment of JKN members was slow, and the referral rates from primary to secondary care remained high. Little is known about how the public views the introduction of JKN or the factors that influence their decision to enroll in JKN.</p><p><strong>Aim: </strong>This research aimed to explore patients' views on the implementation of JKN and factors that influence a person's decision to enroll in the JKN scheme.</p><p><strong>Methods: </strong>This study was informed by interpretative phenomenological analysis (IPA) methodology to understand patients' views. The interview participants were purposively recruited using maximum variation criteria. The data were gathered using in-depth interviews and was conducted in Yogyakarta from October to December 2014. The interviews were transcribed, translated and analyzed using IPA analysis.</p><p><strong>Result: </strong>Twenty three participants were interviewed from eight primary care clinics. Three superordinate themes: access, trust, and separation anxiety were identified which impacted on the uptake of JKN. Participants acknowledged that whilst primary care clinics were conveniently located, access was often complicated by long waiting times and short opening hours. Participants also expressed lower levels of trust with primary care doctors compared to hospital and specialist care. They also reported a sense of anxiety that the current JKN regulation might limit their ability to access the hospital service guaranteed in the past.</p><p><strong>Discussion: </strong>This study identified patients' views that could challenge the implementation of the gate-keeper role of primary care in Indonesia. While the patients valued the availability of medical care close to home, their lack of trust in primary care doctors and fear that they might lost the hospital care in the future appears to have impacted on the uptake of JKN. Unless targeted efforts are made to address these views through sustained public education and further capacity building in primary care, it is unlikely that the full potential of the JKN scheme in primary care will be realized.</p>\",\"PeriodicalId\":39050,\"journal\":{\"name\":\"Asia Pacific Family Medicine\",\"volume\":\"16 \",\"pages\":\"4\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2017-03-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1186/s12930-017-0034-6\",\"citationCount\":\"33\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Asia Pacific Family Medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1186/s12930-017-0034-6\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2017/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Asia Pacific Family Medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1186/s12930-017-0034-6","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2017/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 33
摘要
背景:世界卫生组织(世卫组织)关于全民覆盖的建议已在印度尼西亚作为Jaminan Kesehatan Nasional (JKN)得到实施。它的目的是通过加强初级保健作为医院的看门人,为人民提供公平和高质量的保健。然而,在实施的第一年,联合保健协会成员的招募进展缓慢,初级保健转介到二级保健的比率仍然很高。对于公众如何看待JKN的引入,以及影响他们决定加入JKN的因素,我们知之甚少。目的:本研究旨在探讨患者对实施JKN计划的看法,以及影响患者决定参加JKN计划的因素。方法:本研究采用解释现象学分析(IPA)方法了解患者的观点。使用最大变异标准有目的地招募访谈参与者。数据是通过深度访谈收集的,并于2014年10月至12月在日惹进行。对访谈进行转录、翻译并使用国际音标分析进行分析。结果:对来自8个初级保健诊所的23名参与者进行了访谈。三个上级主题:访问,信任和分离焦虑被确定影响JKN的吸收。与会者承认,虽然初级保健诊所位置便利,但由于等待时间长,开放时间短,就诊往往很复杂。与医院和专科护理相比,参与者对初级保健医生的信任度也较低。他们还报告了一种焦虑感,即目前的JKN规定可能会限制他们获得过去保证的医院服务的能力。讨论:本研究确定了患者的观点,这些观点可能会挑战印度尼西亚初级保健门卫角色的实施。虽然患者重视离家近的医疗服务,但他们对初级保健医生缺乏信任,并担心将来可能失去医院护理,这似乎影响了JKN的采用。除非通过持续的公共教育和进一步的初级保健能力建设作出有针对性的努力来解决这些观点,否则JKN计划在初级保健方面的全部潜力不太可能实现。
Patients' experience of using primary care services in the context of Indonesian universal health coverage reforms.
Background: The World Health Organization (WHO) recommendation on universal coverage has been implemented in Indonesia as Jaminan Kesehatan Nasional (JKN). It was designed to provide people with equitable and high-quality health care by strengthening primary care as the gate-keeper to hospitals. However, during its first year of implementation, recruitment of JKN members was slow, and the referral rates from primary to secondary care remained high. Little is known about how the public views the introduction of JKN or the factors that influence their decision to enroll in JKN.
Aim: This research aimed to explore patients' views on the implementation of JKN and factors that influence a person's decision to enroll in the JKN scheme.
Methods: This study was informed by interpretative phenomenological analysis (IPA) methodology to understand patients' views. The interview participants were purposively recruited using maximum variation criteria. The data were gathered using in-depth interviews and was conducted in Yogyakarta from October to December 2014. The interviews were transcribed, translated and analyzed using IPA analysis.
Result: Twenty three participants were interviewed from eight primary care clinics. Three superordinate themes: access, trust, and separation anxiety were identified which impacted on the uptake of JKN. Participants acknowledged that whilst primary care clinics were conveniently located, access was often complicated by long waiting times and short opening hours. Participants also expressed lower levels of trust with primary care doctors compared to hospital and specialist care. They also reported a sense of anxiety that the current JKN regulation might limit their ability to access the hospital service guaranteed in the past.
Discussion: This study identified patients' views that could challenge the implementation of the gate-keeper role of primary care in Indonesia. While the patients valued the availability of medical care close to home, their lack of trust in primary care doctors and fear that they might lost the hospital care in the future appears to have impacted on the uptake of JKN. Unless targeted efforts are made to address these views through sustained public education and further capacity building in primary care, it is unlikely that the full potential of the JKN scheme in primary care will be realized.