Sociocultural and Economic Factors Influencing JKN Participation: A Cross-Sectional Study in Bajoe, Indonesia

Authors

  • Muhammad Rizki Ashari Universitas Tadulako
  • Arwan Universitas Tadulako
  • Sadli Syam Universitas Tadulako

DOI:

https://doi.org/10.61978/medicor.v2i4.709

Keywords:

National Health Insurance, JKN, Participation, Health Literacy, Public Trust, Family Support, Indonesia

Abstract

The implementation of the Jaminan Kesehatan Nasional (JKN) program in Indonesia seeks to achieve Universal Health Coverage by ensuring equitable access to health services for all citizens. Despite this aim, disparities in participation persist, particularly in rural and coastal regions. This study aimed to analyze the factors influencing community participation in the JKN program within the working area of Bajoe Community Health Center, Bone Regency. A cross sectional quantitative approach was used to survey 291 respondents selected through purposive sampling. Structured questionnaires were administered to assess demographic characteristics and the influence of five key variables: knowledge, trust, income, health condition, and family support. Data were analyzed using univariate and bivariate (Chi square) statistical techniques. Results revealed that knowledge, trust in the JKN system, income level, and family support had statistically significant associations with program participation (p < 0.05). Specifically, individuals with better knowledge, higher trust, greater income, and supportive families were more likely to be enrolled. Conversely, perceived or actual health status showed no significant correlation with participation. These findings suggest that proactive enrollment behavior is influenced more by informational, economic, and social dynamics than by immediate health needs. The study concludes that increasing JKN participation requires multi-dimensional strategies, including culturally tailored public education, institutional trust building, improved subsidy access for low income households, and family centered outreach. These interventions are essential to bridge participation gaps and strengthen the national health insurance framework.

References

Adebayo, E. F., Uthman, O. A., Wiysonge, C. S., Stern, E., Lamont, K., & Ataguba, J. E. (2015). A Systematic Review of Factors That Affect Uptake of Community-Based Health Insurance in Low-Income and Middle-Income Countries. BMC Health Services Research, 15(1). https://doi.org/10.1186/s12913-015-1179-3 DOI: https://doi.org/10.1186/s12913-015-1179-3

Akokuwebe, M. E., & Idemudia, E. S. (2022). A Comparative Cross-Sectional Study of the Prevalence and Determinants of Health Insurance Coverage in Nigeria and South Africa: A Multi-Country Analysis of Demographic Health Surveys. International Journal of Environmental Research and Public Health, 19(3), 1766. https://doi.org/10.3390/ijerph19031766 DOI: https://doi.org/10.3390/ijerph19031766

Alesane, A., & Anang, B. T. (2018). Uptake of Health Insurance by the Rural Poor in Ghana: Determinants and Implications for Policy. Pan African Medical Journal, 31. https://doi.org/10.11604/pamj.2018.31.124.16265 DOI: https://doi.org/10.11604/pamj.2018.31.124.16265

Amara, P. S., Platt, J., Raj, M., & Nong, P. (2022). Learning About COVID-19: Sources of Information, Public Trust, and Contact Tracing During the Pandemic. BMC Public Health, 22(1). https://doi.org/10.1186/s12889-022-13731-7 DOI: https://doi.org/10.1186/s12889-022-13731-7

Ataguba, J. E. (2021). The Impact of Financing Health Services on Income Inequality in an Unequal Society: The Case of South Africa. Applied Health Economics and Health Policy, 19(5), 721–733. https://doi.org/10.1007/s40258-021-00643-7 DOI: https://doi.org/10.1007/s40258-021-00643-7

Barnes, A. J., & Hanoch, Y. (2017). Knowledge and Understanding of Health Insurance: Challenges and Remedies. Israel Journal of Health Policy Research, 6(1). https://doi.org/10.1186/s13584-017-0163-2 DOI: https://doi.org/10.1186/s13584-017-0163-2

