Analysis of the effect of the level of satisfaction of public service synergy management efforts and the status of online BPJS referral users on customer satisfaction

The Sipultak Health Center is one of the health service centers for the community in the North Tapanuli Regency. To make public health services good, the government formed the Social Security Administering Body. The tiered referral services and online referrals implemented by BPJS are still not in line with Law No. 25 of 2009. The problem formulation of this paper is how to analyze the effect of satisfaction levels, efforts to manage public service synergies and the status of BPJS online referral users on customer satisfaction at the Sipultak Health Center. The research method is Logistic Regression Analysis. Held at the Sipultak Health Center. The research sample was 343 respondents. The results of data analysis show that there is an influence on the level of satisfaction (pValue = 0.000), there is an influence on management efforts in improving service quality (pValue = 0.000), there is a synergistic effect on public services (pValue = 0.000), there is an effect on user status (BPJS customer membership (pValue = 0.000) = 0.000), BPJS service quality (pValue = 0.000), and customer fees (pValue = 0.008)). The most dominant factor is the quality of BPJS service with OR = 24,885. It is hoped that the concept of health management which can lead to convenience for humans should be paid

The Sipultak Health Center is one of the health service centers for the community in the North Tapanuli Regency. To make public health services good, the government formed the Social Security Administering Body. The tiered referral services and online referrals implemented by BPJS are still not in line with Law No. 25 of 2009. The problem formulation of this paper is how to analyze the effect of satisfaction levels, efforts to manage public service synergies and the status of BPJS online referral users on customer satisfaction at the Sipultak Health Center. The research method is Logistic Regression Analysis. Held at the Sipultak Health Center. The research sample was 343 respondents. The results of data analysis show that there is an influence on the level of satisfaction (pValue = 0.000), there is an influence on management efforts in improving service quality (pValue = 0.000), there is a synergistic effect on public services (pValue = 0.000), there is an effect on user status (BPJS customer membership (pValue = 0.000) = 0.000), BPJS service quality (pValue = 0.000), and customer fees (pValue = 0.008)). The most dominant factor is the quality of BPJS service with OR = 24,885. It is hoped that the concept of health management which can lead to convenience for humans should be paid more attention so that it does not bring good things and is prohibited by law.
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INTRODUCTION
Public service is a measure of government performance that is most visible to the eye. Public service is a very basic demand for modern government management, people can directly assess government performance based on the quality of public services received, because the quality of public services is in the interest of many people and the impact is directly felt by people from all walks of life. Success in building public service performance in a professional, effective, efficient, and tabular manner will raise the positive image of the government in the eyes of the community. Every implementation of public services must have service standards and be published as a guarantee of certainty for service recipients. Referring to the consideration that everyone has the right to social security to be able to meet the basic needs of a decent life and increase their dignity towards the realization of a prosperous, just and prosperous Indonesian society, the government must provide good and proper services to the community. Based on the results of research at the Sipultak Health Center, Pagaran District, North Tapanuli Regency regarding BPJS Online referrals, people who are registered with BPJS Health in the working area of the Sipultak Health Center, Pagaran District, North Tapanuli Regency who want to seek treatment, must first go to the First Level Health Facilities, which include the Sipultak Health Center, District Pagaran North Tapanuli Regency. People cannot go straight to the hospital, except for emergency patients who need fast treatment and more complete equipment. The patient is said to be an emergency if he is in a sick condition that can cause death or disability. The patient comes to the Puskesmas, heads to the BPJS registration counter room with the BPJS participant card. The online referral system was implemented starting October 1, 2018, this online referral system is accommodated in an application called Primary Care BPJS Kesehatan on the page pcare.bpjskesehatan.go.id. Primary Care is an application used by officers or doctors at first-level health facilities such as puskesmas and clinics to check data on participants who register at the puskesmas. Not only the BPJS Health participant data, the officers at the health center can see directly the data of the referral destination hospital. Officers can find out what specialist doctors or sub-specialists are available, up to the practice schedule of each doctor, from the hospital that is within the closest reach of the puskesmas. Furthermore, if someone is referred, the officer or doctor at the health center only needs to register the participant directly at the destination hospital. The difference is, the use of this online system can make participants know how many queues they are in and the schedule of the doctor who will provide treatment. Based on the description above, it is important to synergize public services regarding public service providers at the Sipultak Health Center so that there are clear boundaries and relationships regarding the rights, responsibilities, obligations and authorities of all parties related to public service providers, carry out a proper administration system in accordance with the general principles of government and in accordance with the demands of Law no. 25 of 2009 concerning public services and providing protection and legal certainty for every patient who seeks treatment with BPJS. To find clear answers to these problems, the authors are interested in conducting research on Analysis of the Influence of Satisfaction Levels, Management Efforts, Public Service Synergy, User Status (Participation, Quality of Service and Dues) BPJS Online Referrals to Customer Satisfaction at the Sipultak Health Center in 2021.
This study aims to determine the effect of management efforts, synergy of public services and user status (participation, quality of service and contributions) of bpjs online referrals on customer satisfaction at the Sipultak Health Center in 2021 It is hoped that the results of this study can provide a theoretical contribution, particularly in relation to the Effect of Satisfaction Levels, Management Efforts, Synergy of Public Services and User Status (Participation, Service Quality and Dues) of BPJS Online Referrals on Customer Satisfaction at the Sipultak Health Center in 2021. The results of this study are expected can provide experience for BPJS customers regarding the influence of BPJS customer satisfaction levels on the quality of BPJS online referral services. The results of this study are expected to be used as input material for the Health Social Security Administering Body in conducting evaluations to improve the quality of better services, especially at the Sipultak Health Center. The results of this study are expected to be used as input for the Puskesmas to find out the factors related to the level of BPJS customer satisfaction with the quality of BPJS online referral services. The results of this study are expected to be able to add to the literature in the library of the Deli Husada Deli Tua Institute of Health in the area of influence of the level of BPJS customer satisfaction on the quality of BPJS online referral services in efforts to improve the quality of BPJS online referral services and the legal perspective on the synergy of public services at the Sipultak Public Health Center.

