Patients' experience of using primary care services in the context of Indonesian universal health coverage reforms.
Patients' experience of using primary care services in the context of Indonesian universal health coverage reforms.
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DOI：
10.1186/s12930-017-0034-6
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发表时间：
2017
影响因子：
--
通讯作者：
Gunn J
中科院分区：
文献类型：
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作者：
Ekawati FM;Claramita M;Hort K;Furler J;Licqurish S;Gunn J
世界卫生组织(世卫组织)关于全民覆盖的建议已在印度尼西亚作为Jaminan Kesehatan Nasional(JKN)实施。它旨在通过加强初级保健作为医院的守门人，为人们提供公平和高质量的卫生保健。然而，在其实施的第一年，招募JKN成员的速度很慢，从初级保健到二级保健的转诊率仍然很高。关于公众如何看待JKN的引入或影响他们决定加入JKN的因素，人们知之甚少。本研究旨在探讨病人对JKN计划实施的意见，以及影响个人决定参加JKN计划的因素。本研究通过解释现象学分析(IPA)方法了解患者的意见。面试参与者是根据最大差异标准有目的地招募的。这些数据是通过深入访谈收集的，于2014年10月至12月在日惹进行。访谈被转录、翻译，并使用IPA分析进行分析。来自8家初级保健诊所的23名参与者接受了采访。三个最重要的主题：接近、信任和分离焦虑被识别出来，它们影响了JKN的使用。与会者承认，虽然初级保健诊所的位置很方便，但由于等待时间长和开放时间短，出入往往很复杂。参与者还表示，与医院和专科医生相比，他们对初级保健医生的信任程度较低。他们还报告说，他们感到焦虑，担心目前的JKN法规可能会限制他们获得过去保障的医院服务的能力。这项研究确定了患者的观点，这些观点可能会挑战印度尼西亚初级保健守门人角色的实施。虽然患者重视离家近的医疗服务，但他们对初级保健医生缺乏信任，以及对未来可能失去医院护理的恐惧，似乎影响了JKN的接受。除非作出有针对性的努力，通过持续的公共教育和进一步的初级保健能力建设来处理这些意见，否则不太可能充分发挥初级保健的JKN计划的潜力。
The World Health Organization (WHO) recommendation on universal coverage has been implemented in Indonesia as Jaminan Kesehatan Nasional (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.