ADLN - Perpustakaan Universitas Airlangga TESIS

ADLN - Perpustakaan Universitas Airlangga

TESIS

PERILAKU MASYARAKAT TERHADAP PEMANFAATAN PELAYANAN KESEHATAN RUMAH SAKIT BERDASARKAN MODEL ANDERSEN (STUDI KASUS DI KECAMATAN DEWANTARA KABUPATEN ACEH UTARA)

LINUR FICCA AGUSTINA

UNIVERSITAS AIRLANGGA FAKULTAS KESEHATAN MASYARAKAT PROGRAM MAGISTER PROGRAM STUDI ILMU KESEHATAN MASYARAKAT SURABAYA 2015

TESIS

PERILAKU MASYARAKAT TERHADAP PEMANFAATAN...



TESIS PERILAKU MASYARAKAT TERHADAP PEMANFAATAN PELAYANAN KESEHATAN RUMAH SAKIT BERDASARKAN MODEL ANDERSEN (STUDI KASUS DI KECAMATAN DEWANTARA KABUPATEN ACEH UTARA)

LINUR FICCA AGUSTINA NIM 101214153035


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PERILAKU MASYARAKAT TERHADAP PEMANFAATAN PELAYANAN KESEHATAN RUMAH SAKIT BERDASARKAN MODEL ANDERSEN (STUDI KASUS DI KECAMATAN DEWANTARA KABUPATEN ACEH UTARA)

TESIS Untuk memperoleh gelar Magister Kesehatan Minat Studi Promosi Kesehatan dan Ilmu Perilaku Program Studi Ilmu Kesehatan Masyarakat Fakultas Kesehatan Masyarakat Universitas Airlangga

Oleh : LINUR FICCA AGUSTINA NIM 101214153035


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KATA PENGANTAR

Puji syukur kehadirat Allah SWT atas Karunia dan Hidayah-Nya penyusunan tesis dengan judul “PERILAKU MASYARAKAT TERHADAP PEMANFAATAN PELAYANAN KESEHATAN RUMAH SAKIT BERDASARKAN MODEL ANDERSEN (STUDI KASUS DI KECAMATAN DEWANTARA KABUPATEN ACEH UTARA)” ini dapat terselesaikan. Tesis ini berisikan analisa mengenai perilaku pemanfaatan pelayanan kesehatan rumah sakit berdasarkan model Andersen. Penelitian ini menganalisis faktor predisposisi, faktor pendukung dan faktor kebutuhan terhadap pelayanan kesehtan rumah sakit di Kecamatan Dewantara Kabupaten Aceh Utara. Penelitian ini menghasilkan saran dalam upaya promosi kesehatan dan peningkatan pelayanan kesehatan rumah sakit sehingga meningkatkan minat masyarakat untuk memanfaatkan kembali rumah sakit lokal di daerah tersebut. Ucapan terima kasih yang tak terhingga saya sampaikan kepada Bapak Dr. M. Bagus Qomaruddin, Drs., M.Sc selaku pembimbing ketua yang dengan kesabaran dan penuh perhatian dalam memberikan bimbingan, semangat dan saran baik secara akademis dan non akademis hingga tesis ini bisa terselesaikan dengan baik. Ucapan terima kasih yang tak terhingga juga saya sampaikan kepada Ibu Muji Sulistyowati, S.KM., M.Kes, selaku pembimbing yang penuh kesabaran, dan meluangkan waktu untuk memberikan bimbingan, motivasi dan saran demi kesempurnaan tesis ini. Dengan terselesainya tesis ini, perkenankan saya mengucapkan terima kasih yang sebesar-besarnya kepada : 1. Rektor Universitas Airlangga Prof. Dr. Fasich, Apt 2. Dekan Fakultas Kesehatan Masyarakat Universitas Airlangga Prof. Dr. Tri Martiana, dr., MS atas kesempatan yang diberikan kepada saya untuk dapat mengikuti dan menyelesaikan pendidikan di Program Magister Ilmu Kesehatan Masyarakat Universitas Airlangga Surabaya 3. Ketua Program Studi Ilmu Kesehatan Masyarakat Dr. Sri Adiningsih, dr., MS., M.CN atas kemudahan dan kelancaran selama menempuh pendidikan di Program Magister Ilmu Kesehatan Masyarakat Universitas Airlangga Surabaya. 4. Ketua Minat Studi Kesehatan Promosi Kesehatan dan Ilmu Perilaku, Dr. M. Bagus Qomaruddin, Drs., M.Sc 5. Ketua dan Panitia Penguji, Bapak Dr. Arief Wibowo, dr., MS, Dr. Djazuli Chalidyanto,S.KM., MARS dan ibu Dr. Dwi Aryani., drg., MARS atas perhatian, bimbingan, dan kerjasamanya telah merelakan waktu dan tenaga untuk menguji tesis saya 6. Seluruh masyarakat di Kecamatan Dewantara Kabupaten Aceh Utara atas kesediaannya meluangkan waktu dan tenaga menjadi responden dalam penelitian ini

