Ekawati Fitriana Murriya, Claramita Mora, Hort Krishna, Furler John, Licqurish Sharon, Gunn Jane
Department of Family and Community Medicine, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Department of General Practice and Primary Health Care, University of Melbourne, Melbourne, Australia.
Asia Pac Fam Med. 2017 Mar 21;16:4. doi: 10.1186/s12930-017-0034-6. eCollection 2017.
The World Health Organization (WHO) recommendation on universal coverage has been implemented in Indonesia as (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.
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.
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.
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.
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.
世界卫生组织（WHO）关于全民医保的建议已在印度尼西亚作为“全民健康保险（JKN）”实施。其旨在通过强化作为医院“守门人”的初级保健，为人们提供公平且高质量的医疗保健。然而，在实施的第一年，JKN成员招募缓慢，从初级保健到二级保健的转诊率依然很高。对于公众如何看待JKN的引入或影响他们加入JKN决策的因素，人们知之甚少。
本研究旨在探讨患者对JKN实施的看法以及影响个人加入JKN计划决策的因素。
本研究采用解释现象学分析（IPA）方法来理解患者的看法。访谈参与者采用最大差异标准进行有目的招募。数据通过深度访谈收集，于2014年10月至12月在日惹进行。访谈内容经转录、翻译后采用IPA分析。
来自八个初级保健诊所的23名参与者接受了访谈。确定了三个上级主题：可及性、信任和分离焦虑，它们影响了JKN的参与情况。参与者承认，虽然初级保健诊所位置便利，但等待时间长和营业时间短常常使可及性变得复杂。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。他们还表示担心当前的JKN规定可能会限制他们获得过去所保证的医院服务的能力。
本研究确定了患者的一些看法，这些看法可能会对印度尼西亚初级保健“守门人”角色的实施构成挑战。虽然患者重视在家附近就能获得医疗服务，但他们对初级保健医生缺乏信任以及担心未来可能失去医院护理，这似乎影响了JKN的参与情况。除非通过持续的公众教育和初级保健方面的进一步能力建设，有针对性地努力解决这些看法，否则JKN计划在初级保健中的全部潜力不太可能实现。