METHODS
This research is an observational study using a crosssectional design where the dependent and independent variables are measured at the same time and carried out in January 2022. The research location is the Working Area of the Sipultak Health Center. The population in this study is a number of people who are BPJS participants in the Working Area of the Sipultak Health Center. The population in this study amounted to 2,407 BPJS participants. Sample research is part of the number and characteristics possessed by the population (Sugiyono, 2015). In this study the sampling technique used was purposive sampling. Purposive sampling is a sampling technique with a specific purpose (Sugiyono, 2015). The sample in this study were 343 people. The types of data are primary data and secondary data. Research variables can be distinguished according to their position and type, namely the dependent variable and independent variable. In this study, the dependent variable is BPJS customer satisfaction at the Sipultak Health Center. The independent variables in this study include the Level of BPJS Patient Satisfaction on the Quality of Online Referral Services, the Health Center's Efforts to Improve the Quality of Online Referral Services for BPJS Customers, the Legal Perspective of Synergy and the Status of Online Referral Users, on Customer Satisfaction. Data analysis, namely bivariate and multivariate analysis. Bivariate analysis is used to determine the relationship between the independent variables. Bivariate analysis in this study used the Chi-square statistical test. Multivariate analysis was carried out to determine the relationship between the independent variables and the dependent variable.
This research has received approval from the ethics committee regarding the implementation of research in the health sector at the Faculty of Medicine, Islamic University of North Sumatra Number: 625/KEPK/FK-UISU/XII/2020.

