Nurillah Agustina, Rahmad Hidayat, Ariy Dermawan, Ayatullah Hadi

Universal Health Coverage and Hospital Service Satisfaction in Socio-Economically Vulnerable Tourism Areas

Introduction

Universal health coverage and hospital service satisfaction in socio-economically vulnerable tourism areas. Explore UHC and hospital service satisfaction in Mataram City's vulnerable tourism area. This study details administrative, access, and clinical quality challenges, offering policy needs for equitable healthcare.

Abstract

This study examines the implementation of Universal Health Coverage (UHC) at the Mataram City General Hospital—a referral facility situated in a socio-economically vulnerable, tourism-dependent area of West Nusa Tenggara, Indonesia. Service quality is assessed across three dimensions: (1) administrative service quality, (2) accessibility of health services, and (3) clinical service quality, framed against the challenges of achieving SDG 3 (Good Health and Well-Being), SDG 1 (No Poverty), and SDG 10 (Reduced Inequalities). Using a descriptive qualitative design, we conducted interviews, observations, and document analysis, and coded the data in NVivo 12 Plus. Findings indicate that administrative processes have improved in clarity, speed, and ease of registration; however, responsiveness and lengthy waiting times persist. Digital platforms have enhanced access, yet geographical barriers and a digital divide continue to constrain equity. Overall clinical quality is satisfactory but limited by insufficient empathy and suboptimal communication from health workers. The study contributes empirically by showing how systemic constraints—uneven resource allocation, workforce shortages, and infrastructure deficits—undermine UHC objectives in vulnerable, tourism-reliant settings. Policy implications include the need for area-based planning, stronger inter-agency coordination, and context-sensitive innovation to deliver more equitable and inclusive services across West Nusa Tenggara.

Review

The study "Universal Health Coverage and Hospital Service Satisfaction in Socio-Economically Vulnerable Tourism Areas" addresses a critical and timely subject: the practical implementation and perceived quality of Universal Health Coverage (UHC) within a specific and challenging context. By focusing on a referral hospital in a socio-economically vulnerable, tourism-dependent region of West Nusa Tenggara, Indonesia, the research provides valuable insights into the complexities of achieving global health goals, particularly SDG 3 (Good Health and Well-Being), SDG 1 (No Poverty), and SDG 10 (Reduced Inequalities). The work offers a much-needed empirical perspective on how UHC initiatives translate into patient satisfaction and service delivery challenges in unique geographical and socio-economic settings. The methodology, employing a descriptive qualitative design with interviews, observations, and document analysis coded in NVivo, appears robust and well-suited for an in-depth exploration of service quality across the three specified dimensions: administrative, accessibility, and clinical. The findings are candid and provide a nuanced picture, acknowledging improvements in administrative clarity and digital access while highlighting persistent issues such as long waiting times, geographical barriers, the digital divide, and deficits in health worker empathy and communication. A key strength is the study's empirical contribution in identifying systemic constraints—uneven resource allocation, workforce shortages, and infrastructure deficits—as fundamental impediments to UHC objectives in such vulnerable, tourism-reliant environments. While the qualitative approach offers deep insights into a specific setting, generalizability across different regions or an expanded quantitative assessment of patient satisfaction could further strengthen future research. Nevertheless, the policy implications drawn are highly pertinent and actionable, advocating for area-based planning, stronger inter-agency coordination, and context-sensitive innovation. These recommendations are crucial for developing more equitable and inclusive health services in similar vulnerable areas. Overall, this paper makes a significant contribution to understanding the operational realities of UHC in challenging contexts and provides a solid foundation for both policy development and further scholarly inquiry.

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