Analysis of factors influencing the effectiveness of National Health Insurance (NHI) services at the regional general hospital of Konawe Kepulauan Regency, Southeast Sulawesi Province, Indonesia

Background: The implementation of the National Health Insurance (NHI) program in Indonesia has significantly expanded healthcare access; however, high coverage does not automatically ensure effective hospital services, particularly in remote and archipelagic regions with limited resources. Internal organizational factors such as work motivation, work ability, work atmosphere, work environment, and the availability of equipment and facilities are considered essential determinants of service effectiveness.
Objective: This study aimed to analyze the factors influencing the effectiveness of NHI services at Konawe Islands Regency General Hospital, Southeast Sulawesi, Indonesia.
Methods: A quantitative observational study with a cross-sectional design was conducted among 206 hospital staff involved in NHI services, with 136 respondents selected using stratified random sampling based on the Slovin formula. Data were collected using validated Likert-scale questionnaires. Statistical analyses included univariate analysis, chi-square tests for bivariate analysis, and multivariate logistic regression to determine dominant influencing factors.
Results: Bivariate analysis revealed that work motivation, work ability, work atmosphere, work environment, and work equipment and facilities were significantly associated with the effectiveness of NHI services (p < 0.05). Multivariate logistic regression showed that work motivation (OR = 5.617), work ability (OR = 3.487), work atmosphere (OR = 3.466), and work equipment and facilities (OR = 4.010) significantly influenced service effectiveness, while the work environment was not statistically significant after adjustment (p = 0.732). Work motivation emerged as the most dominant factor.
Conclusion: Improving NHI service effectiveness in archipelagic hospitals requires strengthening health workers’ motivation and competencies, fostering a conducive work atmosphere, and ensuring adequate equipment and facilities. These findings provide evidence-based recommendations for hospital management and policymakers to enhance healthcare service delivery in geographically isolated regions.