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7. Kedua orang tua, ibunda yang dengan segala pengorbanan luar biasa dengan tiada lelah mendukung, memotivasi, mendampingi, dan mendoakan demi terselesaikan tesis ini. Alm ayahanda yang selalu mendoakan saya, harapan ayahanda kini terwujud. 8. Suami tercinta, Didi Pianda, ST, MSM dengan besar hati mengizinkan saya menyelesaikan pendidikan ini, penuh kesabaran dan cinta kasih sayang, mendukung moril serta materi hingga terselesaikannya pendidikan ini. 9. Putri kecilku, Aisha Nameera yang selalu setia menemani dan memberikan kebahagiaan yang luar biasa saat hiruk pikuk melewati proses akhir pendidikan ini. 10. Semua sahabat terdekat yang memberikan motivasi luar biasa, teman seangkatan 2012 dan semua teman serta kerabat yang turut membantu proses akhir pendidikan saya ini yang tidak bisa disebutkan satu persatu, semoga Allah yang membalas semua kebaikan kalian. 11. Keluarga di Surabaya yang sangat membantu selama saya mengemban pendidikan di Surabaya. Penulis menyadari bahwa penelitian ini masih jauh dari kesempurnaan. Oleh karena itu, kritik, saran dan masukan yang sifatnya membangun diharapkan untuk perbaikan dan penyempurnaan tesis ini. Demikian, semoga tesis ini bisa memberi manfaat bagi diri kami sendiri dan pihak lain yang menggunakan.

Surabaya, Juni 2015

Linur Ficca Agustina

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SUMMARY COMMUNITY BEHAVIOR TOWARD HOSPITAL UTILIZATION BASED ON ANDERSEN MODEL (CASE STUDY IN DEWANTARA SUB DISTRICT NORTH ACEH REGENCY)

Health seeking behavior was a process of influence individual seeking health from individual perspective. Utilization health facilities was the one of health seeking behavior. Good health services was necessity of everyone. Hospital which health care facilities that play important role to provide health services for society. According to WHO, hospital has been a part of social organization and medical that provide comprehensive health services to public both preventif and curative for family and environment. Demand for health services was a global phenomenon, along with social change in community. Demographic changes, socio-economic, the expansion of disease pattern demand for better health quality especially in developing countries. This demand was a reason why people seeking medical treatment accros border to foreign country for better health and satisfaction. The high mobility of patients to utilize health care abroad was a challenge and an opportunity for public health. WHO said that Malaysia receives 360,000 foreign patients from ASEAN countries in 2007. The number of medical tourists to Malaysia was tripled between 2003 and 2007, with more than 341.200 people who visited in 2007, where 72% of those patients are from Indonesia. So that happened in the district of Dewantara Sub District North Aceh Regency, based on the results of the initial survey found 19 of 30 respondents (63%) utilize hospital abroad. This study aimed to analyze relationship between predisposing factors that consists of a social structure included education and employment, health belief from knowledge and attitudes, and preferences, then analyze the relationship of enabling factors consisting of income, financial sources for medical expenses and social support, as well as the relationship of perceived need in needs factors to hospital utilization. The population in this study was individuals or households who use the hospital in the Dewantara district. Samples taken as a research subject that individual who utilize hospital which 100 respondents were taken by purposive sampling. Primary data collected on respondents using a questionnaire that has been tested its validity and reliability. Furthermore, the data collected was analyzed using cross tabulation to know the distribution of respondents based on variables studied in the hospital utilization. The results of cross tabulation analysis found that education does not contribute to respondents decision for hospital utilization. Respondents who had lack of education found utilize hospital to abroad, because they had another enabling factors. It mean that education had not influence hospital utilization of