Baroudi, M., Goicolea, I., Hurtig, A., & Sebastián, M. S. (2022). Social Factors Associated With Trust in the Health System in Northern Sweden: A Cross-Sectional Study. BMC Public Health, 22(1). https://doi.org/10.1186/s12889-022-13332-4 DOI: https://doi.org/10.1186/s12889-022-13332-4

Bronfman, N. C., Repetto, P., Cordón, P., Castañeda, J. V., & Cisternas, P. C. (2021). Gender Differences on Psychosocial Factors Affecting COVID-19 Preventive Behaviors. Sustainability, 13(11), 6148. https://doi.org/10.3390/su13116148 DOI: https://doi.org/10.3390/su13116148

Cho, H. E., Wang, L., Chen, J., Liu, M., Kuo, C., & Chung, K. C. (2019). Investigating the Causal Effect of Socioeconomic Status on Quality of Care Under a Universal Health Insurance System—A Marginal Structural Model Approach. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-4793-7 DOI: https://doi.org/10.1186/s12913-019-4793-7

Couturier, V., Srivastava, S., Hidayat, B., & Allegri, M. D. (2022). Out‐of‐Pocket Expenditure and Patient Experience of Care Under‐Indonesia’s National Health Insurance: A Cross‐sectional Facility‐based Study in Six Provinces. The International Journal of Health Planning and Management, 37(S1), 79–100. https://doi.org/10.1002/hpm.3543 DOI: https://doi.org/10.1002/hpm.3543

Duku, S. K. O. (2018). Differences in the Determinants of Health Insurance Enrolment Among Working-Age Adults in Two Regions in Ghana. BMC Health Services Research, 18(1). https://doi.org/10.1186/s12913-018-3192-9 DOI: https://doi.org/10.1186/s12913-018-3192-9

Edward, J., Thompson, R., & Jaramillo, A. (2020). Availability of Health Insurance Literacy Resources Fails to Meet Consumer Needs in Rural, Appalachian Communities: Implications for State Medicaid Waivers. The Journal of Rural Health, 37(3), 526–536. https://doi.org/10.1111/jrh.12485 DOI: https://doi.org/10.1111/jrh.12485

El‐Sayed, A. M., Vail, D., & Kruk, M. E. (2018). Ineffective Insurance in Lower and Middle Income Countries Is an Obstacle to Universal Health Coverage. Journal of Global Health, 8(2). https://doi.org/10.7189/jogh.08.020402 DOI: https://doi.org/10.7189/jogh.08.020402

Fisher, M., Freeman, T., Mackean, T., Friel, S., & Baum, F. (2020). Universal Health Coverage for Non-Communicable Diseases and Health Equity: Lessons From Australian Primary Healthcare. International Journal of Health Policy and Management. https://doi.org/10.34172/ijhpm.2020.232 DOI: https://doi.org/10.34172/ijhpm.2020.232

Gantiva, C., Jiménez‐Leal, W., & Urriago-Rayo, J. (2021). Framing Messages to Deal With the COVID-19 Crisis: The Role of Loss/Gain Frames and Content. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.568212 DOI: https://doi.org/10.3389/fpsyg.2021.568212

Gustavson, K., Røysamb, E., & Borren, I. (2019). Preventing Bias From Selective Non-Response in Population-Based Survey Studies: Findings From a Monte Carlo Simulation Study. BMC Medical Research Methodology, 19(1). https://doi.org/10.1186/s12874-019-0757-1 DOI: https://doi.org/10.1186/s12874-019-0757-1

Hanson, B. L., Finley, K., Otto, J., & Ward, N. (2022). Role of Trusted Sources and Behavioral Beliefs in Promoting Mitigation Behaviors During the COVID-19 Pandemic: Survey Study. Jmir Human Factors, 9(3), e37454. https://doi.org/10.2196/37454 DOI: https://doi.org/10.2196/37454

