Relationship of Payment System, Waiting Time, and Officer Level
Competency toward Inpatient Satisfaction
Halina Wongso, Ermi Girsang, and Sri Lestari R. Nasution
Faculty of Medicine, Prima Indonesia University, Indonesia
Keywords: Patient Satisfaction, Payment System, Waiting Time, Officer Competency
Abstract: Complaint about the mismatch of waiting time for inpatients in the payment system is one of the
dissatisfaction factors. The rate of patient dissatisfaction with payment waiting times in Indonesia in 2017
reached an average of 52%. The purpose of this study was to identify the relationship of parameters; payment
system, payment waiting time, and staff competence with inpatient satisfaction. The study was conducted in
the form of analytic studies through a cross sectional approach with a population of 1,001 respondents and a
sample of 261 respondents. The research instrument was a questionnaire in accordance with the studied
variables, and validity and reliability were tested at Sarah General Hospital. Data were evaluate using
univariate and bivariate methods with the chi-squared test, and multivariate with multiple logistic regression
at a 95% confidence level (α = 0.05). The results showed that patients who were dissatisfied 19.9%, said the
payment system was very good ( 29.1%), the waiting time between 61-90 minutes (30.3%) was still according
to the standard i.e. <2 hours, the competency of the officers which is very good at around 40.6%. The
parameters tested were related to inpatient satisfaction, with a p – value < 0,000. The most dominant variable
related to patient satisfaction was the competency of officers with a value of Exp (B) / OR = 9,941 by mean
that patients who state competency in the good category have a 9.9 times higher chance of being satisfied
compared to patients who state the competency of officers was not good.
1 INTRODUCTION
The hospital is one of the health service facilities that
were built to provide treatment to the community with
the aim of improving human health. Increased public
awareness of health, will lead to demands for
increased health services. One effort to anticipate this
situation is by maintaining the quality of service to
increase patient satisfaction (Azwar, 2016).
Patient satisfaction is a major factor and is a
measure of success as a result of the services provided
to customers (Tjiptono and Chandra, 2015). Patient
satisfaction affects the organization that health
service providers are required to improve overall
performance (Khunwuthikorn, 2011). Patient
satisfaction is a very important component for service
in the hospital and the higher level of patient
satisfaction will increase the number of patient who
are loyal to the hospital so that it indirectly increases
the operating income of the hospital (Indah, 2019).
One of the patient satisfaction’s indicators in
hospital is administrative services such as the
payment system (billing system) (Erwan, 2015).
Inpatient dissatisfaction in the waiting time for
payment in Indonesia averages 52% (Oktamianiza
and Rahmi, 2019). Based on Kepmenkes No. 129 of
2008 concerning Minimum Service Standards, the
time delivery of information about inpatient bills is ≤
2 hours (MOH RI, 2008).
The long waiting time can result in patient
dissatisfaction. Susanti, Meliala and Kusmedi’s
research (2017) at Tarakan Hospital, Jakarta, shows
that there is an influence of payment duration and
satisfaction of inpatients.
The essence of a high level of patient
dissatisfaction with care and payment systems in a
hospital is a lack of trust (Shan et al., 2016). The
attitude of hospital staff played an important role in
providing health services to patients and could affect
and even reduce the patient satisfaction rate (Fenny,
Enemark, Asante, Hansen, 2014). The overall
treatment outcome, as the most dominant predictor,
was followed by the kindness of the nurse. Items that
reflect received information about the details of the
care under taken have a major influence on patient
236
Wongso, H., Girsang, E. and R. Nasution, S.
Relationship of Payment System, Waiting Time, and Officer Level Competency toward Inpatient Satisfaction.
DOI: 10.5220/0010296102360242
In Proceedings of the International Conference on Health Informatics, Medical, Biological Engineering, and Pharmaceutical (HIMBEP 2020), pages 236-242
ISBN: 978-989-758-500-5
Copyright
c
 2021 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved

satisfaction (Schoenfelder, Klewer and Kugler,
2017).
Research by Tangcharoensathien et al. (2019)
shows that patients whom settle the billing
themselves at normal rates are more satisfied than
those whom settle the billing using social security.
Patients who use social security in Thai hospitals do
not get enough attention when consulting a doctor.
Quynh and Dhar's research (2014) shows that patients
who pay using insurance are completely dissatisfied
with health care procedures, especially during
registration and consultation.
