ANALYSIS OF FACTORS OF COMPLIANCE WITH INDEPENDENT
PARTICIPANTS PAYING BPJS KESEHATAN CONTRIBUTIONS IN DEPOK CITY, WEST JAVA
Jesinda Nurhasna Hafizhawita
Universitas Airlangga, Jawa Timur, Indonesia
KEYWORDS |
ABSTRACT |
bpjs,
health, program. |
Only
66.3% of participants in the JKN Program paid routinely and continued to
reduce until the amount in arrears was 253 billion rupiahs in 2021. The
independent participant group/PBPU has a significant role in this problem.
The research aims to identify the factors that influence the compliance of
independent group participants to pay contributions obediently in Depok City.
This research was carried out in an analytical observational manner with a
cross-sectional design. The research sample was collected from as many as 42
respondents who were selected using a multistage sampling technique. Data
collection using a questionnaire includes Background Factors, Intention,
Actual Behavior Control, and Behavior. The data analysis technique is Chi
Square using the SPSS application. The Results show that background factors
are not related to behavior (P-Value 0.107, 0.804, 0.636, and 0.927), actual
behavior control related to Behavior (P-Value 0.037), and intention related
to Behavior (P-Value 0.047). This study concludes that Actual Behavior
Control has the most substantial relation to Behavior, and the background
factors have no relation with the Behavior of participants who regularly pay
to bpjs Kesehatan). Actual behavior control has a strong relationship with the
participant's obedient Behavior in paying contributions, and intention also
has a significant relationship with the participant's obedient Behavior. At
the same time, background factors have no relationship with participant
compliance behavior. |
DOI: 10.58860/ijsh.v2i5.46 |
|
Corresponding Author: Jesinda Nurhasna Hafizhawita
Email: Jesinda25@gmail.com
INTRODUCTION
Health is also one of the
factors that can help individuals so that other people and countries continue
to develop for the better. The National Social Security System (SJSN) forms a
mandatory social security for Indonesian people called the National Health
Insurance (JKN), whose program is administered by the National Guarantee Agency
(BPJS) (Sukardi, 2016). The
National Health Insurance Administration Agency (BPJS) for Health began
operating in early 2014 (Sambodo et al., 2023). It has a
nature of membership that is mandatory for all Indonesian residents, with the
type of membership itself being divided into two groups, namely Recipients of
Contribution Assistance (PBI) (Wijaya, 2022), namely
health insurance participants for the poor and non-poor people. Able and
non-recipient of Contribution Assistance (PBPU) consisting of wage-earning
workers and their family members, non-paid workers and their family members,
and non-workers and their family members.
Table 1.
Outline of the Number of JKN Program Participants
in the City
of Depok from 2018-2020
The 2018 year |
The 2019 year |
The 2020 year |
|
Number of participants |
Number of participants |
Number of participants |
|
Recipients of state budget assistance |
282,828 |
255,804 |
252,581 |
Recipients of APBD contributions |
117,975 |
189,553 |
186,180 |
Wage Recipient Workers (PPU) |
286,248 |
281,366 |
665,062 |
Non-Wage Recipient Workers (PBPU)/independent |
462,729 |
447,451 |
440,554 |
Non-Employee (BP) |
48,048 |
46,304 |
42,813 |
TOTAL |
1,197,828 |
1,220,478 |
1,587,190 |
Based on the health profile of the City of Depok,
overall participation in the National Health Insurance program continued to
increase from 2018 to 2020, from 1,197,828 to 1,587,190 participants. Although
JKN program participants continue to increase, from the table above, it can be
seen that PBPU or independent participants have declined in the last three
years until 2020. This shows that the participation of Non-Paid Workers (PBPU)
in the JKN program in the calculated BPJS participant data has a reduction
which could be because the participant is disabled.
Table 2. The number of
participants in arrears paying JKN contributions and
the amount of arrears in
Depok City from 2018 – 2021
|
The 2018 year |
The 2019 year |
The 2020 year |
The year 2021 |
Participants who are in arrears of JKN contributions |
204,078 |
214,203 |
225,495 |
319,620 |
JKN contribution arrears |
94 billion rupiahs |
139 billion rupiahs |
174 billion rupiahs |
253 billion rupiahs |
The table above shows that
participants who are in arrears paying JKN contributions are increasing
over time. It was proven that starting in 2018, based on the circulated news,
BPJS Kesehatan Depok City Branch recorded that as many as 204,078 participants
were in arrears of contributions. Half of the arrears were class III participants
with arrears costs of up to 94 billion rupiahs (Hariani, 2018). The data
for delinquent participants themselves explained came from independent
participants in classes I, II, and III (Alamsyah, 2018). In 2019,
Public Relations of the BPJS Kesehatan Depok City Branch, Ridha, also said that
as many as 214 thousand independent participants were in arrears paying
contributions, with data from half of the defaulters being class III
participants (Iswinarno, 2019).
