ANALYSIS OF THE RELATIONSHIP BETWEEN HEALTH CENTER SERVICE QUALITY AND ELDERLY PATIENT SATISFACTION AT GONDANGLEGI HEALTH CENTRE

This study aims to analyze the relationship between Service Quality of Health Centre and elderly patient satisfaction at Gondanglegi Health Centre. This study is correlation analysis with cross sectional approach. The sample was taken by consecutive sampling technique with a sample was obtained 49 respondents. The data was collected by questionnaires and interviews. The data processing uses editing, coding, scoring and tabulating and statistical tests using Mann Whitney. The findings reveal that the quality of health services for the elderly at the Gondanglegi Health Centre in Malang Regency is almost half good. Meanwhile, the satisfaction of elderly patients is almost half of the satisfied patients. On the other hand, there is a relationship between the quality of health care services with the satisfaction of elderly patients at the Gondanglegi Public Health Centre.

The demand for health services is expanding in lockstep with population growth, which forces providers of health services to compete on service quality in order to maintain competitiveness. The quality of health services might be deemed satisfactory or acceptable if the services received meet or surpass expectations (Kotler & Keller, 2009). Patient satisfaction is the outcome of health services, that is why patient satisfaction is the goal of efforts to improve the quality of health services. Elderly are residents aged ≥60 years. Globally, in 2013 the proportion of the population aged 60 years was 11,7% of the total world population and it is estimated that this number will continue to increase (WHO, 2015). The number of elderly people in Indonesia also increases every year. According to Komnas Lansia data in 2009 showed that from the total population there were 7,49% elderly, and increase as many as 7,69% in 2011, and in 2013 the proportion of elderly people was 8,1% of the total population (Komnas Lansia, 2009). With the increase in the number of elderly people, the need for health services becomes important to pay attention to.
According to Yeboah & Gyamfuah (2014) poor service from health workers and long queuing time caused the elderly to not be eager to return to using health care facilities. Further, Ajarmah & Hashem (2015) highlight that patient satisfaction is the main indicator of the effectiveness of health care provider institutions, or in other words that improving service quality has a significant effect on patient satisfaction. Patients who are satisfied with the services they receive will tend to make return visits to these health facilities. These results are in line with the results of Sodani & Sharma (2011). Therefore, patient satisfaction depends on many factors, such as the quality of clinical services, availability of drugs, behavior of health workers in services, infrastructure of the place of service, physical comfort, emotional support, and respect for patient preferences.
Meanwhile, according to Falaha et al. (2016); Liu (2014); and Yeboah & Gyamfuah (2014) shows that the elderly population has distinctive characteristics in using health services. Several socio-demographic variables also influence the elderly in using health services. Therefore, improving the quality of health services for the elderly must pay attention to the condition of the elderly as a whole, starting from health facilities, quality of treatment/care, attitudes of officers, and other variables related to the elderly. So that it can increase the satisfaction of elderly patients, and have an impact on increasing the visits of elderly patients to the local health centers (Puskesmas).

RESEARCH METHOD
The design of this research is correlation analysis with cross sectional approach. The population of all elderly who visited the Gondanglegi health center was 56 people. However, the sample was taken by consecutive sampling technique with a sample was obtained 49 respondents. The independent variable is the quality of health care services, while the dependent variable is the satisfaction of elderly patients. The data was collected by questionnaires and interviews. Furthermore, the data processing uses editing, coding, scoring and tabulating and statistical tests using Mann Whitney.  Figure 1, almost all of the elderly patients who visited the Gondanglegi Health Center were 60-74 years old, as many as 40 people (81.6%). Most of the work of elderly patients who visited the Gondanglegi health center was not working as many as 27 people (55.1%). The gender of elderly patients who visited the Gondanglegi Public Health Center was dominated by women as many as 27 people (55.1%). The educational background of elderly patients is dominated by elementary school graduates as many as 27 people (55.1%). The marital status of the elderly patients were all married as many as 49 people (100%).

Figure 2 Frequency distribution of Gondanglegi Health Center Service Quality
Based on figure above, almost half of the elderly patients who visited the Gondanglegi Public Health Center assessed that the service quality of the Puskesmas was "good", as many as 19 people (39%).

Figure 3 Frequency distribution of Patient Satisfaction
Based on figure above, most of the elderly patients who visited the Gondanglegi health center assessed that the satisfaction of the health centre services was "satisfied" as many as 30 peoples (61%). Meanwhile, 19 peoples (39%) was "dissastisfied".

The Relationship between Health Center Service Quality and Elderly Patient
Satisfaction at Gondanglegi Health Center The results of the Mann-Whitney test analysis obtained a value with p-value = 0,000 <0,05, hence the difference in the quality of health center service scores between respondents who were satisfied and respondents who were not satisfied was statistically significant. This indicates that the difference in the service quality score of the Gondanglegi Health Center can explain the difference in the satisfaction of elderly patients at the Gondanglegi Health Center. As a matter of fact, this result reveal that there is a relationship between the service quality of the health center (Puskesmas) and the satisfaction of elderly patients at the Gondanglegi Health Center.