Housten, A. J., Furtado, K., Kaphingst, K. A., Kebodeaux, C. S., McBride, T., Cusanno, B. R., & Politi, M. C. (2016). Stakeholders’ Perceptions of Ways to Support Decisions About Health Insurance Marketplace Enrollment: A Qualitative Study. BMC Health Services Research, 16(1). https://doi.org/10.1186/s12913-016-1890-8 DOI: https://doi.org/10.1186/s12913-016-1890-8

Kalajahi, R. A., Saadati, M., Azami‐Aghdash, S., Rezapour, R., Nouri, M., Derakhshani, N., & Dalal, K. (2022). Psychometric Properties of Public Trust in Covid-19 Control and Prevention Policies Questionnaire. BMC Public Health, 22(1). https://doi.org/10.1186/s12889-022-14272-9 DOI: https://doi.org/10.1186/s12889-022-14272-9

Kasu, T., Mungure, S., Menelik, G., & Mharakurwa, S. (2021). The Interactions of Public Health Organisational Leadership With Its Environment: A Case Study of the Sally Mugabe Central Hospital in Harare, Zimbabwe. Medical Journal of Zambia, 48(2), 85–93. https://doi.org/10.55320/mjz.48.2.30 DOI: https://doi.org/10.55320/mjz.48.2.873

Khanal, A., GC, S., Panthee, S., Paudel, A., Ghimire, R., Neupane, G., Gaire, A., Sitaula, R., Bhattarai, S., Khadka, S., Khatri, B., Khanal, A., Panthee, B., Wasti, S. P., & Vijay, S. (2022). Fear, Risk Perception, and Engagement in Preventive Behaviors for COVID-19 During Nationwide Lockdown in Nepal. Vaccines, 11(1), 29. https://doi.org/10.3390/vaccines11010029 DOI: https://doi.org/10.3390/vaccines11010029

Kigume, R., & Maluka, S. (2021). The Failure of Community-Based Health Insurance Schemes in Tanzania: Opening the Black Box of the Implementation Process. BMC Health Services Research, 21(1). https://doi.org/10.1186/s12913-021-06643-6 DOI: https://doi.org/10.1186/s12913-021-06643-6

Kino, S., & Kawachi, I. (2019). Can Health Literacy Boost Health Services Utilization in the Context of Expanded Access to Health Insurance? Health Education & Behavior, 47(1), 134–142. https://doi.org/10.1177/1090198119875998 DOI: https://doi.org/10.1177/1090198119875998

Mahmood, S. S., Hanifi, S. M. A., Mia, M. N., Chowdhury, A. H., Rahman, M., Iqbal, M., & Bhuiya, A. (2018). Who Enrols in Voluntary Micro Health Insurance Schemes in Low-Resource Settings? Experience From a Rural Area in Bangladesh. Global Health Action, 11(1), 1525039. https://doi.org/10.1080/16549716.2018.1525039 DOI: https://doi.org/10.1080/16549716.2018.1525039

Masters, R. K., & Reither, E. N. (2019). Accounting for Biases in Survey-Based Estimates of Population Attributable Fractions. Population Health Metrics, 17(1). https://doi.org/10.1186/s12963-019-0196-6 DOI: https://doi.org/10.1186/s12963-019-0196-6

Minyihun, A., Gebregziabher, M. G., & Gelaw, Y. A. (2019). Willingness to Pay for Community-Based Health Insurance and Associated Factors Among Rural Households of Bugna District, Northeast Ethiopia. BMC Research Notes, 12(1). https://doi.org/10.1186/s13104-019-4091-9 DOI: https://doi.org/10.1186/s13104-019-4091-9

Moreno-Fernández, M. M., & Matute, H. (2020). Biased Sampling and Causal Estimation of Health-Related Information: Laboratory-Based Experimental Research. Journal of Medical Internet Research, 22(7), e17502. https://doi.org/10.2196/17502 DOI: https://doi.org/10.2196/17502

Muhlis, A. N. A. (2022). Determinants of the National Health Insurance Uptake in Indonesia. Jurnal Administrasi Kesehatan Indonesia, 10(1), 111–121. https://doi.org/10.20473/jaki.v10i1.2022.111-121 DOI: https://doi.org/10.20473/jaki.v10i1.2022.111-121

