Analisis faktor-faktor yang mempengaruhi keputusan pasien dalam memanfaatkan pelayanan kesehatan di Puskesmas Bangli

ANDARI, Putu Sri, drg. Niken Widyanti S., MDSc

2006 | Tesis | S2 Ilmu Kedokteran Gigi

Pemanfaatan Puskesmas sebagai salah satu sarana pelayanan kesehatan di Kabupaten Bangli Propinsi Bali masih merupakan pilihan bagi masyarakat untuk berobat, terutama pengobatan dasar. Persentase penduduk Kabupaten Bangli yang mempercayakan pemeriksaan kesehatannya yang paling banyak adalah ke Puskesmas yaitu sebanyak 36,74 %, namun terdapat kecenderungan pemanfaatan pelayanan kesehatan di Puskesmas Bangli menurun dari tahun 2002 ke tahun 2004. Tujuan penelitian ini adalah untuk mengetahui faktor-faktor yang mempengaruhi keputusan pasien dalam memanfaatkan pelayanan kesehatan di Puskesmas Bangli. Penelitian ini merupakan penelitian survei analitik dengan rancangan cross sectional, menggunakan 120 orang sampel yang dipilih secara acak dan memiliki kriteria sebagai sampel penelitian dari pasien yang berkunjung ke Puskesmas Bangli. Pengumpulan data dengan menggunakan kuesioner dan wawancara tentang pendidikan, pengetahuan, pengalaman sebelumnya, persepsi tarif, kepemilikan kartu askes, lokasi/aksesibilitas, kelengkapan fasilitas, sikap petugas, persepsi sakit dan pemanfaatan pelayanan kesehatan. Data dianalisis dengan uji statistik regressi berganda. Hasil uji regressi berganda menunjukkan bahwa ada hubungan bermakna antara pendidikan (β=0,014,p=0,48), pengetahuan (β=0,044,p=0,027), pengalaman sebelumnya (β-=0,156, p=0,008), keikut sertaan askes/JPS (β=0,122, p=0,010), lokasi/aksesibilitas (β=0,178, p=0,004), kelengkapan fasilitas (β=0,288, p=0,000), sikap petugas (β=0,196, p=0,009) serta persepsi sakit (β=0,282, p=0,002), dengan pemanfaatan pelayanan kesehatan di Puskesmas Bangli. Semua variabel tersebut mempunyai bobot sumbangan efektif terhadap pemanfaatan pelayanan kesehatan di Puskesmas Bangli sebesar 71,496% (R2,=71,496) dengan perincian: pendidikan =2,854%, pengetahuan=6,294%, pengalaman sebelumnya=7,996 %, keikutsertaan askes/JPS = 5,634%, lokasi/aksesibilitas = 10,694%, kelengkapan fasilitas=13,045 %, sikap petugas = 9,714 %, serta persepsi sakit = 15,265 %. Persepsi tarif secara statisik tidak mempunyai hubungan yang signifikan terhadap pemanfaatan pelayanan kesehatan di Puskesmas Bangli. Kesimpulan: (1) Semakin tinggi pendidikan, pengetahuan serta keikut sertaan askes maka semakin tinggi pemanfatan pelayanan kesehatan di Puskesmas Bangli, (2) Semakin baik pengalaman sebelumnya, sikap petugas serta persepsi sakit maka semakin tinggi pemanfaatan pelayanan kesehatan di Puskesmas Bangli (3) Semakin dekat lokasi/aksesibilitas maka semakin tinggi pemanfaatan pelayanan kesehatan di Puskesmas Bangli, (4) Semakin lengkap fasilitas kesehatan maka semakin tinggi pemanfaatan pelayanan kesehatan di Puskesmas Bangli.(5) Persepsi tarif secara statisik tidak mempunyai hubungan yang signifikan terhadap pemanfaatan pelayanan kesehatan di Puskesmas Bangli.

Background: Public Health Center as one of the health service providers in Bangli Regency, the Province of Bali is still a preferential for people seeking the basic medical treatments, in which thirty-six percent of Bangli people visit Public Health Center of Bangli. However, the utilization of health services in Public Health Center of Bangli tends to decrease from year 2002 - 2004. The purpose of this study is to find out the influencing factors of patient’s decision in utilize the health services in Bangli Public Health Center. Method: A cross sectional study was carried out on 120 samples that were selected randomly from patients visiting Bangli Public Health Center. Questionnaire based on Skala Likert were used to assess the independent variables (education, knowledge, past experiences, perception on cost, health insurance /JPS ownership, location/accessibility, complete facility, staff attitudes, sickness perceptions) and dependent variable (health service utilization). Results: The results of multiple regression analysis revealed that all independent variables (education, knowledge, preceding/past experiences, health insurance/JPS ownership, location/accessibility, complete facility, staff attitudes and sickness perception) except perception on cost were correlated significantly with health service utilization in Bangli Public Health Center (β=0.014, p=0.4; β=0.044, p=0.027; β=0.156, p=0.008; β=0.122, p=0.010; β=0.178, p=0.004; β=0.288, p=0.000, β=0.196, p=0,009; β=0.282, p=0.002) respectively. Except perception on cost, all independent variables gave 71.496% contribution to the health service utilization in Bangli Public Health Center, in which education, knowledge, past experiences, health insurance/JPS ownership, location/accessibility, complete facility, staff attitudes, and sickness perception contributed of 2.854%, 6.294%, 7.996%, 5.634 %, 10.694 %, 13.045 %, 9.714 %, and 15.265% respectively. The Perception on tariff had no significant correlation to the health service utilization in Bangli Public Health Center. Conclusions: (1) The higher the levels of education, knowledge, past experiences, health insurance/JPS ownership, the higher is the utilization of health services in Bangli Public Health Center, (2) The better the staff’s attitude and the sickness perception, the higher is the utilization of the health services in Bangli Public Health Center, (3) The nearer the location/accessibility is to the health center, the higher the utilization of the health services in Bangli Public Health Center (4) The more complete the facilities, the higher is the utilization the health services in Bangli Public Health Center. (5) The Perception on tariff had no significant correlation to the health service utilization in Bangli Public Health Center.

Kata Kunci : Layanan Puskesmas,Pemanfaatan, utilization, Public Health Center, health services