Analysis of Factors Affecting the Level of Patient Satisfaction on the Mobile JKN Registration Procedure at Public Health Center

Patient's assessment of the services of health workers is based on the patient's experience. The patient experience aspect can be interpreted as a treatment or action from a nurse who is currently or has been undergoing, felt and borne by someone who uses health services.The purpose of this study is to analyze influence service quality, perception and response time to level of satisfaction with the Mobile JKN registration procedure at the Guluk-guluk Health Center, Sumenep Regency. The design of this research is an observational quantitative research with a cross sectional approach with the focus of the research being directed at analyzinginfluence service quality, perception and response time to level of satisfaction with the Mobile JKN registration procedure at the Guluk-guluk Health Center, Sumenep Regency. The total population is 134 respondents and a sample of 105 respondents is taken by using Simple Random Sampling technique. The results showed that most of the respondents had good service quality category as many as 58 respondents (55%). Most respondents have a good category perception as many as 58 respondents (55%). Most of the respondents have a fast response time category as many as 92 respondents (87.6%). Most of the respondents have a satisfied category of satisfaction as many as 60 respondents (57.1%). Based on the results of Multiple Linear Regression analysis shows that with a p-value of 0.000 <0.05 then H1 is accepted so it can be concluded that there is a simultaneous influenceservice quality, perception and response time to the level of satisfaction with the Mobile JKN registration procedure at the Guluk-guluk Public Health Center, Sumenep Regency with an effect of 81.2%. It is expected that respondents can provide constructive input and criticism so that the services provided can be in accordance with what is expected.


INTRODUCTION
expected, if the service received exceeds consumer expectations, then the service quality is perceived as good (Wijoyo, 2012).
Understanding the needs and desires of patients is an important factor that affects patient satisfaction. Satisfied patients are a very valuable asset because if patients are satisfied they will continue to use the service of their choice, but if patients are not satisfied they will tell twice as much to others about their bad experience. To create patient satisfaction, hospitals must create and manage a system to obtain more patients and the ability to retain patients.
Based on the above conditions, the authors are interested in examining the analysis of factors that affect the level of patient satisfaction in the Mobile JKN registration procedure at the Guluk-guluk Public Health Center, Sumenep Regency.

MATERIALS AND METHODS
In this study, the researcher used an observational quantitative design with a cross sectional approach, which is a study to study the dynamics of the correlation between risk factors and effects, by approaching, observing or collecting data all at once (point time approach), that is, each subject The study was observed only once and measurements were made on the status of the character or variable of the subject at the time of examination. This does not mean that all research subjects are observed at the same time (Soekidjo, 2012). This research will analyzeinfluence service quality, perception and response time to level of satisfaction with the Mobile JKN registration procedure at the Guluk-guluk Health Center, Sumenep Regency. The total population is 134 respondents and a sample of 105 respondents is taken by using Simple Random Sampling technique. Data analysis using Linear Regression test. This research has gone through an ethical test with the number SK: 2311/KEPK/III/2021.

