TESIS PERILAKU MASYARAKAT TERHADAP PEMANFAATAN PELAYANAN ...repository.unair.ac.id/29503/1/HALAMAN DEPAN.pdf · Tesis ini berisikan analisa mengenai perilaku pemanfaatan pelayanan

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

ADLN - Perpustakaan Universitas Airlangga

TESIS PERILAKU MASYARAKAT TERHADAP PEMANFAATAN... LINUR FICCA AGUSTINA

ii

TESIS





NIM 101214153035



PROGRAM MAGISTER


SURABAYA

2015



iii




TESIS

Untuk memperoleh gelar Magister Kesehatan

Minat Studi Promosi Kesehatan dan Ilmu Perilaku

Program Studi Ilmu Kesehatan Masyarakat

Fakultas Kesehatan Masyarakat

Universitas Airlangga

Oleh :


NIM 101214153035



PROGRAM MAGISTER


SURABAYA

2015



iv



v



vi



vii

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



viii

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



ix

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



x

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.



xi

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.



xii

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

1.2 Kajian Masalah ..................................................................... 11

1.3 Rumusan Masalah ................................................................. 17

1.4 Tujuan Penelitian .................................................................. 17

1.4.1 Tujuan Umum .............................................................. 17

1.4.2 Tujuan Khusus ............................................................. 17

1.5 Manfaat Penelitian ................................................................ 18

1.5.1 Manfaat bagi peneliti .................................................... 18

1.5.2 Manfaat bagi Instansi .................................................... 18

BAB 2. TINJAUAN PUSTAKA

2.1 Perilaku ................................................................................ 19

2.1.1 Pengertian Perilaku ..................................................... 19

2.1.2 Domain Perilaku .......................................................... 20

2.2 Perilaku Kesehatan. .............................................................. 24

2.3 Perilaku Pencarian Kesehatan .............................................. 26

2.4 Pemanfaatan Pelayanan Kesehatan ....................................... 28

2.4.1 Tujuan Model Penggunaan Pelayanan Kesehatan ....... 32

2.5 Pelayanan Kesehatan ........................................................... 32

2.6 Rumah Sakit ........................................................................ 35

2.7 Preferensi dalam Teori Pilihan Rasional Coleman .............. 40

BAB 3. KERANGKA KONSEPTUAL

3.1 Kerangka Konseptual ............................................................. 43



xiii

BAB 4. METODOLOGI PENELITIAN

4.1 Jenis Penelitian....................................................................... 46

4.2 Lokasi dan Waktu Penelitian ................................................. 46

4.2.1 Lokasi Penelitian .......................................................... 46

4.2.2 Waktu Penelitian .......................................................... 47

4.3 Populasi, Sampel dan Teknik Pengambilan Sampel ............. 47

4.3.1 Populasi ....................................................................... 47

4.3.2 Sampel ....................................................................... 47

4.3.3 Teknik Pengambilan Sampel ....................................... 47

4.4 Kerangka Operasional ............................................................ 48

4.5 Variabel Penelitian ................................................................. 49

4.4.1 Variabel bebas............................................................... 49

4.4.2 Variabel tergantung ...................................................... 49

4.6 Variabel Penelitian, Definisi Operasional, Teknik Pengukuran,

dan Skala Data....................................................................... 50

4.7 Intrumen Penelitian ................................................................ 54

4.7.1 Teknik Pengumpulan Data............................................. 54

4.7.2 Uji Validitas dan Reabilitas ......................................... 54

4.8 Teknik Pengolahan dan Analisis Data ................................... 55

BAB 5. HASIL PENELITIAN

5.1 Gambaran Umum Kecamatan Dewantara ............................. 56

5.1.1 Gambaran Umum Tempat Penelitian ........................... 56

5.1.2 Peta lokasi penelitian.................................................... 57

5.2 Hasil Distribusi Frekuensi Responden ................................. 65

5.3 Hubungan Faktor Predisposisi terhadap Perilaku Pemanfaatan

Pelayanan Kesehatan Rumah Sakit

di Kecamatan Dewantara ...................................................... 70

5.4 Hubungan Faktor Pendukung terhadap Perilaku Pemanfaatan



5.5 Hubungan Faktor Kebutuhan terhadap Perilaku Pemanfaatan



BAB 6. PEMBAHASAN

6.1 Faktor Predisposisi terhadap Perilaku Pemanfaatan



6.2 Faktor Pendukung terhadap Perilaku Pemanfaatan


di Kecamatan Dewantara ..................................................... 87

6.3 Faktor Kebutuhan terhadap Perilaku Pemanfaatan


di Kecamatan Dewantara ........................................................ 93