RESULT AND DISCUSSION
The results of the Chi Square test obtained pValue = 0.000, so it can be concluded that there is a significant relationship between the level of customer satisfaction and BPJS customer satisfaction. The results of the analysis obtained Odd Ratio (OR) = 8.150 with a confidence level of 95% CI (5.027-13.211), which means that the level of satisfaction has an opportunity risk of 8.150 times greater for the dissatisfied category compared to satisfied with BPJS customer satisfaction.
The results of the Chi Square Test obtained a pValue = 0.000, so it can be concluded that there is a significant relationship between the efforts of the puskesmas management and BPJS customer satisfaction. The results of the analysis obtained Odd Ratio (OR) = 0.024 with a confidence level of 95% CI (0.013-0.045) which means that the Puskesmas Management Efforts have a risk opportunity of 0.024 times greater for the dissatisfied category compared to satisfied with BPJS customer satisfaction.
The results of the Chi Square Test obtained a pValue = 0.000, so it can be concluded that there is a significant relationship from a legal perspective with BPJS customer satisfaction. The results of the analysis obtained the Odd Ratio (OR) = 8.679 with a confidence level of 95% CI (5.242 -14.370), which means that the synergy of public services has a risk opportunity of 8.679 times greater for the category of dissatisfied compared to satisfied with BPJS customer satisfaction.
The results of the Chi Square Test obtained a value of pValue = 0.000, so it can be concluded that there is a significant relationship between BPJS membership and BPJS customer satisfaction. The results of the analysis obtained Odd Ratio (OR) = 2.566 with a confidence level of 95% CI (2.235 -2.991), which means that BPJS membership has a risk opportunity of 2.566 times greater for the dissatisfied category compared to satisfied with BPJS customer satisfaction.
The results of the Chi Square test obtained pValue = 0.000, so it can be concluded that there is a significant relationship between BPJS service quality and BPJS customer satisfaction. The results of the analysis obtained Odd Ratio (OR) = 24.885 with a confidence level of 95% CI (14.048-44.082) which means that BPJS service quality has a risk opportunity of 24.885 times greater for the dissatisfied category compared to satisfied BPJS customer satisfaction.
The results of the Chi Square Test obtained pValue = 0.008, so it can be concluded that there is a significant relationship between BPJS customer contributions and BPJS customer satisfaction. The results of the analysis obtained Odd Ratio (OR) = 1.823 with a confidence level of 95% CI (1.188-2.798) which means that there is a risk opportunity 1.823 times greater for the dissatisfied category compared to satisfied with BPJS customer satisfaction. It is known that from the 6 independent variables, there were 6 variables that could become candidates for inclusion in the initial model, namely the Level of BPJS Customer Satisfaction, Health Center Management Efforts, Public Service Synergy, BPJS Membership, BPJS Service Quality, BPJS Participant Fees. All variables can be included in the multivariate test stage because these 6 variables have a p value that is smaller than the comparative p value variable (p value <0.25).
The data analysis used for this multivariate analysis is Logistic Regression Analysis, in which this model is chosen to find out the Odd Ratio (OR) the chance of the risk occurring together for estimation purposes. It is known from the results of the final multivariate test that all variables have a p value <0.05, so it can be concluded that of the 6 independent variables, all of them are related to BPJS user satisfaction. The results of the analysis obtained the largest OR is BPJS Service Quality with OR = 24.885 meaning that the dominant variable influences BPJS User Satisfaction in the Sipultak Health Center Working Area in 2021. The final results of this multivariate analysis will produce a logistic regression equation which can explain the probability of BPJS user satisfaction, then made modeling logistic regression test.