Furthermore, in 2020, the records of BPJS Kesehatan Depok City Branch, based on
the explanation from the head of BPJS Kesehatan Depok City Branch, Elisa Adam,
stated that there were 225,495 participants in arrears with a total amount of
arrears of 174 billion Rupiah which were still dominated by class III participants
(Administrator, 2020).
With the
mandatory nature of JKN program participation, it is necessary to comply with
contributions or premium payments from participants so that their membership
remains active and can help develop better services (Khoirunurrofik & Raras, 2021). Based on
the Reasoned Action Approach theory put forward by (Fishbein, n.d.) explains
that Behavior begins with the individual's intention. Belief in Behavior can be
formed through encounters with everyday experiences to produce a belief that
influences it. Actual Behavior Control can also find out whether it is true
that perceived obstacles or facilities have influenced a person to control
Behavior.
Based on the
above background, the purpose of this study is to find out and analyze the
factors that affect the compliance of JKN participants to pay contributions in
the working area of BPJS Kesehatan Depok Branch. So that the benefits of this
study can provide a better understanding of the factors that affect the
compliance of JKN participants in paying contributions. Findings from this
study can also be used to inform policy development by BPJS Kesehatan and the
government.
METHOD
The research used is analytic observational
research. Because this research only collects data and information without
providing intervention or treatment to the population or sample (Wulandari et al., 2022). Based on the
time of data collection, the research design uses cross-sectional because the
data collection of research variables is carried out in a certain period
simultaneously and only once. Thus this research was conducted from November
2021 to July 2022.
Whole participant Worker No Wage Recipient (PBPU) or
independent BPJS in the City Depok, West Java Province, with a total of 440,554
participants using a multistage sampling technique, i.e., combining cluster
sampling techniques and simple random sampling. The calculated sample size was
determined by the Lemeshow formula (1997) to get a total of 42 samples. The
sample proportion was divided into two, namely taken from the sub-districts
with the most membership status and the least, namely in the Sukmajaya and
Cinere sub-districts based on the Coverage of Each Sub-District in Depok City
in 2018. Then the two sub-districts in each sub-district were randomly
selected, and two RWs were selected. In each RW, RT was randomly selected, and
six respondents were taken randomly in each RT.
The variables examined in this study are Background
Factor, Intention, and Actual Behavior Control as independent variables, which
will be tested for their relationship with Behavior as the dependent variable.
Retrieval of information regarding the dependent variable and independent
variable is carried out using a validated questionnaire.
RESULT AND
DISCUSSION
Table 3.
Frequency Distribution of Background Factors for Independent Participants
of the National Health Insurance Program
(JKN) in Depok City in 2022
Variable |
Category |
Frequency |
Percentage (%) |
Age |
young age
group (15-24
years) |
28 |
66,7 |
early
working age group (25-34
years) |
8 |
19.0 |
|
|
middle age
group (35-44
years) |
4 |
9,5 |
|
pre-retirement
age group (45-54 years) |
1 |
2,4 |
|
Retirement age group (55-65 years) |
1 |
2,4 |
|
Total |
42 |
100.0 |
Gender |
Man |
15 |
35,7 |
|
Woman |
27 |
64,3 |
|
Total |
42 |
100.0 |
last education |
Not completed in primary school |
0 |
0.0 |
|
Graduated from elementary school |
1 |
2,4 |
|
Middle school graduate |
2 |
4,8 |
|
Graduated from high school |
13 |
31.0 |
|
Graduated DIII/DIV/S1 |
26 |
61.0 |
|
Total |
42 |
100.0 |
Income |
<IDR 4,377,231.93 |
20 |
47,6 |
|
≥ IDR 4,377,231.93 |
22 |
52,4 |
|
Total |
42 |
100.0 |
Participants in the independent group of the National
Health Insurance program in Depok City showed results in the young age group,
namely around 15-24 years of age, with a percentage of 66.7%. Women, namely
64.3%, also dominated participants. Then in the last education, most graduated
from DIII/DIV/S1 with a percentage of 61%. Independent participants had the
same relative opinion as participants in the category ≥Rp 4,377,231.93 or
from the Regional Minimum Wage (UMR) as much as 52.4%, followed by participants
who have an income of <IDR 4,377,231.93 or less than the Regional Minimum
Wage (UMR) of 47.6%.