The problem often faced by hospitals is that they
have not been able to provide services with service
standards, applicable laws and regulations. Various
efforts can be made to improve patient satisfaction
with hospital services, namely (1) at the individual
level, each health professional increases professional
skills, communication and empathy skills for patients,
applying medical standards and the ethics of the
medical profession in daily practice, ( 2) at the
institutional level, hospitals prioritize patient safety
and security, support resources in hospital operations,
provide manageable workloads to employees,
provide skills and accountability remuneration, and
improve hospital administration systems with an
innovative approach, (3 ) at the national level, the
level of improvement needed in health system
policies both in terms of benefits and equality in
obtaining health services for people registered as
users of social security (Woldeyohanes et al., 2015;
Shan et al., 2016; Nkwinda et al , 2018; Salesman, et
al, 2018). The government must also ensure that all
health facilities, particularly hospitals, comply with
laws and guidelines for national health insurance
through regular monitoring, evaluation and
maintenance of service quality (Daramola et al, 2018;
Turnip et al, 2020; Wijaya et al, 2019).
From a number of previous studies: Patient
satisfaction is a major factor and is a measure of
success as a result of the provided services to
customers (Tjiptono and Chandra, 2015); Patient
satisfaction with services in a hospitals is an
administrative services in the form of a payment
system (billing system) (Erwan, 2015); The long
waiting time can result in patient dissatisfaction
Susanti, Meliala and Kusmedi’s research (2017); The
essence of the high level of patient dissatisfaction
with care and payment systems in a hospitals is a lack
of trust (Shan et al., 2016). Based on various previous
studies, there has been no specific research linking the
parameters of the length of waiting time for an
inpatient, the payment system and the competence of
staff towards patient satisfaction.
2 METOD
This research was conducted at the Stella Maris
Women’s and Children’s Hospital in Medan in
November 2019. The study population was all
inpatients going home about 1,001 patients with a
sample of 261 respondents. Characteristics of the
selected respondents were shown in Table 1.
Table 1: Respondent Characteristic Frequency Distribution
2019.
Characteristic
Total
f %
Age:
a. <43 years
b. ≥43 years
153
108
58.6
41.4
Total 261 100.0
Gender:
a. Men
b. Women
91
170
34.9
65.1
Total 261 100.0
Education:
a. High School
b. Diploma
c. Undergraduate
51
81
129
19.5
31.0
49.5
Total 261 100.0
Occupation:
a. Housewife
b. Government
Official
c. Private Official
d. Entrepreneur
111
30
33
87
42.5
11.5
12.6
33.4
Total 261 100.0
The used instrument was a questionnaire that had
been tested for validity and reliability at Sarah
General Hospital with a sample of 30 respondents.
The results were all valid and the instrument items
were positively and significantly correlated, i.e. the r-
count value was greater than 0.361 Corrected
Indicator – Total Correlation value (Ghozali, 2015).
As well as reliability test with all results greater than
the value of the 0.6 limit of Cronbach’s Alpha, by
Relationship of Payment System, Waiting Time, and Officer Level Competency toward Inpatient Satisfaction
237

means that the questionnaire information can be
trusted and declared reliable or consistent.
Data collection was then carried out by
distributing questionnaires to the 261 in-patients who
were about to discharged after medical treatments.
Data analysis was performed by means of univariate
method, bivariate method using the chi-square test,
and multivariate method using multiple logistic
regression tests with a confidence level of 95% (α =
0.05). In summary,
the reseach
process scheme is
shown in Figure. 1.
Figure 1: The Scheme of Research Process.
