The Health Service Quality Model: State Primary Care Perspective (Survey, Evaluation, and Strategy)
DOI:
https://doi.org/10.51278/bce.v5i3.2672Keywords:
Health Service Quality, Primary Care, Community Satisfaction Index, Importance Performance Analysis, Service Quality Gap ModelAbstract
This Quality of basic health services remains a persistent global and national policy concern, particularly at the primary-care level where community health centers (Puskesmas) serve as the frontline of universal health coverage. This study analyzes the quality of government-owned primary health services through three complementary perspectives: survey, evaluation, and strategy. Previous studies on Puskesmas service quality have generally been limited to a single analytical approach and rarely provide actionable strategic recommendations for both health centers and patients. Respondents consisted of 103 BPJS outpatients, 97 non-BPJS outpatients from eight Puskesmas in Banyumas Regency, and eight heads of Puskesmas. The survey dimension applies the Community Satisfaction Index (CSI), the evaluation dimension applies Importance Performance Analysis (IPA), and the strategy dimension applies the Service Quality Gap Model. The CSI results indicate that service quality for both BPJS and non-BPJS patients is categorized as “good,” although conformity levels remain below 100 percent. IPA findings show no service element in Quadrant A for BPJS patients, whereas complaint, suggestion, and feedback handling emerge as the top priority for non-BPJS patients. The Gap Model reveals perception–expectation gaps in requirements and cost/tariff for BPJS patients, while gaps for non-BPJS patients extend to requirements, completion duration, cost/tariff, staff competence, staff behavior, and complaint handling. These findings imply that Puskesmas management should strengthen patient feedback channels and prioritize improvements in staff competence and complaint-handling mechanisms to enhance overall service quality.
References
Afiyah, N., & Ayuningtyas, D. (2023). Factors influencing the implementation of health service quality governance in Puskesmas: Systematic review. Asian Journal of Health Sciences, 2(3).
Akanyako, J. (2024). Do patient satisfaction and trust matter in the relationship between service quality and patient loyalty in the health sector? African Journal of Empirical Research, 5(2), 662–675.
Ali, J., Jusoh, A., Idris, N., & Md Nor, K. (2024). Healthcare service quality and patient satisfaction: A conceptual framework. International Journal of Quality & Reliability Management, 41(2), 608–627.
Bakhtiar, B., Trisna, T., & Andriani, A. (2025). Analysis of patient service quality using the Importance Performance Analysis method at the community health centre. International Journal of Engineering, Science and Information Technology, 5(4), 85–91.
Cai, Y., Liu, Y., Liu, S., Wang, C., & Jiang, Y. (2025). A cross-sectional study on the relationship between length of stay and patient satisfaction based on the SERVQUAL model. Scientific Reports, 15(1), 1–9.
Cui, J., Du, J., Zhang, N., & Liang, Z. (2025). National patient satisfaction survey as a predictor for quality of care and quality improvement: Experience and practice. Patient Preference and Adherence, 19, 193–206.
Değer, M. S., & İşsever, H. (2024). Service quality and related factors in primary health care services: A cross-sectional study. Healthcare (Switzerland), 12(10), 1–15.
Endalamaw, A., Khatri, R. B., Erku, D., Nigatu, F., Zewdie, A., Wolka, E., & Assefa, Y. (2023). Successes and challenges towards improving quality of primary health care services: A scoping review. BMC Health Services Research, 23, 893.
Ferreira, D. C., Vieira, I., Pedro, M. I., Caldas, P., & Varela, M. (2023). Patient satisfaction with healthcare services and the techniques used for its assessment: A systematic literature review and a bibliometric analysis. Healthcare (Switzerland), 11(5), 639.
Guzmán-Leguel, Y. M., & Rodríguez-Lara, S. Q. (2025). Assessment of patients' quality of care in healthcare systems: A comprehensive narrative literature review. Healthcare (Switzerland), 13(14), 1714.