Naderifar, M., Goli, H., & ghaljaie, fereshteh. (2017). Snowball Sampling: A Purposeful Method of Sampling in Qualitative Research. Strides in Development of Medical Education, 14(3). https://doi.org/10.5812/sdme.67670 DOI: https://doi.org/10.5812/sdme.67670

Nandi, S. S., Lambe, U. P., Sarkar, K., Sawant, S., & Deshpande, J. M. (2021). A Rapid Point of Care CC16 Kit for Screening of Occupational Silica Dust Exposed Workers for Early Detection of Silicosis/Silico-Tuberculosis. Scientific Reports, 11(1). https://doi.org/10.1038/s41598-021-02392-y DOI: https://doi.org/10.1038/s41598-021-02392-y

Nour-Eldein, H., Abdulmajeed, A., & Ismail, M. (2014). Research Publications in Medical Journals (1992-2013) by Family Medicine Authors—Suez Canal University-Egypt. Journal of Family Medicine and Primary Care, 3(4), 368. https://doi.org/10.4103/2249-4863.148112 DOI: https://doi.org/10.4103/2249-4863.148112

Nugroho, S. T., Ahsan, A., Kusuma, D., Irawaty, D. K., Amalia, N., & Hati, S. R. H. (2023). Income Disparity and Healthcare Utilization: Lessons From Indonesia’s National Health Insurance Claim Data. Asian Pacific Journal of Cancer Prevention, 24(10), 3397–3402. https://doi.org/10.31557/apjcp.2023.24.10.3397 DOI: https://doi.org/10.31557/APJCP.2023.24.10.3397

Nyande, F. K., Ricks, E., Williams, M., & Jardien‐Baboo, S. (2022). Socio-Cultural Barriers to the Delivery and Utilisation of Child Healthcare Services in Rural Ghana: A Qualitative Study. BMC Health Services Research, 22(1). https://doi.org/10.1186/s12913-022-07660-9 DOI: https://doi.org/10.1186/s12913-022-07660-9

Odusola, A. O., Stronks, K., Hendriks, M. E., Schultsz, C., Akande, T. M., Osibogun, A., Weert, H. v., & Haafkens, J. (2016). Enablers and Barriers for Implementing High-Quality Hypertension Care in a Rural Primary Care Setting in Nigeria: Perspectives of Primary Care Staff and Health Insurance Managers. Global Health Action, 9(1), 29041. https://doi.org/10.3402/gha.v9.29041 DOI: https://doi.org/10.3402/gha.v9.29041

Panda, S. (2023). Public Trust in Government Doctors and Hospitals in India. International Journal of Social Economics, 50(11), 1602–1617. https://doi.org/10.1108/ijse-07-2022-0498 DOI: https://doi.org/10.1108/IJSE-07-2022-0498

Park, S., Langellier, B. A., & Meyers, D. J. (2022). Association of Health Insurance Literacy With Enrollment in Traditional Medicare, Medicare Advantage, and Plan Characteristics Within Medicare Advantage. Jama Network Open, 5(2), e2146792. https://doi.org/10.1001/jamanetworkopen.2021.46792 DOI: https://doi.org/10.1001/jamanetworkopen.2021.46792

Parsons, S., Songco, A., Booth, C., & Fox, E. (2021). Emotional Information-Processing Correlates of Positive Mental Health in Adolescence: A Network Analysis Approach. Cognition & Emotion, 35(5), 956–969. https://doi.org/10.1080/02699931.2021.1915752 DOI: https://doi.org/10.1080/02699931.2021.1915752

Politi, M. C., Grant, R. L., George, N., Barker, A. R., James, A. S., Kuroki, L. M., McBride, T. D., Liu, J., & Goodwin, C. (2020). Improving Cancer Patients’ Insurance Choices (I Can PIC): A Randomized Trial of a Personalized Health Insurance Decision Aid. The Oncologist, 25(7), 609–619. https://doi.org/10.1634/theoncologist.2019-0703 DOI: https://doi.org/10.1634/theoncologist.2019-0703