3 RESULTS AND DISCUSSION
Based on the measurement results of the overall data
from 261 respondents who willing to participate in
the survey and filled out the questionnaires, it showed
that the average value of the payment system was
around 6.3, the waiting time was around 70.2
minutes, the competency of the officers was around
6.6 and the patient satisfaction was around 29.2. The
detailed data for each variable are: (i) Payment
systems with maximum and minimum scores
obtained from respondents were 10 and 1,
respectively, and an average value of around 6.3 out
of 10. These values can be interpreted that there are
respondents who experienced the payment system
was very good, also some still perceived it is not
good, but on average respondent feel good about the
integrated payment system and clarity in item charged
during treatment in the hospital. (ii) The longest
payment time was 145 minutes and the fastest time
was 30 minutes which in the average payment time
was 70.2 minutes. The majority of respondents assess
the type of payment factor (self funded or insurance)
affect the length of time of payment. Insurance
payment method has a longer waiting time compare
to the self funded because the insurance payment
method requires more administrative paperwork to be
filled in for their assessment of patient’s policy
coverage. The insurance’s verifier will audit the
billing before issued final guarantee letter if all billing
was covered or partially covered. (iii) The maximum
score of officers competency was about 10 and a
minimum score was 2. The average score was 6.6 out
of 10, where the friendly, polite, responsive, good
interpersonal skill and communicable officers were
considered good and who lack of technical skill in
explaining the breakdown of the expenses considered
to be lack of professionalism because the officers had
to ask the nurse when patient need more information
about the item charged in the billing statement. (iv)
the patient satisfaction with a maximum value by
respondents was approximately 38 with a minimum
value of around 17. The average value of patient
satisfaction is 29.2 out of 40. The majority assesses
how officers mannered, behaved and communicate
was considered as factors that influence respondent
satisfaction. The measured data distribution for
independent and dependent variables can be seen in
Figure 2.
HIMBEP 2020 - International Conference on Health Informatics, Medical, Biological Engineering, and Pharmaceutical
238

Figure 2: Measured data distribution for independent and
dependent variables of 261 respondents.
Based on univariate analysis of the questionnaire
data, it was found that the payment system with very
good assessment was around 29.1%, the waiting time
between 61-90 minutes was around 30.3% (average
value of 70.2 minutes), the officer competency with
very good assessment was around 40.6%, the satisfied
patients were 80.1%, and the unsatisfied patients were
19.9% (Table 2).
Table 2: Variable Frequency Distribution (n=261).
Variables
Quantit
y
n %
Payment System:
Very Good
Good
Average
Deficient
Poor
76
70
72
28
15
29.1
26.8
27.6
10.7
5.7
Payment Waiting Time
(minutes):
≤ 30
31 – 60
61 – 90
91 – 120
≥ 120
28
67
79
35
52
10.7
25.7
30.3
13.4
19.9
Officers Competency:
Very Good
Good
Average
Deficient
Poor
106
95
22
26
12
40.6
36.4
8.4
10.0
4.6
Patient Satisfaction:
Satisfied
Not Satisfied
209
52
80.1
19.9
Based on bivariate analysis, all independent
variables were found to be significantly related to
patient satisfaction (p-value ≤ 0.05), namely the
payment system (billing) (p = 0.003), the payment
waiting time of (p = 0.012), and the officers
competency of (p = 0,000). The details Chi-Square
statistical test results can be seen in Table3.
Table 3: The Relationship of Each Independent and
Dependent Variable
Variables
Patient satisfaction
Quantity
p-value
Satisfied
Not
satisfied
n % n % N %
Payment System:
Very good
Good
Average
Deficient
Poor
76
68
62
3
0
100,0
97,1
86,1
10,7
0,0
0
2
10
25
15
0,0
2,9
13,9
89,3
100,0
76
70
72
28
15
100,0
100,0
100,0
100,0
100,0
0,003
Payment Waiting
Time (minutes):
≤ 30
31 – 60
61 – 90
91 – 120
≥ 120
28
62
43
24
52
100,0
92,5
82,7
68,5
65,8
0
5
9
11
27
0,0
7,5
17,3
31.5
34,2
28
67
52
35
79
100,0
100,0
100,0
100,0
100,0
0,012
Officer
Competency:
Very Good
Good
Average
Deficient
Poor
106
94
7
2
0
100,0
98,9
31,8
7,7
0,0
0
1
15
24
12
0,0
1,1
68,2
92,3
100,0
106
95
22
26
12
100,0
100,0
100,0
100,0
100,0
0,000
The results of multivariate analysis with multiple
logistic regression tests showed that of the 3 variables
as model candidates which are payment system,
payment waiting time and officers competency, all
related to the satisfaction of inpatients returning
home.
Table 4 shows the results of multiple logistic
regression tests. Where B is a beta value, Sig. is
significant, Exp (B) is exponential beta read as an OR
(Odds ratio) value, and 95% CI for exp (B) is a 95%
confidence level for beta exponential values for the
upper and lower limits of the Lower and Upper. The
most dominant variable related to patient satisfaction
was the staff competency variable which has a value
of Exp (B) / OR = 9,94 1 by means that patient who
state competency in the good category have a 9.9
times higher chance of being satisfied compared to
patients who state the competency of officers was not
good.
