TANGIBLES AND EMPATHY AS PRIMARY DRIVERS OF PATIENT SATISFACTION: UNMASKING A LATENT QUALITY CRISIS IN INDONESIA’S UNIVERSAL HEALTH COVERAGE SYSTEM

Abstract

Universal Health Coverage (UHC) represents a global commitment to healthcare equity. Indonesia's Jaminan Kesehatan Nasional (JKN), one of the world's largest single-payer systems, has made remarkable strides in expanding financial access. However, this rapid expansion raises critical questions about the quality of care delivered, with patient satisfaction serving as a vital, yet complex, barometer. This study moves beyond surface-level metrics to provide a nuanced analysis of the architectural and relational drivers of patient satisfaction among JKN beneficiaries, utilizing the multi-dimensional SERVQUAL framework. A quantitative, cross-sectional survey was conducted between July and August 2025 at a regional referral hospital in East Java. A cohort of 100 JKN inpatients was selected via purposive sampling. Data were collected using a validated 30-item, 5-point Likert scale questionnaire. To ensure the statistical integrity of our findings in the presence of non-constant error variance, we employed a multiple linear regression model with robust standard errors. The regression model was statistically significant and explained a substantial 37.2% of the variance in patient satisfaction (Adjusted). All five SERVQUAL dimensions were significant predictors. Critically, the analysis revealed a distinct hierarchy of influence. The Tangibles of the care environment (physical infrastructure, amenities) emerged as the most potent predictor, followed closely by Empathy (compassionate, individualized care). A pivotal finding was the profound disconnect between high aggregate satisfaction scores (mean range > 4.20) and a strikingly low willingness to return for future care (mean = 3.00), exposing a significant satisfaction-loyalty paradox. The patient experience under Indonesia's JKN is predominantly shaped by two fundamental pillars: the perceived quality of the physical environment and the perceived humanity of care delivery. The identified satisfaction-loyalty paradox points to a latent quality crisis—a silent dissatisfaction masked by patient gratitude and social desirability biases. This suggests that while the JKN has succeeded in reducing financial barriers, it has yet to fully address the quality and dignity of the care experience. For the UHC promise to be fully realized, policy and practice must pivot from a singular focus on access to a dual focus on investing in both hospital infrastructure and the relational capacity of the healthcare workforce.