Perceptions of Indonesian general practitioners in maintaining standards of medical practice at a time of health reform

Syah, Nur Afrainin; Roberts, Chris; Jones, Alison; Trevena, Lyndal; Kumar, Koshila

doi:10.1093/fampra/cmv057

Cited by 20 publications

(22 citation statements)

References 17 publications

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“…Their less positive attitude was likely related to a perception that gatekeeping formed an additional burden in their daily duties. A study in Indonesia has found that GPs perceive increasing demand from patients as one of the barriers to performing optimally as primary care physicians [10]. Moreover, it has been reported that patients perceive the quality of primary care as low and that they view the gatekeeper as an access barrier to more advanced services perceived to be of higher quality [7].…”

Section: Discussionmentioning

confidence: 99%

“…Perceiving primary care to be of low quality, urban patients often request direct referral to secondary care facilities [7]. Currently, the strict regulations applying to NHI bene ciaries for accessing healthcare curtail such swift referrals and lead to more tension in physician-patient relationships [10,26]. Such frequent con icts may generate additional stress for GPs, thereby inducing more negative attitudes towards the gatekeeping function.…”

Section: Discussionmentioning

confidence: 99%

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Exploring General Practitioners’ Perceptions About the Primary Care Gatekeeper Role in Indonesia

Mulyanto

Wibowo

Kringos

2020

Preprint

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Background In the current healthcare delivery system funded by National Health Insurance (NHI) in Indonesia, the gatekeeper role of primary care services is critical to ensuring equal healthcare access for the population. To be effective, gatekeeping relies on the performance of general practitioners (GPs). However, the perceptions held by Indonesian GPs about their gatekeeper role are not yet well documented. This study describes the self-perceived knowledge, attitudes and performance of Indonesian GPs with respect to the gatekeeper role and explores associated factors. Methods We conducted a cross-sectional study of all primary care facilities (N = 75) contracted by the regional NHI office in the Banyumas district. The 73 participating GPs completed a written questionnaire that assessed their knowledge, attitudes and performance in relation to the gatekeeper role. Personal and facility characteristics were analysed in a generalised linear model as possible associating factors.ResultsGPs scored relatively high in the domains of knowledge and performance but scored lower in their attitudes towards the gatekeeper role of primary care. In the full-adjusted model, no factors were significantly associated with the knowledge score. Work experience as GPs, private or civil service employment status and rural or urban location of the primary care facility were linked to attitude scores. Full- or part-time employment and type of facility were factors associated with the performance score. Conclusion GPs in Indonesia are knowledgeable and report that they adequately perform their function as gatekeepers in primary care. However, their attitudes towards the gatekeeper function are less positive. Attitudes and performance with respect to the primary care gatekeeper role are likely influenced more by contextual factors such as location and type of facility than by personal factors. Efforts to address contextual issues could include improvements in practice standards for privately practising physicians and public information campaigns about gatekeeping regulations. Such efforts will be crucial to improving the gatekeeper role of primary care in Indonesia and assuring efficient access to high-quality care for all.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Exploring General Practitioners’ Perceptions About the Primary Care Gatekeeper Role in Indonesia

Mulyanto

Wibowo

Kringos

2020

Preprint

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“…The transformation of health insurance/Asuransi Kesehatan (ASKES) (low coverage and fragmented health insurance system) into BPJS Kesehatan (universal coverage) since 5 years ago does not significantly improve the performance and satisfaction of GPs in managing the NCDs patients because the BPJS Kesehatan implements policies which are similar to ASKES era in terms of insurance company's lack of respect for professional autonomy of the GPs. The GPs perceived that they were controlled and constrained by the health insurance policies in their clinical decision-making process and patient management strategies 3 . Policies implemented by health insurance companies should be in line with professional autonomy.…”

Section: Discussionmentioning

confidence: 99%

General Practitioners’ Autonomy in the Management of Non-Communicable Diseases (NCDs) in the JKN Era: Is It Feasible?

Syah

2019

rpcpe

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Demographic, epidemiological, and nutritional transitions increase life expectancy, changes in lifestyles and behaviors of Indonesian people. These changes are resulting in a growing contribution of non-communicable diseases (NCDs) to morbidity and mortality, especially metabolic disorders, such as type 2 diabetes mellitus (DM), hypertension, and dyslipidemia. Approximately 10.9% of the Indonesian population above 15 years old suffers from type 2 DM (21.2 million) and 34.1% have hypertension (66.3 million) in 2018. These figures increase significantly from 2013 figure; 6.9% and 25.8% respectively1. The metabolic disorders, which in turn, are responsible for vascular problems such as renal failure, stroke, and heart attack. Not surprisingly, then, 60% of Indonesian national health insurance (JKN) funds are spent on the NCDs. This condition causes a deficit and threatens the sustainability of the JKN program.

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“…Therefore, a more extensive public information campaign in television, radio, or at any community meetings is essential so that people can understand what is JKN, what is covered, what is not covered, and what are the GPs’ roles in the JKN scheme. While the literature showed that GPs also felt overwhelmed with the JKN working load [44], an insurance specialist may also help to inform the patients about any JKN regulation changes at the clinics settings.…”

Section: Discussionmentioning

confidence: 99%

Patients’ experience of using primary care services in the context of Indonesian universal health coverage reforms

et al. 2017

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BackgroundThe 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.AimThis 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.MethodsThis 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.ResultTwenty 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.DiscussionThis 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.

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Perceptions of Indonesian general practitioners in maintaining standards of medical practice at a time of health reform

Cited by 20 publications

References 17 publications

Exploring General Practitioners’ Perceptions About the Primary Care Gatekeeper Role in Indonesia

Exploring General Practitioners’ Perceptions About the Primary Care Gatekeeper Role in Indonesia

General Practitioners’ Autonomy in the Management of Non-Communicable Diseases (NCDs) in the JKN Era: Is It Feasible?

Patients’ experience of using primary care services in the context of Indonesian universal health coverage reforms

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