Service quality of mobile JKN registration procedures at guluk-guluk health center, sumenep regency
The results showed that most of the respondents had good service quality category as many as 58 respondents (55%). In addition, a number of 31 respondents (30%) have sufficient service quality category. While a number of 16 respondents (15%) have poor service quality category.
Service is an activity or a series of tools that are invisible (cannot be touched), which occur due to interactions between consumers and employees or other things provided by service providers that are intended to solve consumer problems (Winarsih, 2015).
People as consumers certainly want quality services. Service quality is defined as the level of excellence expected and control over the level of excellence to meet customer desires. Service quality can be interpreted as an effort to fulfill consumer needs and desires as well as the accuracy of delivery in balancing consumer expectations (Oktafani, 2014).
One of the services that is widely used by the community is health services. Utilization of health services by using the service facilities provided either in the form of outpatient care, inpatient care, home visits by health workers or other forms of activity from the use of these services based on the availability and continuity of services, community acceptance and fairness, easily accessible by the community, affordable and quality (Anwar, 2014).
Good services are health services that are available to the community (acceptable) and sustainable (sustainable). This means that all types of health services needed by the community are found and their presence in the community is available at any time of need. Health services must be reasonable (appropriate) and acceptable (acceptable) by the community. This means that the health service can overcome the health problems faced, does not conflict with customs, culture, beliefs and beliefs of the community, and is unnatural, is not a condition of good health care.
The location angle is easily accessible by the community, so the distribution of health facilities is very important. Coverage of auxiliary facilities to determine effective demand. If the facility is easily accessible by using the available means of transportation, this facility will be widely used. Past user levels and trends are the best indicators of short and long term changes in future demand.
The services provided are affordable (affordable) by the community, where the cost of these services is sought in accordance with the economic capacity of the community. Expensive health services may only be enjoyed by some people. And shows the level of perfection of the health services provided (quality/quality) and shows the healing of the disease and the safety of actions that can satisfy the service users in accordance with the standards that have been set.
According to researchers, health services must have various basic requirements, namely the basic requirements that influence the community in determining their choices regarding the use of health services. The services needed by the community in general are health services that are available in the community and sustainable, health services must be reasonable and acceptable to the community, locations are easily accessible by the community, the services provided are affordable and the perfection of health services provided. With good service, it will attract people to use health facilities properly and wisely.
In the results of the study, it was found that most of the respondents had good service quality categories, but there were a small number of respondents who considered that the quality of services provided by health workers to patients was in the poor category. Where this is because patients judge that health workers are less responsive to immediately provide health services so that they tend to be slow. In addition, it is also caused by patients assessing that health workers are less concerned with patient complaints where officers are less concerned with patients. However, despite complaints from patients, most of the patients assessed that the services provided were in accordance with what was expected.

Patient perception on the mobile jkn registration procedure at the guluk-guluk health center, sumenep regency
The results showed that most of the respondents had a good category perception as many as 58 respondents (55%). In addition, a number of 33 respondents (32%) have a perception of the category of being sufficient. While a number of 14 respondents (13%) have a perception of the category less.
Service is an activity or a series of tools that are invisible (cannot be touched), which occur due to interactions between consumers and employees or other things provided by service providers that are intended to solve consumer problems (Ratminto and Winarsih, 2015).
People as consumers certainly want quality services. Service quality is defined as the level of excellence expected and control over the level of excellence to meet customer desires (Dimas and Oktafani, 2014). Service quality can be interpreted as an effort to fulfill consumer needs and desires as well as the accuracy of delivery in balancing consumer expectations (Dimas and Oktafani, 2014).
Good services are health services that are available to the community (acceptable) and sustainable (sustainable). This means that all types of health services needed by the community are found and their presence in the community is available at any time of need. Health services must be reasonable (appropriate) and acceptable (acceptable) by the community. This means that health services can overcome the health problems faced, do not conflict with customs, culture, beliefs and beliefs of the community, and are unnatural, not a condition of good health services (Suryono, 2013).
The goals of health services include providing consultation to patients who need the opinion of a specialist doctor, with treatment or not and to provide follow-up for inpatients who have been allowed to go home but whose health condition is still under control. Outpatient should have a comfortable and pleasant environment for the patient. This is important to note because it is from outpatient treatment that patients get the first impression about the puskesmas. A good outpatient environment should be spacious enough and have good air circulation, comfortable seating, attractive furniture and no disturbing sounds.
Based on the results of the study, it was found that there were a small number of respondents who had perceptions in the less category. Where this is due to the incompatibility of patient expectations with the reality of services provided by health workers. According to the respondents, several things that must be improved are related to the patient's confidence in the abilities of health workers, where most of the respondents do not believe in the abilities of health workers. This is also because officers are considered slow in examining the complaints expressed by patients.