Background
Factors Relationship With Behavior
Table 4.
Cross-tabulation of Background Factors with Behavior of
Independent JKN
Program Participants in Depok City in 2022
Variable |
Behavior |
Total |
P-Value |
||||
obey |
Not obey |
||||||
n |
% |
n |
% |
n |
% |
||
Age |
|
|
|
|
|
|
0.107 |
≤23 years old |
5 |
23,8 |
16 |
76,2 |
21 |
50.0 |
|
>23 years |
10 |
47,6 |
11 |
52,4 |
21 |
50.0 |
|
Gender |
|
|
|
|
|
|
0.804 |
Man |
5 |
38.5 |
8 |
61.5 |
13 |
31.0 |
|
Woman |
10 |
34.5 |
19 |
65.5 |
29 |
69.0 |
|
Education |
|
|
|
|
|
|
0.636 |
Graduated from SD-Graduated from SMA |
5 |
31,3 |
11 |
68.8 |
16 |
38.0 |
|
Graduated DIII/DIV/S1 |
10 |
38.5 |
16 |
61.5 |
26 |
62.0 |
|
Income |
|
|
|
|
|
|
0,927 |
<Rp 4.377.231,93 |
7 |
35,0 |
13 |
65,0 |
20 |
47,6 |
|
≥Rp 4.377.231,93 |
8 |
36,4 |
14 |
63,6 |
22 |
52,4 |
The results showed no relationship between the age of
the participants and the Behavior (P=0.107) of the independent group
participants to pay their dues regularly in Depok City. While the relationship
between participant gender and Behavior (P=0.804) for independent group
participants to pay dues regularly in Depok City in 2022. the educational
outcomes of participants had no relationship with Behavior (P=0.636), nor did
participants' income relationship with Behavior with a P-value of 0.927.
Intention
Intention variables were
obtained with three categories in this variable which were made by researchers
based on the Reasoned Action Approach theory by (Fishbein, n.d.). This identification was assessed using a Likert
scale, namely a score of 1 to 4, with a score of 1 being very unwilling to pay,
a score of 2 being not intending to pay, a score of 3 being intending to pay,
and a score of 4 being very intent on paying.
Table 5.
Frequency Distribution of Intention for Independent Participants
of the National Health Insurance Program (JKN)
in Depok City in 2022
Intention |
Not interested |
Interested |
Total Score |
Means |
||
n |
% |
n |
% |
|||
pay BPJS contributions with the JKN mobile application |
9 |
21,4 |
33 |
78.9 |
132 |
3,14 |
pay BPJS contributions through a bank or digital wallet, or e-Commerce |
4 |
9,5 |
38 |
90.5 |
147 |
3.50 |
pay BPJS contributions through branch offices, post offices, minimarkets |
1 4 |
34,3 |
28 |
66,7 |
119 |
2.83 |
Total |
|
|
|
|
|
3,16 |
The results found that participants who did not
intend to pay contributions to BPJS Health tended to be 4.5 times more likely
to have disobedient Behavior in paying contributions regularly. The results
showed a relationship between Intention and Behavior (P=0.047) in the
independent group participants of the National Health Insurance program. The
results of the study found that most participants in Depok City who had the
intention to pay tended to behave disobediently in paying contributions to BPJS
for health.
Relationship of Intention with Behavior
The results of the cross-tabulation and
relationship test for the Intention variable indicate that the intention to pay
contributions is the Behavior of obediently paying contributions to BPJS Health
regularly.
Table 6.
Cross-tabulation of Intention with Behavior of Independent JKN
Program
Participants in Depok City in 2022
Intention |
Behavior |
Total Score |
P-Value |
||||
Obey |
Not obey |
||||||
n |
% |
n |
% |
n |
% |
||
Intend |
13 |
41.9 |
18 |
58,1 |
31 |
73,8 |
0.047 |
Not Intended |
2 |
18,2 |
9 |
81.8 |
11 |
26,2 |
It was found
that participants who did not intend to pay contributions to BPJS Kesehatan
tended to be 4.5 times more likely to have delinquent Behavior in paying
contributions regularly. The results showed a relationship between Intention
and Behavior (P=0.047) in the independent group participants of the National
Health Insurance program. The results of the study found that most of the
participants in Depok City who had the intention to pay tended to be disobedient
in paying their contributions to BPJS Kesehatan.
Actual Behavior Control
The results of identifying the Actual Behavior
Control variable are described by three categories in this variable which were
made by researchers based on the theory of the Reasoned Action Approach (Fishbein, n.d.).
Table 7.
