Patient Satisfaction Level based on Demographic Factors using
SERVQUAL Instruments in Public Hospital in
Banda Aceh, Indonesia
Ratna Juwita
1,2
, Hajjul Kamil
1
, Kartini Hasballah
3
, Elly Wardani
1
, Marthoenis
1
1
Master Program of Nursing Science, Faculty of Nursing, Syiah Kuala University, Banda Aceh, 23111
2
Nursing Academy of Akimba, Banda Aceh 26583
3
Faculty of Medicine , Syiah Kuala University, Banda Aceh, 23111
Keywords: Characteristic, Demographics, Satisfaction, Health services
Abstract: Quality health services are any efforts made by the service providers with the aim of providing high quality
and excellent services to improve the health of individuals, groups or communities alike. This study aims to
determine the differences in satisfaction among the patients in Type I, Type II, Type III, service rooms
based on the demographic characteristics of health services at the Regional General Hospital of dr. Zainoel
Abidin (RSUDZA) in Banda Aceh. This quantitative comparative study employed the Cross-Sectional
design. The population was all Type I, Type II, Type III, patients treated in the inpatient rooms. The
probability sampling method with the simple random sampling criteria was used to draw 383 patients while
the data were harnessed using the SERVQUAL Instrument. The results show that no differences were
observed in satisfaction among the Type I, Type II, Type III, patients with the p-value of > 0.05 (p = 0.237).
The management of RSUDZA needs to improve the quality of health services to provide satisfaction to its
patients by focusing on all service dimensions.
1 INTRODUCTION
Since January 1, 2014, Indonesia ratified its health
financing system. The National Health Insurance
System (SJSN) Act No. 40 of 2004 stated that from
2014 to 2019 health insurance will gradually cover
the health costs of all Indonesians. The system will
cover the cost of health maintenance and primary
health care to those who have paid health insurance
fees either by themselves or by the government. The
system is realized in the form of a compulsory social
health insurance mechanism. The Health Insurance
Agency (BPJS) is in charge of the National Health
Insurance (JKN). The agency follows the technical
guidelines for JKN implementation stated in the
Minister of Health Regulation Number 28 of 2014.
The regulation demands the hospital health facilities
to provide excellent quality services. The regulation
also stipulates that all health insurance participants
have the right to health facilities based on the
amount of contribution fee paid.
Thus, all hospitals in Indonesia have to provide
services following the provisions by the National
Health Insurance. Hospitals, as the provider of
health facilities, accommodate individual health
services such as promotion, preventive, curative and
rehabilitative services and provide inpatient,
outpatient and emergency services (Permenkes RI
No 129, 2008). Furthermore, the Article 24 of
paragraph 1 in the Public Hospital Act No. 44 of
2009, classified the public hospitals in Indonesia
into four categories, A, B, C, and D. Each type of
hospital has inpatient service facilities for Type I,
Type II, Type III, and VIP.
Service quality is an inherent aspect of a
hospital. The quality of service delivered by the
nurses in a hospital dictates the patient satisfaction.
Several factors influence patient satisfaction one of
which is the patients' demographic. To measure the
quality of health services, Parasuraman, Zeithaml,
and Berry, (1988) conducted a unique study on
several types of services and managed to identify ten
dimensions of service quality that determine patient
170
Juwita, R., Kamil, H., Hasballah, K., Wardani, E. and Marthoenis, .
Patient Satisfaction Level based on Demographic Factors using SERVQUAL Instruments in Public Hospital in Banda Aceh, Indonesia.
DOI: 10.5220/0008396100002442
In Proceedings of the Aceh International Nursing Conference (AINC 2018), pages 170-175
ISBN: 978-989-758-413-8
Copyright
c
 2022 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved

satisfaction. The findings have been empirically
tested and developed into the measurement
instrument for quality perspective according to the
customer called The SERVQUAL Instrument
(service quality). The instrument aimed at measuring
the five dimensions of patient satisfaction toward
public health services, namely, tangible, reliability,
responsiveness, assurance, and empathy.