Relationship of Payment System, Waiting Time, and Officer Level Competency toward Inpatient Satisfaction
239

Table 4: Results of Multiple Logistic Regression Tests
Variables B Sig.
Exp
(B
)
95%CI for
Exp(B)
Payment system
Waiting Time
Officers Competency
Constant
2,140
1,588
2,297
-9,831
0,004
0,014
0,001
0,000
8,497
4,893
9,941
3,857-18,718
2,151-11,132
4,432-22,299
3.1 Payment Systems
Based on the results of the study showed that there
was a relationship between the payment system
(billing) with patient satisfaction which states that the
payment system is in the good category, has a 8.4
times higher chance of being satisfied compared to
patients who claim the payment system is not good.
The results of this study are in line with research
conducted by Anggita (2012) in inpatients at Graha
Permata Ibu Women’s and Children’s Hospital
Bekasi that an inadequate payment system causes
patients to feel less satisfied. While for patients who
think that the payment system is good, they are
satisfied with hospital services. Research conducted
by Zulfa (2013) on patients at Puspa Husada
Women’s and Children’s Hospital Bekasi, a hospital
with fast and accurate billing payment system
resulted in patients to be satisfied, while some
respondents said they were dissatisfied because the
hospital billing payment system was less accurate.
Furthermore, Oktamianiza & Rahmi's research
(2019) at Dr. Rasidin State General Hospital Padang
found dissatisfaction in the inpatient’s payment
system because the payment system was still
manually recorded. Susanti, Meliala and Kusmedi’s
research (2017) at Tarakan Hospital Jakarta found
that since they change the implementation of the
billing system, it has increased the level of customer
satisfaction.
According to the results of this study it prove that
the payment system has made 72% of patients feel
satisfied by stating that the payment system used was
good, while 28% of respondents stated that the
payment system was still not good, which means it
still needs to be reviewed and improved so that it can
satisfy all respondents or patients. For respondents
who were satisfied, stated that the payment system
was quickly carried out, the data was integrated in
detail, and all expenses were clearly stated.
Patients feel that the payment system was not
good because the inpatient billing payment system
was felt to be less professional because whenever the
patient asked about the billing estimation, the system
cannot generate the real time data. The officer had to
coordinate with the nurse, pharmacy or other unit to
updating the data before informing the patient the
current billing. In addition, the payment system was
considered to be inadequate because the inpatient
billing payment system must wait for reports from
related unit, thus it was time consuming and resulted
in increases the waiting time. Some respondents also
stated that the expenses were not clearly stated,
causing them to assume that the payment system was
inadequate or still need to be improved in such that
the payment system could be better and be able to
satisfy all patients.
Another patient dissatisfaction related to the
payment system is the Electronic Data Capture (EDC)
of banks which often experience disruptions thus
caused delay in the payment system process.
3.2 Payment Waiting Time
Based on the study results showed that there was a
relationship between the payments waiting time with
inpatient satisfaction. Patients who stated the
payment duration is still appropriate (< 2 hours) had
a 4.8% higher chance of being satisfied than patients
who stated the payment duration was inappropriate (≥
2 hours).
Research by Oktamianiza and Rahmi (2019)
conducted in Dr. Rasidin State General Hospital
Padang found that 54.8% of patients were dissatisfied
with the waiting time for inpatient payments.
Furthermore, Alamsyah research (2017) in the
Masmitra General Hospital Bekasi that the average
length of the patient's family received billing
information from the cashier was 160 minutes (> 2
hours). Research by Zulfa (2018) at the Puspa Husada
Women’s and Children’s Hospital Bekasi found there
were complaints from the patient's family about the
long waiting time for them to receive the billing
information after medical treatments. The waiting
time for the administration process was average from
2 to 2.5 hours.
The mismatch of waiting time for inpatients in the
payment system was caused by the long waiting time
to get billing information where in general the
calculation were started once the doctor's visit and
allows a patient to go home. The calculation should
have been done in real time. Adequate use of
information technology was a factor that can help
accelerate administrative service activities. A better
relationship between the hospital and the patient is a
necessity in retaining customers or patients. One
effort to retain customers or patients is to provide
satisfaction with patients by increasing payment
services once patients are allowed to go home by
cutting service waiting times.
