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1.1 Background
Health services are one of the most needed services by the community. One of the health
service facilities that have a very important role in providing health services to the public is the
hospital. The hospital is an institution in the chain of the National Health System and carries out
the duty to provide health services to the entire community, because the development and
implementation of health in hospitals need to be directed to the national goals in the field of
health. Not surprisingly, the health field needs to be fixed in order to provide services health is
best for society. Health services in question is of course a fast service, precise, cheap and
friendly. Given that a country will be able to carry out development properly if it is supported by
a healthy society physically and spiritually. To maintain customers, the hospital is always
required to maintain consumer confidence carefully by paying attention to the needs of
consumers as an effort to meet the wishes and expectations of the services provided. Consumers
of hospitals in this case patients who expect services in hospitals, not only expect medical
services and nursing but also expect comfort, good accommodation and harmonious relationships
between hospital staff and patients, thus the need to improve the quality of health services in

1.2 Problem Formulation

Based on the background that has been described, the issues to be raised in this paper are:
1.2.1 Portrait of Health Services in Indonesia ?
1.2.2 Reality that happened ?
1.2.3 Community Problems / Complaints ?

1.3 Purpose of writing

The purpose of making this paper is for all of us, especially readers to understand and to
see the real picture of health services in Indonesia.


2.1 Theoretica
Health services are divided into two groups, namely:
2.1.1 Primary health care, or public health services, is the first health service, which is first
needed by the community when they experience health problems or accidents.
2.1.2 Secondary and tertiary health care is a hospital where people need further treatment
(referral) There are different levels of hospitals in Indonesia, from type D hospitals to
grade A hospitals.

2.2 Portrait of health services in Indonesia

Good health care is a necessity for everyone. Everyone wants to feel appreciated, want to
be served, want to get the same position in the eyes of society. But there is often a dichotomy in
health care efforts in Indonesia. There have been so many cases that illustrate how dismal faces
of health care in this country are. It is as if good health services are only for those who have thick
purses. While the less fortunate people do not get fair and proportional treatment. Poor people do
not seem to be sick.
It is incomprehensible what makes the gap between rich and poor in the health care
domain. Doctors in different hospitals often implicitly identify themselves to patients. That
medical education is not cheap. Therefore, as the fruits of the expensive education that must be
taken, the public must pay the meaning of healthy life with a remarkable nominal. Perhaps the
initial paradigm when one chooses his way of life as a physician suffers from disorientation.
Devotion to society and nation is not a factor that dominates one's desire to become a doctor.
There are commercialization factors that sometimes underlie a person in the course of medicine
as his choice. This paper is not made to discredit a doctor, absolutely not. The doctor is a very
noble job. Doctors are positions that make a person more appreciative of life. The substance is
that today the image of a doctor occurring in Indonesia is a commercialization of non-health care
jobs. If the paradigms that are disoriented can be straightened then the position of a doctor will
return to a noble level.


Health services seem to be often not worth the cost. Hospitals sometimes do not serve
patients well and are friendly. Doctors sometimes make a diagnosis that tends to be arbitrary.
Not to mention the nurses in the hospital are often lazy when working. One person once said that
hospitals in Japan do not provide entertainment facilities such as televisions for hospital
employees. Thus the working conditions will be much more conducive because the concentration
will not be split between work and entertainment affairs. While in Indonesia the existence of
television for hospital employees is a necessity. Actually this condition can damage work
productivity. Although there is always the justification that professionalism is always upheld in
the profession. It is not clear the validity of the discourse, but it seems to see the condition of
existing hospitals in Indonesia with its services, the discourse is true regardless of the conditions
that exist in hospitals in Japan.

2.3 Reality that Happened

Budiarto (2004) in his research on the effect of service quality on customer satisfaction in
14 hospitals spread in ten provinces in Indonesia shows that the quality of hospital services that
includes the availability of medical facilities and other facilities that support medical services in
addition to human resources significantly to customer satisfaction. The public's view on the
quality of health services in Indonesia is declining. Indonesian patients who seek medical
treatment abroad continue to increase. A data from one site mentions in Singapore alone every
year about 300,000 international patients come for treatment. Approximately 7200 of them are
Indonesian citizens (Patient Physician Communication website 13 May 2009). Meanwhile, the
number of Indonesians who have gone to Malaysia in recent years has surpassed that to
Singapore. Other data mention the number of Indonesian patients seeking treatment at Lam Wah
Ee Hospital Malaysia reached 12,000 per year or about 32 patients per day. At Adventist
Hospital Malaysia the number of Indonesian patients is recorded to reach 14,000 per year or
about 38 patients per day. Even at least a thousand patients from Aceh and surrounding areas are
reportedly forced to go abroad every month, especially to Penang, Malaysia, to get excellent
health services. This tendency comes because they are not satisfied with the health services
provided by hospitals in Aceh and surrounding areas. (Serambi On Line July 14, 2007). The high
interest of foreign medical treatment such as Malaysia and Singapore is generally caused by the
factor of completeness of facilities and the quality of service provided has fulfilled the patient's