2 METHODS
The descriptive, comparative study used a
crossectional approach. The study compared the
patient satisfaction of the Health Care and Social
Security Agency (BPJS) type I, type II and type III
cardholders based on their demographics with the
service quality determined by the hospital
(Sugiyono, 2016). Furthermore, The population in
this study were all BPJS cardholders, 185.390
people, treated in the inpatient rooms at the
RSUDZA of Banda Aceh in 2016. With the
confidence level of 95%, a total sample of 383
people was drawn using the Statcalt Epi Info
Version 7.2 application. Simple random sampling
was used to determine the samples while their
criteria were identified beforehand. Only the patients
with a BPJS health insurance and treated more than
three days at hospital inpatient wards were involved
in this study.
The instrument consists of three parts; Part A, B,
and C. Part A reviewed patient’s demographic
characteristics while Part B and C, adopted from
SERVQUAL questionnaires by Parasuraman et al.,
(1988), surveyed their satisfaction toward health
services at the hospital. The study was carried out at
a public hospital in Banda Aceh between March 13
and April 13, 2018. It commenced by drawing the
respondents, explaining the aims of the study,
interviewing the respondents regarding the level of
satisfaction felt. The study used the one-way
ANOVA statistical test. The test looked at whether
there was a significant difference in satisfaction
among the type I, type II and type III patients by
observing the significance value of (P) in the
analysis results. The Logistic Regression Test was
administered to identify the factors that most
influence the level of health service satisfaction
based on the demographic characteristics of
respondents at a significance level of (p <0.05).
3 FINDINGS
3.1 Demographic Data
Demographic data of study participants are
described in Table 1. Table 1 shows that the number
of the senior citizens in the inpatient rooms of
RSUDZA, Banda Aceh was 157 patients (41%),
202 patients (52.7%) were males, 357 patients
(93.2%) came from outside Banda Aceh, and 342
patients (89%) lived more than 10 km from the
hospital. The number of patients who suffered from
the illness within the last few days and few weeks
were 208 people (54%), and 256 respondents
(66.8%) reported to have been in the hospital for
more than four days. Nuclear family accounted for
230 patients (60.1%), and patients with a school
diploma reached 108 persons (28.2%). Most of the
patients were farmers, unskilled laborers, and
pensions totaling 191 people (49.9%) and those who
had an income of more than IDR 2.700.000,- were
249 people (65%). The figure for the non-smoking
respondents were 317 patients (82.8%), those whose
family and friend never visited reached 230 patients
(60.1%), and 160 patients (41.8%) never purchased
food outside the hospital. More then half of the
patients received health service fee assistance (PBI)
and the figures for those whose fees paid by the
central government were 236 persons (61.6%).
While 182 patients (47.5%) frequently paid the
BPJS fees, 291 patients did not know the BPJS fees
paid. The number of patients who had to pay for the
health service of more than IDR 500.000,- reached
201 people (52.5%) while only 185 people (48.3)
were not fined due to the late payment of the health
insurance fees.
3.2 Measuring Satisfaction
The findings show that most respondents, 277
respondents (72.3%), were not satisfied with health
services provided in the wards at the public hospital.
The analysis of variance (ANOVA) test shows that
the type I, type II and type III respondents have a
minus mean value of satisfaction with a p-value of
0.24, indicating that there is no difference in the
satisfaction level of the patients treated in type I,
type II, and type III inpatient care.
Patient Satisfaction Level based on Demographic Factors using SERVQUAL Instruments in Public Hospital in Banda Aceh, Indonesia
171

Table 1: Respondents characteristic (n = 383).
