Maharani Chatila, Afief Desie Frihandini, Weber Dorothea, Marx Michael, Loukanova Svetla
Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany.
Department of Public Health, Universitas Negeri Semarang, Semarang, Indonesia.
BMC Health Serv Res. 2019 May 8;19(1):290. doi: 10.1186/s12913-019-4121-2.
In 2014, Indonesia launched a mandatory national health insurance system called Jaminan Kesehatan Nasional (JKN). The reform introduced new conditions for primary care physicians (PCPs) that could influence their job satisfaction. This study assessed PCPs' satisfaction and its predictors in two cities in Central Java, Indonesia, following the reform.
In this exploratory, cross-sectional study, we recruited 276 PCPs from the selected area. The data were all collected in 2016 using self-report questionnaires and interviews. PCPs' satisfaction was measured using a modified version of the Warr-Cook-Wall Job Satisfaction Scale which contains 19 items and uses a Likert-type response scale. Analysis of variance, the Kruskal-Wallis H test, both with Bonferroni corrections for post hoc testing, and Cochran-Mantel-Haenszel tests were used to compare overall job satisfaction between participant groups. We used simple and multiple linear regression analyses to identify the predictors of PCP satisfaction. Furthermore, a logistic regression analysis for binary outcome was applied to model the PCPs intention to leave practice.
PCPs' mean overall satisfaction level was 3.19 out of 5. They tended to be very satisfied with their relationship with colleagues, working hours, and physical working conditions. However, the PCPs were dissatisfied with the new referral system, the JKN health services standards, and JKN policy. The factors significantly associated with job satisfaction (p < 0.001) included type of practice, performance of managerial tasks, and PCPs' perceptions of and experiences with patients. PCP satisfaction was negatively associated (p = 0.004) with PCPs' intention to leave their practice.
The PCPs investigated in these two cities in Central Java had moderate satisfaction after the Indonesian health care reform. PCPs who worked in solo practices, performed managerial tasks, and had good experiences with patients tended to have higher satisfaction scores, which in turn prevented them from developing an intention to leave their practice. The three aspects that PCPs with which most dissatisfied were related with the JKN reform. Because of that, the government and BPJS for Health should aim to improve the JKN system in order to increase PCPs' satisfaction.
2014年，印度尼西亚推出了一项名为“国民健康保险”（Jaminan Kesehatan Nasional，JKN）的强制性国家医疗保险制度。这项改革为基层医疗医生（PCP）带来了可能影响其工作满意度的新情况。本研究评估了改革后印度尼西亚中爪哇两个城市基层医疗医生的满意度及其预测因素。
在这项探索性横断面研究中，我们从选定地区招募了276名基层医疗医生。所有数据均于2016年通过自我报告问卷和访谈收集。基层医疗医生的满意度使用Warr-Cook-Wall工作满意度量表的修订版进行测量，该量表包含19个项目，并采用李克特式反应量表。方差分析、带有Bonferroni校正用于事后检验的Kruskal-Wallis H检验以及Cochran-Mantel-Haenszel检验用于比较参与者群体之间的总体工作满意度。我们使用简单和多元线性回归分析来确定基层医疗医生满意度的预测因素。此外，应用二元结果的逻辑回归分析来模拟基层医疗医生离开执业的意愿。
基层医疗医生的平均总体满意度水平为5分中的3.19分。他们往往对与同事的关系、工作时间和工作物理条件非常满意。然而，基层医疗医生对新的转诊系统、国民健康保险医疗服务标准和国民健康保险政策不满意。与工作满意度显著相关（p < 0.001）的因素包括执业类型、管理任务的执行情况以及基层医疗医生对患者的看法和经验。基层医疗医生的满意度与他们离开执业的意愿呈负相关（p = 0.004）。
在印度尼西亚医疗改革后，对中爪哇这两个城市调查的基层医疗医生满意度中等。在个体诊所工作、执行管理任务且与患者有良好经验的基层医疗医生往往有较高的满意度得分，这反过来又阻止了他们产生离开执业的意愿。基层医疗医生最不满意的三个方面与国民健康保险改革有关。因此，政府和国民健康保险管理机构应旨在改进国民健康保险制度，以提高基层医疗医生的满意度。
