Analysis of factors affecting Puskesmas performance: a case study of health center in national health insurance era

Background: Indonesian National Health Insurance (JKN) has been implemented since January 1, 2014. The study aimed to analyze the factors that affect poor quality of puskesmas (public health center) in JKN era. Materials and methods: The research used qualitative method to examine the natural condition of the object. Triangulation was conducted. This study was conducted in CHC I group consisted 3 units of puskesmas with low Minimum Service Standard (MSS) and CHC II group consisted 2 units puskesmas with high MMS. Results: Input, process, output, environment, leadership, management, and organizational work culture in CHC II were performed better than CHC I. Better medical service was found in CHC II. Environment in the form of government policy and local government were better in CHCII. Leadership, management and culture of organizational work were better in CHC II. Output of public health target indicators in the form of MSS in CHC II was slightly better than in CHC I. It was found that puskesmas performance affected by sufficient human resource, funds, and facilities availability. Conclusions: It can be concluded that human resource, funds, and facilities in public health center influenced its performance in JKN era