Characteristics Categories f %
Age Adolescent 107 27.9
Adult 119 31.1
Elderly 157 41.0
Sex Male 202 52.7
Female 181 47.3
District of origin Banda Aceh 26 6.8
Outside Banda Aceh 357 93.2
Distance from the hospital < 5 km 10 2.6
5-10 km 31 8.1
>10 km 342 89.3
Length of illness Day/week 208 54.3
Month 107 27.9
Year 68 17.8
Number of family members Nuclear family 230 60.1
Extended family 126 32.9
Dyad family 27 7.0
Level of Education Not completed education 3 0.8
Primary School 88 23.0
Middle School 89 23.2
High School 108 28.2
Diploma III 45 11.7
Undergraduate 50 13.1
Occupation Civil servant 62 16.2
Private employee 56 14.6
Businessman 46 12.0
Not working 28 7.3
Others 191 49.9
Income (IDR) ≤ 2.700.000 134 35.0
> 2.700.000 249 65.0
Length of care <4 days 127 33.2
> 4 days 256 66.8
Smoking history Yes 66 17.2
No 317 82.8
Family or friend visits Never 230 60.1
Sometimes 129 33.7
Always 24 6.3
Food purchase Never 160 41.8
Sometimes 143 37.3
Always 80 20.9
BPJS insurance status PBI 243 63.4
NON-PBI 103 26.9
Self-funding 14 3.7
Others 23 6.0
BPJS insurance fees (IDR) 80.000 49 12.8
51.000 18 4.7
25.000 25 6.5
Others 291 76.0
Routinely pay BPJS fees Yes 182 47.5
No 20 5.2
Others 181 47.3
BPJS Payment Status Central government 236 61.6
Salary Deduction 94 24.5
Self-funding 24 6.3
Others 29 7.6
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BPJS penalty fees Ever 24 6.3
Never 185 48.3
Unknown 174 45.4
Healthcare fees at the hospital (IDR) ≤500.000
128
33.4
>500.000
201
52.5
Unknown 54 14.1
Table 2: Distribution of respondents based on satisfaction (n=383).
Category Frequency %
Satisfied 106 27,7
Unsatisfied 277 72,3
Total 383 100
Table 3: Differences in patient satisfaction (n=383).
Health care level Mean SD 95% CI P-Value
Type I -8.46 9.03 (-10.72) – (-6.21)
0.24
Type II -10.21 10.29 (-12.40) – (-8.01)
Type III -8.01 10.82 (-9.41) – (-6.61)
Table 4: A comparison of patient satisfaction based on the quality dimensions (n=383).
Service quality Health care level Mean SD P-Value
Tangible
Type I -1,21 2,22
0,737
Type II -1,28 1,98
Type III -1,43 2,23
Reliability
Type I -1,75 2,00
0,129
Type II -2,26 2,61
Type III -1,61 2,64
Responsiveness
Type I -2,26 2,80
0,092
Type II -2,68 3,19
Type III -1,85 3,10
Assurance
Type I -1,10 1.95
0,575
Type II -1,40 1,76
Type III -1,17 1,97
Empathy
Type I -2,12 2,84 0,23
Type II -2,56 2,85
Type III -1,93 3,01
Table 5: Factors Influencing the Level of Patient Satisfaction.
Demographic
Characteristics
df 95% CI P-Value
Age 1 1.113-1.982 0.007
District of Origin 1 0.116-0.608 0.002
Education 1 0.558-0.996 0.047
The comparison of patient satisfaction based on the
quality dimension indicated that the highest
difference was observed in the responsiveness
dimensions, especially in the type II care facility
(95% CI = (-3.37) - (-2.01)). For the empathy
dimension, a significant difference was also found in
the type II care facility (95% CI = (-3.17) - (-1.95)).
The district of origin is the factor that most
contributes to satisfaction with the p-value of <0.05
(p = 0.002).
Patient Satisfaction Level based on Demographic Factors using SERVQUAL Instruments in Public Hospital in Banda Aceh, Indonesia
173

4 DISCUSSION
The findings show that 277 out of 383 patients
(72.3%) treated in the inpatient rooms of RSUDZA,
Banda Aceh, were not satisfied with the health
service at the hospital. The Analysis of Variances
(ANOVA) test produced the mean of each insurance
class at -8.5875 with the interval between -9.6367
and -7.5382. With the p-value of >α 0,05 (p=0,247)
it means that there was no difference in patient
satisfaction based on health insurance classes at the
inpatient rooms of RSUDZA, Banda Aceh.
Equal services provided for the type I, type II
and type III health insurance beneficiaries seems to
contribute to such result. The qualifications of
Human Resources at the hospital across each
treatment class made the patient feel satisfied with
the treatment class received according to the
guideline of BPJS paid either by the central
government, salary deductions or self-funding.
According to Tjiptono (1996), customer
satisfaction is a post-purchase evaluation in which
the chosen alternatives at least provide an equal
outcome or beyond customer expectations, while
dissatisfaction arises when the post-purchase
assessment does not meet customer expectations.