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respondents. Respondent who was an employee in company had chose to utilize hospital to abroad, because they had insurer cost from their work. It meant employment found indirectly influence the decision of respondents to utilize hospital abroad. Respondents who chose to utilize hospital to abroad caused they had lack of knowledge regarding health support facilities in local hospital And respondents who was utilize local hospital found that they tend not to utilize the local hospital for continue their treatment. Respondents with a preferences of infrastructure known prefer to take advantage of overseas hospitals, it because the hospital environment very clean and pleasant for patient and his family. Respondents who had a preferences of costs known tend to chose utilize local hospital. While at the enabling factors was found high income tend to utilize hospital to abroad. Respondents who was utilize hospital to abroad found they paid the treatment by their personal income. And respondents who had insurance BPJS, JKA and Askes known mostly prefer utilize local hospital. Respondents who was utilize hospital abroad had social support from their friend. And respondents who was utilize the local hospital had social support from their family. And the need factors, that perceived high of need was known utilize hospital to abroad. In the other hand, respondents who was asses their health status in mild condition chose to utilize the local hospital. So, the conclusion is predisposing factors that low education, employment with insurer of cost, lack of knowledges, respondents with support attitudes, and preferences of infrastructure was found determine the utilization of hospital abroad. From the enabling factors, high income, personal income, and friends support was determine respondent decisions for utilize hospital to abroad. And respondents who had perceived high of need was tend utilize hospital to abroad. Based on the conclusion in this study, the suggestion to local hospital is provide promotion related health support facilities available in local hospital. The local hospital need perform health promotion about disease for patient and family. They also need to improve the health services appropriate to minimum standard of hospital services.

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ABSTRACT Hospital Utilization Based On Andersen Model Hospital utilization was a result of health seeking behavior by a person. A good hospital services needed by everyone. Hospital was provide comprehensive health care, both curative and preventive to the public. The growth of demand for better health services was a global phenomenon, this demand can be based of someone travel to seek and utilize hospital until abroad. The purposes of this research was analizing the relationship between predisposing factors included education, employment, knowledge, attitudes and preferences. The enabling factors included income, financial resources and social support and perceived need from need factors for hospital utilization. This study used observational analytical with cross sectional design. The samples of 100 person was taken by purposive sampling. This study was conducted by using a questionnaire with cross tabulation analysis. The result showed that low education, employment with insurer cost, lack of knowledges, support attitudes, and preferences of infrastructure was found more utilize hospital abroad. From enabling factors, high income, personal income and friends support was chose utilize hospital abroad. Perceived high of the need factors was found utilize hospital abroad. As a conclusion, there is a tendency of respondents to utilize hospital abroad from predisposing, enabling and need factors of Andersen. So, the suggestion in this study to local hospital is provide promotion related health support facilities available, doing perform health promotion and improve the minimum standard of hospital services.

Keywords

: health behavior, hospital abroad, andersen model.

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DAFTAR ISI

Halaman SAMPUL DEPAN ................................................................................... i SAMPUL DALAM ................................................................................... ii HALAMAN PRASYARAT GELAR ...................................................... iii HALAMAN PENGESAHAN .................................................................. iv HALAMAN PERSETUJUAN ................................................................ v PERNYATAAN TENTANG ORISINILITAS ...................................... vi KATA PENGANTAR .............................................................................. vii SUMMARY ......................................................................................... ix ABSTRACT ......................................................................................... xi DAFTAR ISI ......................................................................................... xii DAFTAR TABEL .................................................................................... xv DAFTAR GAMBAR ............................................................................... xvii DAFTAR LAMPIRAN ............................................................................ xviii SINGKATAN ......................................................................................... xix BAB 1. PENDAHULUAN 1.1 Latar Belakang ...................................................................... 1.2 Kajian Masalah ..................................................................... 1.3 Rumusan Masalah ................................................................. 1.4 Tujuan Penelitian .................................................................. 1.4.1 Tujuan Umum .............................................................. 1.4.2 Tujuan Khusus ............................................................. 1.5 Manfaat Penelitian ................................................................ 1.5.1 Manfaat bagi peneliti .................................................... 1.5.2 Manfaat bagi Instansi ....................................................