Response time health officers in the mobile JKN registration procedure at the guluk-guluk health center, sumenep regency
The results showed that most of the respondents had a fast response time category as many as 92 respondents (87.6%). While a number of 13 respondents (12.4%) had a slow response time category.
Waiting time is the time used by patients to get health services from the registration point to entering the doctor's examination room. Patient waiting time is one component that has the potential to cause dissatisfaction. The length of patient waiting time reflects how the hospital manages service components that are tailored to the patient's situation and expectations (Depkes RI, 2010).
The category of distance between waiting time and examination time which is estimated to be satisfactory or unsatisfactory for the patient, among others, is when the patient comes from registering to the counter, queuing and waiting for a call to the general polyclinic to be analyzed and examined by a doctor, nurse or midwife for more than 90 minutes ( old category), 30 -60 minutes (medium category) and 30 minutes (fast category). Waiting times in Indonesia are set by the Ministry of Health (Kemenkes) through minimum service standards. Each hospital or health center must follow the minimum service standards regarding this waiting time. The minimum service standard in outpatients based on the Ministry of Health Number 129/Menkes/SK/II/2008 is less or equal to 60 minutes (Kemenkes, 2013).
The speed and accuracy of the assistance given to patients who come to the Puskesmas requires standards according to their competence and ability so that they can guarantee a health treatment with a fast response time and appropriate treatment. This can be achieved by improving facilities, infrastructure, human resources and management of Puskesmas according to standards (Kepmenkes, 2009).
The Canadian of Association Emergency Physician (2012) wrote that the incidence of lack of stretchers for handling acute cases has a serious impact on the arrival of new patients who may be in very critical condition. The American College of Emergency Physician (2013) writes that in Puskesmas experiencing problems with the large number of patients who want to get services, placing a doctor in the triage area can speed up the process of discharge or discharge for minor patients and help start treatment for patients whose condition is more ill. Green, et.al. (2014) which suggests that very small and simple changes in staffing have an impact on delays in handling.
Response Time (response time) is a service standard that must be owned by a health service. The researcher also concludes that Response Time is an element of Responsiveness which is one of the factors of patient satisfaction at the Puskesmas. The achievement of the standard Response Time of nurses in services at the Puskesmas is influenced by the availability of infrastructure, human resources and a good Puskesmas management system. With a good arrangement, the puskesmas can provide services with accurate time and are able to provide good service even though there are very many patients who come.
From the results of the study, the researchers found that the response time given by health workers in Public health center overall in the fast category. This can happen because the management system applied in the puskesmas is well organized where the functional positions are very professional. Response time tends to be faster in the morning and when it is nearing noon it will usually be a little slower because of the large number of queues.

Patient satisfaction level in the mobile JKN registration procedure at the guluk-guluk health center, sumenep regency
The results showed that most of the respondents had satisfaction in the satisfied category as many as 60 respondents (57.1%). While a number of 45 respondents (42.9%) had a dissatisfied category of satisfaction.
Understanding the patient's needs and desires is an important factor affecting patient satisfaction. Satisfied patients are a very valuable asset because if patients are satisfied they will continue to use the service of their choice, but if patients are not satisfied they will tell twice as much to others about their bad experience. To create patient satisfaction, health facilities must create and manage a system to obtain more patients and the ability to retain patients (Hendawan, 2015).
Patients are sick people who are treated by doctors and other health workers in practice (Yuwono, 2017). While satisfaction is a person's feeling of pleasure that comes from a comparison between the pleasure of an activity and a product with his expectations (Nursalam, 2016). Nursalam (2016) states that satisfaction is a person's feelings of pleasure or disappointment that arise after comparing their perceptions or impressions of the performance or results of a product and their expectations. Tjiptono (2014) argues that customer satisfaction is an emotional response to experiences related to certain purchased products or services, retail outlets, or even behavioral patterns (such as shopping behavior and buyer behavior), as well as the market as a whole.
According to Yamit (2017), customer satisfaction is the result (outcome) that is felt on the use of products and services, equals or exceeds the desired expectations. Meanwhile, Pohan (2014) states that patient satisfaction is the level of patient feelings that arise as a result of the performance of the health services he gets, after the patient compares with what he expects. Another opinion of Mamik (2015) that patient satisfaction is an evaluation or assessment after using a service, that the selected service at least meets or exceeds expectations.
According to Wijono (2014) several things that affect patient satisfaction are the approach and behavior of officers, especially at the time of the first visit, the quality of the information provided, the appointment procedure, waiting time, health checks and taking drugs, public facilities in health facilities and the results of treatment received.
Patient satisfaction is a benchmark that the services provided by health workers are good or not. Patient satisfaction is influenced by various things, namely the suitability between patient expectations and the reality that patients encounter in the field, the second form of service during the service process is provided by health workers, personal behavior of health workers to patients, atmosphere and physical conditions of the environment that are managed. by puskesmas staff, fees or prices to be paid by patients and promotions or advertisements that are in accordance with reality.
From the results of the study, it was found that almost half of the respondents were dissatisfied with the services provided by health workers where this was due to the incompatibility of the reality and patient expectations of the health services provided. While most patients are satisfied with the services provided by health workers inPublic health center because health workers are able to serve patients very well, health workers hear patient complaints and respond to them do not distinguish between JKN and non-JKN patients. In addition, the facilities and infrastructure available atPublic health center very complete and has a clean environment.