The public hospital in Banda Aceh continues to
improve its health service quality. It was apparent
from the accreditation it received in 2016 as a 5-star
hospital in Aceh. The standard aims to increase the
commitment, awareness, and ability of the health
workers, especially those who are directly related to
patients.
The findings from the five determining
dimensions of the health service quality will be
discussed.
The analysis on tangibility shows that the
majority of type I, type II and type III patients were
not satisfied with the health service provided and no
significant correlation was found between physical
proof and patient satisfaction (p= 0.737). According
to Parasuraman et al., (1988), services in the
dimensions of physical evidence include facilities,
equipment, staff appearance, cleanliness and room
comfort. Besides, the ability of the hospital as the
service provider to regulate and provide sound
conditions of its personnel is an essential factor in
this dimension. The appearance and readiness of
health workers, rooms and equipment will have a
significant impression on the quality of health
services because patients will firstly look at the
physical evidence when visiting the hospital.
The public hospital seems to place reliability as
its second priority in meeting patient satisfaction. It
was apparent from the result of the study (p=0.129).
According to Parasuraman et al., (1988), reliability
is the ability of health workers to provide fast,
precise and non-convoluted services. It can have a
significant effect on patients in getting the desired
health services
.
The p-value of (0,092 > 0,05) indicates that most
of type I, type II and type III patients were not
satisfied with the hospital reliability performances. It
means that the health workers have not performed
their best in delivering health services. They have
failed to react accordingly to patient complaints and
meet their needs. According to Parasuraman et al.,
(1988), responsiveness is the ability of health
workers to respond to patient complaints and meet
their needs as best as possible.
The majority of the respondents were not
satisfied with the assurance dimension with the p-
value of (0,575 > 0,05). Dissatisfaction describes the
real experience of the patients that do not correspond
to their expectation on how health workers can
assure the patients to feel safe during treatment, be
consistent and have sufficient knowledge to answer
patient questions. According to Parasuraman et al.,
(1988), service assurance is the ability of health
workers to provide safe and comfortable services
following the standards set by the service provider.
On the average, the beneficiaries of type I, type
II, and type III health insurance were not satisfied
toward empathy dimension with the p-value of
(0.234 >0.05). According to Parasuraman et al.,
(1988), empathy service is the ability of health
workers to provide care with mindfulness and
compassion about what patients experience. The
wards in the public hospital have not
comprehensively implemented emphatic services
such as giving special attention, having comfortable
service hours, always prioritizing the interests of
patients and understanding the specific needs of its
patients.
An analysis of the factors that contribute to the
level of satisfaction shows that age, district of origin,
and education have a significant influence on patient
satisfaction with p-value of < 0.05 at (p = 0.007), (p
= 0.002), and (p = 0.047) respectively.
The age of a patient determines how the patients
behave toward his illness and their relationship with
the health workers (Gunarsa and Gunarsa, 2012).
The results showed that of the 157 elderly
respondents, 52.8% were satisfied with the health
services provided in the inpatient room of this
hospital. Resmisari (2008) argued that older patients
found themselves to be more satisfied than younger
patients. Elderly patients often make use of their
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time to ask health workers about their condition. The
study also found that 47 respondents (58.5%) with
low education were satisfied with the health services
at the hospital. According to Notoatmodjo (2005),
the level of education is one of the determining
factors that influences patient expectations and
perceptions toward health services.
The final factor that influences patient
satisfaction is the district of origin. 357 respondents
(93%) who come from outside Banda Aceh felt
satisfied with the health service given at hospital
wards. This finding contradicts with Husin's (2004)
statement that people who live far away from
healthcare facilities tend to be dissatisfied compared
to those who live nearby. If the effort made to reach
a healthcare facility is not comparable to the services
provided, the patients will tend to be displeased.
5 CONCLUSION
Patient satisfaction has a considerable impact on the
hospital because as the consumer of health care, they
often expect high-quality services. Therefore, there
is a need for further studies on the implementation of
national health insurance in term of the membership
status and BPJS health insurance fees by primarily
focusing on the right of the patients.
ACKNOWLEDGEMENT
The main author very grateful to the Akimba for
funding this research and for their support in
completing this study. Lastly, all the authors thanked
the patient in the inpatient room at RSUDZA general
hospital of Banda Aceh for their participation in this
research.
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