expectation. Various reasons that trigger a lot of medical treatment and check their health abroad,
such as excellent service and punctuality, they quickly get a diagnosis certainty so as not to make
patients anxious or bored because waiting for the diagnosis that does not come and still many
advantages they can get there . As previously mentioned, at this time, the number of patients
seeking treatment abroad namely Singapore and Malaysia, dominated by patients from
Indonesia. This is a serious problem, considering that in addition to dealing with the issue of trust
in services in Indonesia, it is also related to the government's revenue from the hospital service
sector. The 2006 data states that the country's foreign exchange reserves that are sucked into
foreign hospitals reach US $ 600 million annually. Improving the quality of health services can
be done from various aspects of services such as improving the quality of health facilities,
improving the quality of professionalism of human resources and improving the quality of
hospital management. Quality service must be maintained by taking measurements continuously,
to be known the weaknesses and shortcomings of services provided and made follow-up
according to the priority of the problem.

2.4 Community Problems / Complaints

The problems are also evident from some hospital service users who are still complaining
about the services provided, as seen from the many complaints about slow service, the lack of
friendly and non-communicative behavior of the nurse officers.
From the data in Table 1.2, there are public complaints or dissatisfaction with the results
of service, it is clear that public complaints will show the quality of services provided, because
the core of public services leads to improving the welfare of the community and improving the
quality of service received by the community.

2.5 Hospital Profile Siloam Surabaya

Siloam Hospitals Surabaya has been established for more than 20 years. Siloam Hospitals
Surabaya has been accredited from KARS provided by the Ministry of Health of Indonesia and
awarded by the World Health Organization (WHO) and Asia Pacific Society of Infection Control
(APSIC) for the Asia Pacific Hand Hygiene Excellence Award.

The hospital is located in the business and shopping center of Surabaya, East Java. The
superior services offered Siloam Hospitals Surabaya, including Cardiology, Orthopedics, and

2.6 Hospital Service Siloam Surabaya

2.6.1 Emergency
1) 24-hour Emergency Department
2.6.2 Inpatient Facilities
1) 160 beds, including:
a) 6 Intensive Care Unit (ICU) Beds
b) 5 High Care Unit (HCU)
c) 4 Neonatal Intensive Care Unit (NICU) Beds
d) 2 Labor and Delivery Suites
e) 5 Isolation Rooms
f) 10 Maternity Beds
g) 20 Paediatric Beds
h) 3 One-day Care Beds
i) 6 Operating Theatres
2.6.3 Diagnostic Services
1) Ambulatory Blood Pressure (ABP)
2) Ambulatory Electrocardiogram (Holter Monitoring)
3) Echocardiography
4) Electrocardiogram (ECG)
2.6.4 Radiology Services
1) 1.5T MRI
2) Cath Lab
3) Computed Tomography (CT) Scan
4) Digital X-Ray
5) Ultrasonography 4D
6) Fluoroscopic Examinations

2.6.5 Laboratory Services

1) Clinical Pathology
2) Microbiology & Immunology
3) Anatomical Pathology
1) Emergency Cardiac Center
2) Orthopedic Center
3) Comprehensive Stroke Center
4) Digestive Surgery Center
1) Haemorhoid Clinic
2) Wound & Diabetic Education Clinic
3) Incontinence Clinic
4) Pain Clinic
5) Spine Clinic
6) ABCDe (Children's Growth) Clinic
2.6.8 Other Specialties
1) Acupuncture
2) Anaesthesiology
3) Andrology
4) Cardiology & Vascular
5) Cardiothoracic Surgery
6) Clinical Nutrition
7) Dentistry
8) Dermatology
9) ENT
10) Gastroenterology
11) Geriatry
12) Haematology Oncology
13) Internal Medicine
14) Nephrology

15) Neurology
16) Neurosurgery
17) Obstetry & Gynecology
18) Opthalmology
19) Pathology
20) Paediatry
21) Paediatric Surgery
22) Pulmonology
23) Plastic & Reconstruction Surgery
24) Psychiatry
25) Psychology
26) Radiology
27) Rheumatology
28) Rehabilitation Medicine
29) Sports Medicine
30) Surgical Oncology
31) Urology

2.7 Analisa SWOT (Strengh, Weakness, Opportunity dan Threat)

SWOT is an abbreviation of Strenghths (strength), Weakness (weakness), Opportunities
(opportunities), and Threats (threats). This is a technique for providing a framework for
systematically identifying organizational positions, how they relate to the external environment
and the problems and opportunities faced. The purpose of the SWOT analysis is to separate the
underlying issues and facilitate the strategic approach. So it can be concluded SWOT analysis is
the development of relationships or interactions between internal elements (strengths and
weaknesses) to external elements (opportunities and threats).
2.7.1 Internal factors
Internal factor consists of strength and weakness is a factor that comes from within the
object itself. If the object is an organization say BEM, then its internal factors include how the
quality of human resources in the BEM, how with financial management in the BEM and others.
From here we agree OBJEK that we discuss is the Organization.