The effect of service quality on satisfaction levels in the mobile JKN registration procedure at the guluk-guluk health center, sumenep regency
Based on the results of Linear Regression analysis shows that the p-value 0.000 <0.05 then H1 is accepted so it is concluded that partially there is influence quality of service to level of satisfaction with the Mobile JKN registration procedure at the Guluk-guluk Health Center, Sumenep Regency.
Health services are an important factor in improving the health and welfare of every human being throughout the world. According to Law No. 36 of article 19 of 2009 concerning health, explains that everyone has the right to obtain health services and the government is responsible for the availability of all forms of quality, safe, efficient, and affordable health efforts by all levels of society. One of these efforts is to increase the availability and equity of basic health facilities such as puskesmas in each area (Bappenas, 2013).
Service quality (service quality) can be known by comparing the perceptions of consumers on the services they receive with the services they actually expect on the service attributes of a company. Service quality is perceived as good and satisfactory if the service received or perceived is as expected, if the service received exceeds consumer expectations, then the service quality is perceived as very good and of high quality. Service quality is perceived as bad if the service received is lower than expected (Amrizal, 2014). The quality of health services refers to the level of perfection in the appearance of health services that can satisfy every user of health services in accordance with the level of satisfaction of the average population.
Service quality (service quality) can be known by comparing the perceptions of consumers on the services they receive with the services they actually expect on the service attributes of a company. Service quality is perceived as good and satisfying if the service received or perceived is as expected, if the service received exceeds consumer expectations, then the service quality is perceived as very good and of high quality (Wijoyo, 2012).
The researcher believes that understanding the patient's needs and desires is an important thing that affects patient satisfaction. Satisfied patients are a very valuable asset because if patients are satisfied they will continue to use the service of their choice, but if patients are not satisfied they will tell twice as much to others about their bad experience. To create patient satisfaction, puskesmas must create and manage a system to acquire more patients and the ability to retain patients. With a good arrangement, the puskesmas can provide services with accurate time and are able to provide good service even though there are very many patients who come.