J. Supranto. (2018). Measurement of customer satisfaction levels. Rineka Cipta Indonesia.
Karume, A. K., Nyongesa, K., Okutoyi, L., & Kinuthia, J. (2025). Patient's expectations and perceptions on quality of care: an evaluation using SERVQUAL gap in Kenya. PLOS ONE, 20(3), e0315910.
Kim, S., Rho, E., & Teo, Y. X. J. (2024). Citizen satisfaction research in public administration: A systematic literature review and future research agenda. Administration & Society, 56(7), 1–32.
Kotler, P., & Keller, K. L. (2016). Marketing management (15th global ed.). Pearson Education.
Lee, J. B., & Kim, S. (2024). Understanding gaps between objective and subjective performance measures: Accreditation of public service organizations and citizen satisfaction. Administration & Society, 56(2), 195–222.
Li, G., Chen, Y., & Lou, X. (2024). Complaint management system and patient satisfaction in grassroots hospitals. Medicine, 103(8), e37275.
Lucero-Prisno, D. E., Shomuyiwa, D. O., Kouwenhoven, M. B. N., Dorji, T., Adebisi, Y. A., Odey, G. O., George, N. S., Ajayi, O. T., Ekerin, O., Manirambona, E., Xu, L., Obnial, J. C., Viola, A. M., Ogunkola, I. O., Ahmed, M. M., Ogaya, J. B., Sium, A. F., Suntay, M. L. R., Chung, W. K., … Wong, M. C. S. (2024). Top 10 public health challenges for 2024: Charting a new direction for global health security. Public Health Challenges, 3(4), e70022.
Martilla, J. A., & James, J. C. (1977). Importance-performance analysis. Journal of Marketing, 41(1), 77–79.
No. 36. (2009). Law of the Republic of Indonesia Number 36 of 2009 concerning Health.
No. 81. (2010). Presidential Regulation Number 81 of 2010 concerning the Grand Design of Bureaucratic Reform 2010–2025.
Nugraha, E., Hendrawan, D., Budiman, A., Sutrisni, I. G. A. M., Hateyaningsih, H., Irham, R., & Oktavia, A. (2025). Customer satisfaction index of participants in the Indonesian National Health Insurance Program in 2024. PREPOTIF: Jurnal Kesehatan Masyarakat, 9(3).
Oliver, R. L. (1980). A cognitive model of the antecedents and consequences of satisfaction decisions. Journal of Marketing Research, 17(4), 460–469.
Osborne, S. P. (2020). Public service logic: Creating value for public service users, citizens, and society through public service delivery. Routledge.
Parasuraman, A., Zeithaml, V. A., & Berry, L. L. (1985). A conceptual model of service quality and its implications for future research. Journal of Marketing, 49(4), 41–50.
RI 14. (2017). Decree of the Minister of Administrative and Bureaucratic Reform of the Republic of Indonesia Number 14 of 2017 concerning Guidelines for Preparing the Community Satisfaction Survey of Public Service Delivery Units.
Singh, R. P., Hidayat, W. G. P. A., & Purnamaningsih, P. (2025). The impact of perceived service quality, trust, and hospital image on patient satisfaction and patient loyalty. South Eastern European Journal of Public Health, 2783–2798.
Sürücü, L., & Maslakci, A. (2020). Validity and reliability in quantitative research. Business & Management Studies: An International Journal, 8(3), 2694–2726.
Suwandi, S., Hikma, N., Yudit, Y., Sudirman, S., & Yani, A. (2025). Literature review: The effect of Puskesmas accreditation status on patient satisfaction with service quality as an intervening variable. Devotion: Journal of Research and Community Service, 6(5), 460–467.
Wang, S., Lu, Q., Ding, L., Ni, W., & Zheng, Y. (2026). Analysis of case management service quality for PCI patients based on the SERVQUAL model: A single-center prospective study. Frontiers in Public Health, 13, 1686646.
World Health Organization. (2024). WHO results report 2024–2025. World Health Organization.
Wulandari, R. D., Laksono, A. D., Rohmah, N., & Ashar, H. (2023). Regional differences in primary healthcare utilization in Java Region, Indonesia. PLOS ONE, 18(3), e0282709.
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