1 11 17 17 17 17 18 18 18

BAB 2. TINJAUAN PUSTAKA 2.1 Perilaku ................................................................................ 2.1.1 Pengertian Perilaku ..................................................... 2.1.2 Domain Perilaku .......................................................... 2.2 Perilaku Kesehatan. .............................................................. 2.3 Perilaku Pencarian Kesehatan .............................................. 2.4 Pemanfaatan Pelayanan Kesehatan ....................................... 2.4.1 Tujuan Model Penggunaan Pelayanan Kesehatan ....... 2.5 Pelayanan Kesehatan ........................................................... 2.6 Rumah Sakit ........................................................................ 2.7 Preferensi dalam Teori Pilihan Rasional Coleman ..............

19 19 20 24 26 28 32 32 35 40

BAB 3. KERANGKA KONSEPTUAL 3.1 Kerangka Konseptual .............................................................

43

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BAB 4. METODOLOGI PENELITIAN 4.1 Jenis Penelitian....................................................................... 4.2 Lokasi dan Waktu Penelitian ................................................. 4.2.1 Lokasi Penelitian.......................................................... 4.2.2 Waktu Penelitian .......................................................... 4.3 Populasi, Sampel dan Teknik Pengambilan Sampel ............. 4.3.1 Populasi ....................................................................... 4.3.2 Sampel ....................................................................... 4.3.3 Teknik Pengambilan Sampel ....................................... 4.4 Kerangka Operasional ............................................................ 4.5 Variabel Penelitian ................................................................. 4.4.1 Variabel bebas............................................................... 4.4.2 Variabel tergantung ...................................................... 4.6 Variabel Penelitian, Definisi Operasional, Teknik Pengukuran, dan Skala Data....................................................................... 4.7 Intrumen Penelitian ................................................................ 4.7.1 Teknik Pengumpulan Data............................................. 4.7.2 Uji Validitas dan Reabilitas ......................................... 4.8 Teknik Pengolahan dan Analisis Data ................................... BAB 5. HASIL PENELITIAN 5.1 Gambaran Umum Kecamatan Dewantara ............................. 5.1.1 Gambaran Umum Tempat Penelitian ........................... 5.1.2 Peta lokasi penelitian.................................................... 5.2 Hasil Distribusi Frekuensi Responden ................................. 5.3 Hubungan Faktor Predisposisi terhadap Perilaku Pemanfaatan Pelayanan Kesehatan Rumah Sakit di Kecamatan Dewantara ...................................................... 5.4 Hubungan Faktor Pendukung terhadap Perilaku Pemanfaatan Pelayanan Kesehatan Rumah Sakit di Kecamatan Dewantara ...................................................... 5.5 Hubungan Faktor Kebutuhan terhadap Perilaku Pemanfaatan Pelayanan Kesehatan Rumah Sakit di Kecamatan Dewantara ......................................................

BAB 6. PEMBAHASAN 6.1 Faktor Predisposisi terhadap Perilaku Pemanfaatan Pelayanan Kesehatan Rumah Sakit di Kecamatan Dewantara ...................................................... 6.2 Faktor Pendukung terhadap Perilaku Pemanfaatan Pelayanan Kesehatan Rumah Sakit di Kecamatan Dewantara ..................................................... 6.3 Faktor Kebutuhan terhadap Perilaku Pemanfaatan Pelayanan Kesehatan Rumah Sakit di Kecamatan Dewantara ........................................................

46 46 46 47 47 47 47 47 48 49 49 49 50 54 54 54 55

56 56 57 65

70

74

71

75

87

93

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BAB 7. PENUTUP 7.1 Kesimpulan ................................................................................. 7.2 Saran ...........................................................................................