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240

The results given from this research shows that
19.9% of patients stated that the waiting time was
inappropriate in the sense of the length of time to
calculate the hospital bill was more than 2 hours. This
needs to be address as a concern for hospital therefore
it can improve the service of payment waiting time to
be less than 2 hours. The fastest time of service was
35 minutes while the longest time was 145 minutes or
2.25 hours. If observed the average waiting time of
70.2 minutes, which means more than 1 hour the
patient gets hospital bill payment services, the
waiting time was still in the appropriate category. The
majority of respondents expressed satisfaction based
on the length of the waiting time for payment of
hospital bills. Payment waiting time of more than 2
hours will make patients feel less satisfied. The faster
the bill payment service, the more satisfaction that is
felt by the patient hence in the end it can improve the
hospital image.
3.3 Officers Competency
A review of officers' competency shows that there
was a relationship with inpatient satisfaction. The
correspondence which stated the officer’s
competency is good, had a 9.9 times higher chance of
being satisfied compared to patients who stated the
competency of officers was not good. These results
indicate that the process of completing the
administration of inpatients was influenced by human
resources (HR). Factors that influence patient
satisfaction were officers who are less responsive in
providing services for bill payment of the overall
expense to be paid by patients when they want to go
home.
Administrative services must be professionally
carried out by a competent officer and speedily
processed with the aim to shorten the waiting time
thus the patient or patient's family feels satisfied.
Administrative services that were processed by
incompetent officers and manually carried out
provide obstacles to the flow of information between
one unit and another, as well as the impact of the
delay in information needed. The essence of a high
level of patient dissatisfaction with care and payment
systems in a hospital is a lack of trust (Shan et al.,
2016). The attitude of hospital staff played an
important role in providing health services to patients
and could affect and even reduce the patient
satisfaction rate (Fenny, Enemark, Asante, Hansen,
2014).
Satisfaction of inpatients also relates to the
competence of administrative staff. Officer
competence refers to the speed of the officers in
providing administrative services, not complicated,
meticulous in calculating the expenses that have been
used by patients during treatment. In addition, the
officer exhibit good communication skills when
communicating to patient or the patient's family in
informing the patient’s billing. Officers must display
a friendly, responsive and polite attitude to make the
patient and family feel comfortable. Officers must
explain in detail what expenses should be paid by the
patient and family. All of these services aim to satisfy
patients and families so they get a deep impression
while being treated in the facility.
This study also found that some respondents
stated that the officer did not explain in detail related
to what the expenses listed on the bill, and usually
explained the outline only. In addition, some
respondents also stated that the officer’s competency
was not met the expectation, this was because the
officers did not explain the bill in an easily
understood language. There were medical
consumables such as medicines that must be asked to
the nurse first. Officers usually explain general things
while about drugs and laboratory examinations
cashiers do not well understand and must refer the
question to pharmacist or laboratory analyst.
Moreover patients get less satisfied when the billing
statement was miscalculated. This affected the
patient satisfaction in terms of trust to hospital image.
4 CONCLUSIONS
Patient satisfaction is related to the fulfilment of the
expectation. The hospital as one of the health services
provider is expected to provide effective and efficient
services. Observing the results of the study, patients
who were satisfied by 80.1%, and those who were
dissatisfied with 19.9%, the majority indicate the
payment system was very good (29.1%), the waiting
time was still in good range of 61-90 minutes (30.3
%) or an average value of 70.2 minutes (still
according to the standard i.e. <2 hours), and the
officers competence was very good (40.6%). An
incompetence of the officers were caused by the lack
of officer's technical skill causing confusion in
explaining billing details properly and must
coordinate with nurses in the use of consumable
medical items.
Payment system, payment duration, and staff
competence were related to patient satisfaction that
allowed to go home p <0.05. The most dominant
variable related to patient satisfaction was the officers
competency who have an Exp (B) / OR value of 9.941
by mean that patients who state competency in the
Relationship of Payment System, Waiting Time, and Officer Level Competency toward Inpatient Satisfaction
241

good category have a 9.9 times higher chance of
being satisfied compared to patients who state that the
competency of officers was not good.
In conclusion, this study can help the hospital
management to review their strategic planning in
order to increase the patient satisfaction which will
result in the increase in revenue. The hospital
management should pay more attention in developing
the human resources by increasing officer’s technical
skill as well as interpersonal skill to be able to deliver
personalized services to patient to fulfil their
expectation. With the more attentive officer, the
weakness of the payment system and the long waiting
time can be overcome and not affecting hospital
image and can maintain patient loyalty.
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