Discussion
Based on the results of the analysis, almost half of the elderly patients who visited the Gondanglegi health center assessed that the service quality of the puskesmas was "good" as many as 19 people (38.8%). This shows that the Gondanglegi Health Center has provided services that meet the expectations of most respondents. This reality is in line with the government's efforts to offer complete health services for the elderly with holistic techniques provided to sick and healthy elderly people who will maintain the most suitable health conditions. However, the fact that almost half of the respondents consider it less good" and a small proportion consider it poor, shows that the current Puskesmas offers are no longer able to meet the expectations of all patient. It is the duty of the Gondanglegi Health Center to jointly improve the privileges of its services to the elderly to the maximum. Hence, it can attract the interest of the elderly to visit the puskesmas and make the puskesmas the main choice in seeking treatment. This phenomenon shows that the service quality of Gondanglegi Health Center needs to be continuously developed through gradual service development efforts.
Based on figure 3, most of the elderly patients who visited the Gondanglegi Public Health Center assessed that the satisfaction of the Puskesmas service was satisfied as many as 30 people (61.2%) this indicates that the Gondanglegi Health Center services have met the expectations of most respondents. However, the fact that almost half (38.8%) of respondents were dissatisfied, this indicates that the Puskesmas services have not been able to meet the expectations of all respondents. This is a challenge for the Gondanglegi Health Center to further improve its services so that it can satisfy all elderly patients who visit the Gondanglegi Health Center. This fact is consistent with the results on service quality which also indicates that it has not met the expectations of all respondents.
According to Gunarsa in (Suryawati & Dharmino, 2006) there are various non-medical variables determine patient satisfaction, including: education level, socio-economic background, culture, physical environment, occupation, personality and life experience of the patient. Additionally, patient satisfaction is influenced by patient characteristics, namely: age, education, occupation, ethnicity, socioeconomic, and disease diagnosis. The same thing was expressed by Anderson in (NOVA, nd) which states that with the same service for the same case, the level of satisfaction felt by the patient will be different. This depends on the background of the patient itself, individual characteristics that have existed before the onset of the disease called predisposing factors. These factors include: rank, economic level, social position, education, socio-cultural background, general ethnicity, gender, mental attitude and personality of a person.
Based on the results of the Mann-Whitney test analysis in table 1, it indicates that the difference in service quality scores at the Gondanglegi Health Center can explain the difference in the satisfaction of elderly patients at the Gondanglegi Health Center. This fact shows that there is a relationship between the quality of puskesmas services and the satisfaction of elderly patients at the Gondanglegi Health Center. Therefore, when Puskesmas services are improved, it will increase the satisfaction of elderly patients as well. Notoatmodjo (2010) highlight that satisfied patients will maximize the utilization of health services. Utilization of health services is part of health behavior in the form of activities related to efforts to maintain and improve health. Efforts to utilize health services are also As a result, understanding and enhancing quality is a significant problem for all healthcare organizations. Quality is regarded a critical aspect in service distinction and excellence, as well as being a possible source of sustainable competitive advantage (Taner & Antony, 2006). Furthermore, Lestari et al. (2009) reveal that there are several determinants of patient satisfaction, including tangibles, such as equipment and personnel, reliability, responsiveness, assurance, and empathy. Besides that, there are several non-medical variables that can also affect patient satisfaction, including: education level, socio-economic background, culture, physical environment, occupation, personality and environment, also influenced by patient characteristics, namely: age, education, occupation, ethnicity, socioeconomic, and disease diagnosis.

ANALYSIS OF THE RELATIONSHIP BETWEEN HEALTH CENTER SERVICE QUALITY AND ELDERLY PATIENT SATISFACTION AT GONDANGLEGI HEALTH CENTRE
The services given by the Public Health Center are a critical aspect in allowing patients to take benefit of the Public Health Center's services. In a highly competitive environment like today's, the Public Health Center's appearance, reliability, and guarantee in providing services to patients are the most important factors in the impression that patients will have while using the Public Health Center's services, so the perception of service users, in this case the patient, will appear on the perceived quality of service. Satisfaction, retention, and even loyalty will arise as a result of good service quality perceptions, assisting in the implementation of the company's strategy and the attainment of the organisation goals (Nim, 2017;Simamora, 2020). Regarding service quality on patient satisfaction, this study found that service quality had a positive and significant effect on patient satisfaction.
The creation of service quality will almost likely result in customer satisfaction. The quality of this service will eventually provide benefits, such as the construction of a harmonious relationship between producers of goods and services and customers, a sound foundation for developing client loyalty, and the formation of profitable word-of-mouth recommendations (Schaars, 1991in Tjiptono, 2008. The customer's perception of the service they actually receive (perceived service) is compared to the service that is actually expected to determine service quality (expected service). Whenever reality exceeds expectations, the service can be described as high quality, and vice versa.

CONCLUSION
To sum up everything that has been stated so far, the quality of health services for the elderly at the Gondanglegi Health Center in Malang Regency is almost half good with obtained percentage of 39% in "good" category. The satisfaction of elderly patients at the Gondanglegi Health Center in Malang Regency is almost half of the satisfied patients with obtained result of 61% of satisfied respondent. Besides that, there is a relationship between the quality of health care services with the satisfaction of elderly patients at the Gondanglegi Public Health Center.