Influence perception of satisfaction level in mobile JKN registration procedure at guluk-guluk health center, sumenep regency
Based on the results of Linear Regression analysis shows that the p-value is 0.002 < 0.05, then H0 is rejected and H1 is accepted, so it can be concluded that partially there is influence perception of level of satisfaction with the Mobile JKN registration procedure at the Guluk-guluk Health Center, Sumenep Regency.
The role of health workers in providing health services is very important, especially as health service implementers, so it is natural that the ability and performance of health workers is one of the determinants of success in health services. Health workers should be able to have a rational attitude as well as have a high spirit of service, be creative, innovative, disciplined, knowledgeable and skilled and be able to uphold the ethics of the health workforce.
Health services are a form of professional service that is an integral part of health services based on health science and tips aimed at individuals, families, groups, or communities, both healthy and sick. Puskesmas officers are required to complete their duties properly so that patient satisfaction is maintained. To handle patients who come to visit, the officers must be skilled and able to carry out their duties properly. One of the factors driving the performance of health workers is motivation.
The quality of puskesmas services can be seen from the performance and ability of the puskesmas health workers. The ability of a health worker is a person's ability to do something with certain expertise in a health center or organization that is expected to be able to carry out his responsibilities in order to achieve a goal. The ability of health workers is one element in maturity related to abilities or skills that can be obtained from education, training and an experience, every health worker must have certain abilities and skills to help communities, groups and individuals (Thoha 2008). According to Wijono (2014) several things that affect patient satisfaction are the approach and behavior of the officers, especially at the time of the first visit, the quality of the information provided, the appointment procedure, the waiting time for drugs, health checks and drug taking, public facilities at the hospital and the results of the treatment received.
Patient satisfaction is a benchmark that the services provided by health workers are good or not. Patient satisfaction is influenced by various things, namely the suitability between patient expectations (perceptions) and the reality that patients encounter in the field, the second form of service during the service process is provided by health workers, personal behavior of health workers to patients, atmosphere and physical conditions of the environment. managed by the puskesmas staff, the costs or prices to be paid by the patients and promotions or advertisements that are in accordance with reality.

Influence response time to the satisfaction level in the mobile JKN registration procedure at the guluk-guluk health center, sumenep regency
Based on the results of Linear Regression analysis shows that the p-value is 0.006 <0.05, then H0 is rejected and H1 is accepted, so it can be concluded that partially there is response time to level of satisfaction with the Mobile JKN registration procedure at the Guluk-guluk Health Center, Sumenep Regency.
A person's satisfaction with services is related to the ability of the service provider to provide satisfaction. Consumer satisfaction can be defined as big quality or broad quality (wide satisfaction). This broad satisfaction is related to the overall quality of service quality, financing, distribution channels, guarantee of safe use and aspects of employee morality/performance of a health service organization. Community satisfaction in utilizing outpatient services is influenced by several factors, including the response time of health workers to patients (Depkes RI, 2018).
Ambulatory service is one form of existing medical services. In simple terms, outpatient services are medical services provided to patients not in the form of inpatient care. In the sense of outpatient this includes not only those organized by service facilities that are commonly known such as hospitals, health centers or clinics, but also those held at the patient's home (Depkes RI, 2018).
In carrying out its function as a health-minded development center, community empowerment center, primary community health service center, and primary individual health service center, the Puskesmas is obliged to provide mandatory health efforts at the Puskesmas and development health efforts, including: Health Promotion Efforts, Environmental Health Efforts, Efforts to Maternal and Child Health and Family Planning, Nutrition Improvement Efforts, Infectious Disease Prevention and Eradication Efforts, and Treatment Efforts (Depkes RI, 2017).
Health care standards are part of the health service itself and play an important role in overcoming the problem of the quality of health services. If a health care organization wants to provide quality health services in an obedient or consistent manner, this desire must be translated into a health service standard or operational procedural standard. Health service standards are an organizational tool to describe the quality of health services into operational terminology so that everyone involved in health services will be bound in a system, whether patients, health service providers, health care support, or the management of health service organizations, and will be responsible for accountability in carrying out their respective duties and roles (Imbalo, 2015).
Response Time (response time) is a service standard that must be owned by a health service. The researcher also concludes that Response Time is an element of Responsiveness which is one of the factors of patient satisfaction at the Puskesmas. The achievement of the standard Response Time of nurses in services at the Puskesmas is influenced by the availability of infrastructure, human resources and a good Puskesmas management system. With a good arrangement, the puskesmas can provide services with accurate time and are able to provide good service even though there are very many patients who come.