Frequency Distribution of Actual Behavior Control for Independent Participants
of the National Health Insurance Program (JKN) in Depok City in 2022
Actual Behavioral Control |
Disagree |
Agree |
Total Score |
Means |
||
n |
% |
n |
% |
|||
advice from BPJS |
1 |
2,4 |
31 |
97.6 |
144 |
3,43 |
recommendation from family |
4 |
9,5 |
38 |
90.5 |
144 |
3,43 |
ease of paying BPJS contributions |
4 |
9,5 |
38 |
90.5 |
145 |
3.45 |
Total |
|
|
|
|
|
3,44 |
Based on the results of the identification of the
Actual Behavior Control variable described in Table 7, it was found that the total average score was 3.44
or above the standard value (3.20). The results were above 80% as well as each
sub-variable. So there is no problem with this variable.
Relationship between Actual
Behavior Control and Behavior
Table 8 is the result of cross-tabulation between
the Actual Behavior Control and Behavior variables in independent group/PBPU
participants of the National Health Insurance program in Depok City.
Table 8.
Cross-tabulation of Actual Behavior Control with Behavior of Independent JKN
Program Participants in Depok City in 2022
Actual Behavior Control |
Behavior |
Total |
P-Value |
||||
obey |
Not obey |
||||||
n |
% |
n |
% |
n |
% |
||
Good |
12 |
54.5 |
10 |
45.5 |
22 |
52,4 |
0.008 |
Not enough |
3 |
15.0 |
17 |
85.0 |
20 |
47,6 |
It
shows that participants with less Actual Behavior Control tend to have five
times more obedient or disobedient Behavior. The data processing results found a
strong relationship between Actual Behavior Control and Behavior (P=0.008) in
the independent group participants of the JKN program in Depok City.
Analysis of the Relationship
between Background Factors and the Behavior of Independent Participants of the
National Health Insurance Program in Depok City
Based on the results of the
study, it was found that this variable had no relationship with Behavior. The
Reasoned Action Approach theory developed by (Wells et al., 2011) explains that there are no results that can show
signs that this variable is related to a person's behavior problems. Gender,
both male and female, does not affect Behavior in paying regular contributions
to BPJS Kesehatan (Handayani et al., 2020). Education only affects an interest in registering
as a participant. However, compliance with paying contributions is based on
something other than high education but on awareness of one's needs (Adani et al., 2019). Meanwhile, the income of the informal sector is
volatile. It prioritizes daily needs rather than paying contributions, so many
arrears are found in the independent participant group (Mai et al., 2020).
Analysis of the Relationship
between Intention and Behavior of Independent Participants of the National
Health Insurance Program in Depok City
The study's results found a
relationship between the intention and the Behavior of the JKN Program
Participants to pay their dues regularly. Intention dramatically influences the
decision to carry out a behavior, so the BPJS forms various ways to make it
easier for participants to pay JKN program contributions (Wahyudi et al., 2021). They explained that existing access is insufficient to shape participants
to behave obediently to routinely pay contributions to BPJS Kesehatan because
the services provided do not affect participants' perceptions of the risks that
might occur (Permatasari et al., 2022). Based on research by (Manurung et al., 2022) stated that participants' interest in paying
contributions through branch offices has decreased because there are already
new services that can facilitate the payment of contributions easily. In
addition, there are problems with payments at branch offices and minimarkets
due to additional transportation costs. However, this is still the choice of
participants to pay contributions because a wrong signal often constrains
access to JKN payment via the internet.
Analysis of the Relationship
between Actual Behavior Control and Behavior of Independent Participants of the
National Health Insurance Program in Depok City
Actual Behavior Control was
found to be related to participants' Behavior in paying the JKN program
contributions. The behavioral control participants feel she is very influential
because it can hinder or facilitate JKN program participants to remain active
by paying contributions to BPJS (Fatimah, 2019). Control behavior that is exposed around the
community, both from a distance between facilities and participants, which can
facilitate or hinder greatly influencing the Behavior of JKN program
participants to choose to comply in paying contributions to BPJS so that they
remain active participants and can use the facilities offered by health
services that work with BPJS Health (Fatimah, 2019).
CONCLUSION
Based on the
results and discussion, it was found that Actual behavior control had a strong
relationship with the participant's Behavior to comply with paying dues.
Intention also had a significant relationship with the participant's Behavior
to comply. Meanwhile, the background factor has no relationship with the
participant's compliance behavior.
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|
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2023 by the authors. It was submitted for possible open-access publication
under the terms and conditions of the Creative Commons Attribution (CC BY SA) license (https://creativecommons.org/licenses/by-sa/4.0/). |