xiv

BAB 7. PENUTUP

7.1 Kesimpulan ................................................................................. 96

7.2 Saran ........................................................................................... 97

DAFTAR PUSTAKA

LAMPIRAN



xv

DAFTAR TABEL

Halaman

Tabel 1.1 Hasil Studi Awal Pola Pencarian Pengobatan dan

Pemanfaatan Pelayanan Kesehatan Masyarakat Kecamatan

Dewantara

8

Tabel 1.2 Hasil Studi Awal Pemanfaatan Pelayanan Kesehatan Luar

Negeri Masyarakat Kecamatan Dewantara

10

Tabel 2.1

Standar Pelayanan Minimal Rumah Sakit Pada Rawat Jalan

dan Rawat Inap

39

Tabel 4.1 Variabel Penelitian, Definisi Operasional, Teknik Pengukuran

dan Skala Data

50

Tabel 5.1 Distribusi Frekuensi Pendidikan Responden di Kecamatan

Dewantara Tahun 2014

58

Tabel 5.2 Distribusi Frekkuensi Pekerjaan Responden di Kecamatan


58

Tabel 5.3 Distribusi Frekuensi Pengetahuan Responden di Kecamatan


58

Tabel 5.4 Distribusi Frekuensi Pengetahuan Responden Tentang

Layanan Rawat Jalan dan Rawat Inap di Kecamatan


59

Tabel 5.5. Distribusi Frekuensi Sikap Responden di Kecamatan


60

Tabel 5.6 Distribusi Frekuensi Sikap Responden Tentang Layanan

Rawat Jalan dan Rawat Inap di Kecamatan Dewantara Tahun

2014

60

Tabel 5.7 Distribusi Frekuensi Preferensi Responden di Kecamatan


63

Tabel 5.8 Distribusi Frekuensi Pendapatan Responden di Kecamatan


63

Tabel 5.9 Distribusi Frekuensi Sumber Finansial Biaya Pengobatan

Responden di Kecamatan Dewantara tahun 2014

63

Tabel 5.10 Distribusi Dukungan Sosial Responden di Kecamatan


64

Tabel 5.11 Distribusi Responden Menurut Perceived Need di Kecamatan

Dewantara tahun 2014

64

Tabel 5.12 Tabulasi Silang Pendidikan terhadap Perilaku Pemanfaatan

Pelayanan Kesehatan Rumah Sakit di Kecamatan Dewantara

Tahun 2014

65

Tabel 5.13 Tabulasi Silang Pekerjaan terhadap Perilaku Pemanfaatan


Tahun 2014

66



xvi

Tabel 5.14 Tabulasi Silang Pengetahuan terhadap Perilaku Pemanfaatan


Tahun 2014

67

Tabel 5.15 Tabulasi Silang Sikap terhadap Perilaku Pemanfaatan


Tahun 2014

68

Tabel 5.16 Tabulasi Silang Preferensi terhadap Perilaku Pemanfaatan


Tahun 2014

69

Tabel 5.17 Tabulasi Silang Pendapatan terhadap Perilaku Pemanfaatan


Tahun 2014

71

Tabel 5.18 Tabulasi Silang Sumber Finansial Biaya Pengobatan terhadap

Perilaku Pemanfaatan Pelayanan Kesehatan Rumah Sakit di

Kecamatan Dewantara Tahun 2014

72

Tabel 5.19 Tabulasi Silang Dukungan Sosial terhadap Perilaku

Pemanfaatan Pelayanan Kesehatan Rumah Sakit di


73

Tabel 5.20 Tabulasi Silang Perceived Need terhadap Perilaku

Pemanfaatan Pelayanan Kesehatan Rumah Sakit di


74



xvii

DAFTAR GAMBAR

Halaman

Gambar 1.1 Faktor yang Mempengaruhi Perilaku Pemanfaatan Pelayanan

Kesehatan Berdasarkan Model Andersen di Kecamatan

Dewantara

13

Gambar 2.1 Model Pemanfaatan Pelayanan Kesehatan Andersen 31

Gambar 3.1 Kerangka Konseptual Perilaku Pemanfaatan Pelayanan

Kesehatan

43

Gambar 4.1 Kerangka Operasional Penelitian 48

Gambar 5.1 Peta Kecamatan Dewantara Kabupaten Aceh Utara 57



xviii

DAFTAR LAMPIRAN

Lampiran 1 Kuesioner Penelitian

Lampiran 2 Analisis Cross Tabulasi



xix

SINGKATAN

ASKES : Asuransi Kesehatan

BPJS : Badan Penyelenggara Jaminan Kesehatan

JKA : Jaminan Kesehatan Aceh

WHO : World Health Organization

UGD : Unit Gawat Darurat





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TESIS PERILAKU MASYARAKAT TERHADAP PEMANFAATAN PELAYANAN ...repository.unair.ac.id/29503/1/HALAMAN DEPAN.pdf · Tesis ini berisikan analisa mengenai perilaku pemanfaatan pelayanan