DISCUSSION
To analyze data on the level of satisfaction of BPJS patients and the quality of Online Referral services, the efforts of the Puskesmas management to improve the quality of Online Referral services to BPJS customers and the synergy of public services at the Puskesmas by identifying several variables so that the frequency distribution of these variables can describe the data that has been collected. Frequency distribution of data on BPJS patient satisfaction level and online referral service quality, Puskesmas management efforts to improve the quality of online referral services for BPJS customers and the synergy of public services at the puskesmas can show variable descriptions that describe respondents' responses. The results of the analysis obtained the Odd Ratio (OR) = 8.150 with a confidence level of 95% CI (5.027-13, 211) which means that the satisfaction level has a risk opportunity of 8.150 times greater for the dissatisfied category compared to satisfaction with BPJS customer satisfaction, so it can be concluded that there is a relationship between the level of BPJS customer satisfaction and BPJS user satisfaction at the Sipultak Health Center. The results of the analysis obtained Odd Ratio (OR) = 0.024 with a confidence level of 95% CI (0.013-0.045) which means that the Puskesmas Management Efforts have a risk opportunity of 0.024 times greater for the dissatisfied category compared to satisfied with BPJS customer satisfaction. It was concluded that there was a significant influence on efforts to improve the quality of BPJS Online Referral Services with BPJS Customer Satisfaction at the Sipultak Health Center. The results of the analysis obtained the Odd Ratio (OR) = 8.679 with a confidence level of 95% CI (5.242 -14, 370 ) which means that the synergy of public services has a risk opportunity of 8.679 times greater for the dissatisfied category compared to those who are satisfied with BPJS customer satisfaction. It was concluded that there is a significant effect of the Synergy of Public Services on BPJS Customer Satisfaction at the Sipultak Health Center. The results of the analysis obtained Odd Ratio (OR) = 2.566 with a confidence level of 95% CI (2.235 -2.991), which means that BPJS membership has a risk opportunity of 2.566 times greater for the dissatisfied category compared to satisfied with BPJS customer satisfaction, so it can be concluded that there is a relationship BPJS customer participation with BPJS user satisfaction at the Sipultak Public Health Center. The results of the analysis obtained Odd Ratio (OR) = 24.885 with a confidence level of 95% CI (14.048-44.082), which means that BPJS service quality has a risk opportunity of 24, 885 times greater for the dissatisfied category than satisfied with BPJS customer satisfaction, so it can be concluded that there is a relationship between the quality of BPJS online referral services and BPJS customer satisfaction at the Sipultak Health Center. The results of the analysis obtained Odd Ratio (OR) = 1.823 with a confidence level of 95% CI (1.188-2.798) which means that there is a risk opportunity 1.823 times greater for the dissatisfied category compared to satisfied with BPJS customer satisfaction. Thus, there is a relationship between contributions and the satisfaction of BPJS participants in the health facilities at the Sipultak Health Center level with a very strong relationship. This is in accordance with the hypothesis which states that there is a relationship between contributions and the satisfaction of BPJS participants at the Sipultak Health Center. it can be concluded that there is a relationship between the quality of BPJS online referral services and BPJS customer satisfaction at the Sipultak Community Health Center. The results of the analysis obtained Odd Ratio (OR) = 1.823 with a confidence level of 95% CI (1.188-2.798) which means that there is a risk opportunity 1.823 times greater for the dissatisfied category compared to satisfied with BPJS customer satisfaction. Thus, there is a relationship between contributions and the satisfaction of BPJS participants in the health facilities at the Sipultak Health Center level with a very strong relationship. This is in accordance with the hypothesis which states that there is a relationship between contributions and the satisfaction of BPJS participants at the Sipultak Health Center. it can be concluded that there is a relationship between the quality of BPJS online referral services and BPJS customer satisfaction at the Sipultak Community Health Center. The results of the analysis obtained Odd Ratio (OR) = 1.823 with a confidence level of 95% CI (1.188-2.798) which means that there is a risk opportunity 1.823 times greater for the dissatisfied category compared to satisfied with BPJS customer satisfaction. Thus, there is a relationship between contributions and the satisfaction of BPJS participants in the health facilities at the Sipultak Health Center level with a very strong relationship. This is in accordance with the hypothesis which states that there is a relationship between contributions and the satisfaction of BPJS participants at the Sipultak Health Center. 188-2,798) which means that it has a risk opportunity of 1.823 times greater for the dissatisfied category compared to satisfied with BPJS customer satisfaction. Thus, there is a relationship between contributions and the satisfaction of BPJS participants in the health facilities at the Sipultak Health Center level with a very strong relationship. This is in accordance with the hypothesis which states that there is a relationship between contributions and the satisfaction of BPJS participants at the Sipultak Health Center. 188-2,798) which means that it has a risk opportunity of 1.823 times greater for the dissatisfied category compared to satisfied with BPJS customer satisfaction. Thus, there is a relationship between contributions and the satisfaction of BPJS participants in the health facilities at the Sipultak Health Center level with a very strong relationship. This is in accordance with the hypothesis which states that there is a relationship between contributions and the satisfaction of BPJS participants at the Sipultak Health Center.

CONCLUSION AND SUGGESTION
There is a significant influence on the level of customer satisfaction on BPJS customer satisfaction. There is a significant influence of puskesmas management efforts on BPJS customer satisfaction. There is a significant effect of the synergy of public services on BPJS customer satisfaction. There is a significant influence of BPJS membership on BPJS customer satisfaction. There is a significant effect of BPJS service quality on BPJS customer satisfaction. There is no significant effect of BPJS customer fees on BPJS customer satisfaction. Of the six variables that have a risk relationship, the dominant factor for BPJS customer satisfaction is the BPJS service quality variable with OR = 24.885

Suggestions
In the implementation of public services, it is better if the community participates in the implementation of the public service itself so that the community can obtain the services they expect from the state apparatus whose duty is to serve the community. We recommend that in providing quality health services, especially online referral services for patients who seek treatment using BPJS, the Sipultak Health Center has really prepared the best service so that it can create a positive image for the health service unit in the eyes of the public. It is better if the concept of administering health that can cause harm to humans must be given more attention so that it does not bring things that are harmful and prohibited by law. And so that there is synergy between legal perspectives on public services provided at the Sipultak Health Center, the BPJS itself must pay attention directly and the active role of the people who use the BPJS. Participants are expected to increase their activity as independent BPJS participants at the first level of health facilities by routinely participating in activities carried out by the BPJS such as outreach and prolanis activities. BPJS Health is expected to maintain and improve the quality of service by providing clean and tidy examination rooms, complete medical equipment and medical personnel according to the health facilities at the Sipultak Health Center. BPJS Health is expected to carry out evaluations related to regulations for contributions for BPJS participants.
Funding Statement.