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As a developing country with a projected population of 255 million in 2015 according to the Statistics Central Bureau1, the Indonesian healthcare industry must also grow to serve its population. In order to provide healthcare services, the Indonesian Ministry of Health (Kemenkes) employs a Health Referral System which is authorized by the Health Minister Regulation No. 001 Year 2012 regarding Individual Healthcare Referral System (Hukor, 2014). In the Referral System, patients’ health service is provided by three tiers; tier one is provided by primary healthcare facilities, e.g., Puskesmas, clinics or Pratama hospitals, that provide basic healthcare services; tier two is provided by hospitals both generals and specialized hospitals, that provide specialist healthcare services; and tier three is provided by hospitals that provide sub specialist healthcare services. Thus, it is evident that hospitals hold a vital role in providing healthcare services to the people.
According to Data Rumah Sakit Online2, there are 2,333 hospitals with a total of 283,515 inpatient beds available. Although the overall ratio beds to population is still around the WHO standard (1:1000), there many areas in which the ratio is below standard345. This inpatient bed shortage will surely affect the healthcare service quality since hospitals have to reject the patients due to bed shortage. Moreover, many Indonesian hospitals in tier two also state that they endure health personnel shortages including general and specialist doctors, nurses and administrative staff678910. Furthermore, besides those two there are some other factors that could hinder healthcare service quality, e.g., complex/time-consuming administration process in hospital, medicine or medical equipment unavailability, etc.11.
On the 1st January 2014, the Indonesian Government launched the National Health Coverage (JKN)12, authorized by Law No. 40 Year 2004 (SJSN, 2004), through BPJS which is established by Law No. 24 Year 2011 (BPJS, 2011), as a concrete effort to guarantee that the healthcare of all Indonesian citizens are covered. Consequently, this program will increase the number of patients in the hospitals. As hospitals in general are not well-prepared to anticipate the increase, hospitals capacity (facility and healthcare personnel) is unable to meet the demand for healthcare services13. Therefore, this event will further exacerbate the earlier situation in which services quality is already hindered by the lack of bed, health personnel, etc.
A poor health service quality is certainly undesirable, especially since the subject is a human being. As human beings and the prime consumers of health services, patients undoubtedly have their own expectations and perceptions of the health services they experience. Understanding patients’ perception is deemed necessary because patient satisfaction is essential for quality assurance in medical services and hospitals (Laslet, 1994 in Sohail, 2003). Moreover, O’Connor et. al., (as cited in Shabila et. al., 2014) noted that “patients’ perspective is increasingly viewed as a meaningful and important indicator of health service quality that should be taken into account as part of a comprehensive assessment of quality health care”. Thus, understanding patients’ expectation and perceptions and analyzing the gaps can further give direction for hospitals, viz. the management, in order to improve their services quality from the patients’ perspectives, e.g., by evaluating hospitals’ current services against the gaps.