96 97

DAFTAR PUSTAKA LAMPIRAN

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DAFTAR TABEL

Halaman Tabel 1.1

Tabel 1.2 Tabel 2.1 Tabel 4.1 Tabel 5.1 Tabel 5.2 Tabel 5.3 Tabel 5.4

Tabel 5.5. Tabel 5.6

Tabel 5.7 Tabel 5.8 Tabel 5.9 Tabel 5.10 Tabel 5.11 Tabel 5.12

Tabel 5.13

Hasil Studi Awal Pola Pencarian Pengobatan dan Pemanfaatan Pelayanan Kesehatan Masyarakat Kecamatan Dewantara Hasil Studi Awal Pemanfaatan Pelayanan Kesehatan Luar Negeri Masyarakat Kecamatan Dewantara Standar Pelayanan Minimal Rumah Sakit Pada Rawat Jalan dan Rawat Inap Variabel Penelitian, Definisi Operasional, Teknik Pengukuran dan Skala Data Distribusi Frekuensi Pendidikan Responden di Kecamatan Dewantara Tahun 2014 Distribusi Frekkuensi Pekerjaan Responden di Kecamatan Dewantara Tahun 2014 Distribusi Frekuensi Pengetahuan Responden di Kecamatan Dewantara Tahun 2014 Distribusi Frekuensi Pengetahuan Responden Tentang Layanan Rawat Jalan dan Rawat Inap di Kecamatan Dewantara Tahun 2014 Distribusi Frekuensi Sikap Responden di Kecamatan Dewantara Tahun 2014 Distribusi Frekuensi Sikap Responden Tentang Layanan Rawat Jalan dan Rawat Inap di Kecamatan Dewantara Tahun 2014 Distribusi Frekuensi Preferensi Responden di Kecamatan Dewantara Tahun 2014 Distribusi Frekuensi Pendapatan Responden di Kecamatan Dewantara Tahun 2014 Distribusi Frekuensi Sumber Finansial Biaya Pengobatan Responden di Kecamatan Dewantara tahun 2014 Distribusi Dukungan Sosial Responden di Kecamatan Dewantara Tahun 2014 Distribusi Responden Menurut Perceived Need di Kecamatan Dewantara tahun 2014 Tabulasi Silang Pendidikan terhadap Perilaku Pemanfaatan Pelayanan Kesehatan Rumah Sakit di Kecamatan Dewantara Tahun 2014 Tabulasi Silang Pekerjaan terhadap Perilaku Pemanfaatan Pelayanan Kesehatan Rumah Sakit di Kecamatan Dewantara Tahun 2014

8

10 39 50 58 58 58 59

60 60

63 63 63 64 64 65

66

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Tabel 5.14

Tabel 5.15

Tabel 5.16

Tabel 5.17

Tabel 5.18

Tabel 5.19

Tabel 5.20

Tabulasi Silang Pengetahuan terhadap Perilaku Pemanfaatan Pelayanan Kesehatan Rumah Sakit di Kecamatan Dewantara Tahun 2014 Tabulasi Silang Sikap terhadap Perilaku Pemanfaatan Pelayanan Kesehatan Rumah Sakit di Kecamatan Dewantara Tahun 2014 Tabulasi Silang Preferensi terhadap Perilaku Pemanfaatan Pelayanan Kesehatan Rumah Sakit di Kecamatan Dewantara Tahun 2014 Tabulasi Silang Pendapatan terhadap Perilaku Pemanfaatan Pelayanan Kesehatan Rumah Sakit di Kecamatan Dewantara Tahun 2014 Tabulasi Silang Sumber Finansial Biaya Pengobatan terhadap Perilaku Pemanfaatan Pelayanan Kesehatan Rumah Sakit di Kecamatan Dewantara Tahun 2014 Tabulasi Silang Dukungan Sosial terhadap Perilaku Pemanfaatan Pelayanan Kesehatan Rumah Sakit di Kecamatan Dewantara Tahun 2014 Tabulasi Silang Perceived Need terhadap Perilaku Pemanfaatan Pelayanan Kesehatan Rumah Sakit di Kecamatan Dewantara Tahun 2014

67

68

69

71

72

73

74

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DAFTAR GAMBAR

Halaman Gambar 1.1

Gambar 2.1 Gambar 3.1 Gambar 4.1 Gambar 5.1

Faktor yang Mempengaruhi Perilaku Pemanfaatan Pelayanan Kesehatan Berdasarkan Model Andersen di Kecamatan Dewantara Model Pemanfaatan Pelayanan Kesehatan Andersen Kerangka Konseptual Perilaku Pemanfaatan Pelayanan Kesehatan Kerangka Operasional Penelitian Peta Kecamatan Dewantara Kabupaten Aceh Utara

13

31 43 48 57

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DAFTAR LAMPIRAN

Lampiran 1 Kuesioner Penelitian Lampiran 2 Analisis Cross Tabulasi

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SINGKATAN

ASKES BPJS JKA WHO UGD

: Asuransi Kesehatan : Badan Penyelenggara Jaminan Kesehatan : Jaminan Kesehatan Aceh : World Health Organization : Unit Gawat Darurat

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ADLN - Perpustakaan Universitas Airlangga TESIS

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