Sadeghi, S. (2024). Investigating the Detection of Undeclared Cyproheptadine in Weight Gain Herbal Supplements, Creajensing. International Journal of Medical Toxicology and Forensic Medicine, 14(02), 43922. https://doi.org/10.32598/ijmtfm.v14i02.43922 DOI: https://doi.org/10.32598/ijmtfm.v14i02.43922

Shahin, M. A. H., & Hussien, R. M. (2020). Risk Perception Regarding the COVID-19 Outbreak Among the General Population: A Comparative Middle East Survey. Middle East Current Psychiatry, 27(1). https://doi.org/10.1186/s43045-020-00080-7 DOI: https://doi.org/10.1186/s43045-020-00080-7

Shewamene, Z., Tiruneh, G., Abraha, A., Reshad, A., Terefe, M. M., Shimels, T., Lemlemu, E., Tilahun, D., Wondimtekahu, A., Argaw, M., Anno, A., Abebe, F., & Kiros, M. (2021). Barriers to Uptake of Community-Based Health Insurance in Sub-Saharan Africa: A Systematic Review. Health Policy and Planning, 36(10), 1705–1714. https://doi.org/10.1093/heapol/czab080 DOI: https://doi.org/10.1093/heapol/czab080

Shrime, M. G., Verguet, S., Johansson, K. A., Desalegn, D., Jamison, D. T., & Kruk, M. E. (2015). Task-Sharing or Public Finance for the Expansion of Surgical Access in Rural Ethiopia: An Extended Cost-Effectiveness Analysis. Health Policy and Planning, 31(6), 706–716. https://doi.org/10.1093/heapol/czv121 DOI: https://doi.org/10.1093/heapol/czv121

Twum, P., Yeboah, E. B., Agyei‐Baffour, P., & Mensah, K. A. (2023). The Potency of a Free Maternal Healthcare Policy in Achieving Universal Health Coverage a Cross-Sectional Qualitative Study. F1000research, 12, 78. https://doi.org/10.12688/f1000research.123492.1 DOI: https://doi.org/10.12688/f1000research.123492.1

Ward, P., Rokkas, P., Cenko, C., Pulvirenti, M., Dean, N. R., Carney, A. S., Brown, P., Calnan, M., & Meyer, S. B. (2015). A Qualitative Study of Patient (Dis)trust in Public and Private Hospitals: The Importance of Choice and Pragmatic Acceptance for Trust Considerations in South Australia. BMC Health Services Research, 15(1). https://doi.org/10.1186/s12913-015-0967-0 DOI: https://doi.org/10.1186/s12913-015-0967-0

Yego, N. K., Nkurunziza, J., & Kasozi, J. (2023). Predicting Health Insurance Uptake in Kenya Using Random Forest: An Analysis of Socio-Economic and Demographic Factors. Plos One, 18(11), e0294166. https://doi.org/10.1371/journal.pone.0294166 DOI: https://doi.org/10.1371/journal.pone.0294166

Zohar, T., Negev, M., Sirkin, M., & Levine, H. (2022). Trust in COVID-19 Policy Among Public Health Professionals in Israel During the First Wave of the Pandemic: A Cross-Sectional Study. Israel Journal of Health Policy Research, 11(1). https://doi.org/10.1186/s13584-022-00529-6 DOI: https://doi.org/10.1186/s13584-022-00529-6

Downloads

Published

2024-10-31

How to Cite

Ashari, M. R., Arwan, & Syam, S. (2024). Sociocultural and Economic Factors Influencing JKN Participation: A Cross-Sectional Study in Bajoe, Indonesia. Medicor : Journal of Health Informatics and Health Policy, 2(4), 245–258. https://doi.org/10.61978/medicor.v2i4.709