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KUESIONER GAMBARAN KARAKTERISTIK DAN RESPON MASYARAKAT TERHADAP PROGRAM JAMINAN KESEHATAN NASIONAL ( JKN ) IDENTITAS RESPONDEN NAMA : ALAMAT : Kuesioner Respon Masyarakat Terhadap Program JKN I. Karakteristik Petunjuk : Berilah tanda (X) pada jawaban yang kamu anggap benar 1. Berapakah usia bapak / ibu ? ……………………………. 2. Jenis kelamin a. Laki - Laki b. Perempuan 3. Apa pendidikan bapak / ibu a. SD b. SMP c. SMA d. D3 e. S1 4. Apakah pekerjaan bapak / ibu ? a. PNS b. TNI / POLRI c. PEGAWAI SWASTA d. WIRASWASTA

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Transcript of Quesion Er

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KUESIONER

GAMBARAN KARAKTERISTIK DAN RESPON MASYARAKAT TERHADAP PROGRAM JAMINAN KESEHATAN NASIONAL ( JKN )

IDENTITAS RESPONDEN

NAMA :

ALAMAT :

Kuesioner Respon Masyarakat Terhadap Program JKN

I. Karakteristik

Petunjuk : Berilah tanda (X) pada jawaban yang kamu anggap benar

1. Berapakah usia bapak / ibu ?…………………………….

2. Jenis kelamin a. Laki - Lakib. Perempuan

3. Apa pendidikan bapak / ibua. SDb. SMPc. SMAd. D3e. S1

4. Apakah pekerjaan bapak / ibu ?a. PNSb. TNI / POLRIc. PEGAWAI SWASTAd. WIRASWASTA

5. Berapakah penghasilan bapak/ibu dalam sebulan?a. < Rp 2.000.000b. Rp 2.100.000 – Rp4.000.000c. < Rp4.000.000

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6. Berapakah pengeluaran bapak/ibu dalam sebulan ?a. < Rp. 2000.000b. Rp. 2.100.000 – Rp. 4000.000c. > Rp. 4.000.000

7. Apakah penghasilan bapak/ibu mempengaruhi ikut sertaan JKN?a. Yab. Tidak

II. RESPON8. Apa jenis JKN yang diikuti?

a. PBIb. Non PBI

9. Kapan bapak / ibu mulai mengikuti JKN?a. Sehatb. Sakitc. Kontrol

10. Dari mana bapak/ibu mengetahui program JKN?a. Temanb. Saudarac. Ikland. Pemerintah

11. Apakah pendapat bapak/ibu tentang program JKN?a. Senangb. Tidak senang

12. Apakah program JKN memberikan keuntungan bagi bapak/ibu?a. Yab. Tidak

13. Apakah bapak/ibu mengalami kesulitan dalam proses registrasi program JKN ? a. Yab. Tidak

14. Apakah pelayanan program JKN sudah sesuai dengan yang diharapkan?a. Yab. Tidak

15. Apakah fasilitas kesehatan yang diberikan sesuai dengan yang diharapkan?

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a. Yab. Tidak


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