1) Strength
a) RS. Siloam already has a brand that is quite famous in its service.
b) RS. Siloam Has 9 regions and branch offices throughout Indonesia and continues
to grow to date.
c) Siloam Hospital already has several hospitals, specialist clinics and cancer
treatment centers.
d) Standart service refers to international standards.
e) Have professors, doctors, and medical treatment that has been professional.
f) Hospital Building. Siloam resembles a hotel in it (such as: Minimarket,
Restaurant, and Cafeteria)
g) RS. Siloam has the most complete equipment and sophisticated equipment (such
as: Laboratory analyst, Radiology, and Cath lab)
h) RS. Siloam embraces integrated IT technology across branch areas.
i) Always provide new innovations in the service.
j) The best service is sufficient in accordance with the exelence services provided to
the customer.
2) Weakness
a) RS. Siloam Surabaya where the building is less big and wide.
b) The narrow area of the parking lot of the hospital. Siloam Surabaya (less
c) From antiquity until now take care of administration at the time of patient return
very long (-, +) 1 hour / more.
d) The quality management system related to its human resources is still weak.
e) Employee jobdesk system is still irregular.
f) Late culture is still a habit
2.7.2 External Factors
External factors consist of opportunity and threat that is the factor that comes from
outside the object. If the object is an organization say BEM, then its external factors include how
with the support of deans and students and others. From here we agree OBJEK that we discuss is
the Organization.

1) Opportunity
a) Services offered in accordance with the expected by the customer.
b) Innovation is created always made an example by competitors.
c) The increasing need for medic services makes RS. Siloam increasingly expand its
d) Complete Equipment and Best Service to make RS. siloam to expand network
abroad (Global)
e) RS. Siloam Open operational 24 hours
2) Threat
a) Service Rate room rates are relatively expensive from kempetitor.
b) Increasing the opening of new Hospital services in various places.
c) Many emerging new Hospitals with various forms of attractive offers

2.8 The Table of satisfaction level at Indonesian’s Hospital



3.1 Conclusion
The dismal face of health care in Indonesia should be a lesson for all parties to improve
the condition. Not only the role of doctors or the Minister of Health in the realization of a healthy
life but the participation of all societies. There must be a change of vision in an effort to live
healthy. Doctors and all elements in the world of health should be more concerned about society.
Social aspects must be upheld not just the financial aspect that gets more attention. Likewise, the
community must synergize with the health care workers by respecting and responding positively
to their position as community servants. Indeed this solution seems theoretical. However, it
should be realized that the change can not be done suddenly. Change requires a long and tiring
process. It seems that what Aa 'Gym says about the concept of change is very relevant to the
present condition.
Tips to change the nation: start from yourself, start from the smallest things and be
considered trivial and start right now.
Two of the things described earlier about the high price of healthy living and health care in
Indonesia are two things that are closely related. The stigma that is present in the midst of society
today is the cost of expensive health is not supported by adequate health services. Two things
that should not be cut at all. Due to various factors of poor service people with thick pockets
prefer to seek treatment abroad. Because of the high cost of medical treatment for the small
people chose an alternative path even smelling klenik though as a shortcut to heal. Two
currencies are very different between the two conditions above.
Choosing medical treatment abroad can not be considered an act of betraying the nation. Due to
the fact that existing hospitals in Indonesia do not have sufficient facilities to provide better
health insurance coverage to their patients. But there are certain parties who do care abroad
because of their distrust of the capacity of doctors and hospitals in this country. Perspectives like
this invite a lot of questions. Actually doing overseas care means slowly killing doctors and local
hospitals. But this should be a stepping stone for doctors and hospitals to improve their
credibility so that the patient's trust in them can be safeguarded. Thus the generalization of the
inadequate ability of doctors and hospitals can be eliminated. When public confidence in the


capacity of doctors in Indonesia can be answered well by the doctor itself it will be established a
very good cooperation between both parties.

3.2 Suggestions
To provide quality services that oriented to customer needs and a good hospital image in
the community then the hospital needs to make continuous improvement efforts with the
following steps:
3.2.1 Improve service to patients with a friendly attitude and also can understand and
understand the state of the patient.
3.2.2 Increasing discipline and cometmen in working at all Hospital officers in order to provide
services that quickly, accurately, and can perform tasks, functions and roles well in
accordance with the vision and mission.
3.2.3 To improve the technical quality, it is necessary to implement education and training
programs in accordance with excellent service standards so as to provide services that can
meet the needs and satisfaction for patients.
3.2.4 To improve the functional quality, it is necessary to carry out the training, especially
related to human relations, namely about the attitude and a good way of communication
in order to give character personality to human resources.
3.2.5 Hospital Party is expected to continuously improve facilities, infrastructure and health of
hospital environment and maintain and improve existing facilities, such as procurement
of medical equipment and medical support, facility repair in the inpatient and cleanliness
of hospital environment