Analysis of Factors Inhibiting the Community to be the National
Health Insurance Participants (Jaminan Kesehatan Nasional
Indonesia)
Aulia Devi Isnaini
Faculty of Public Health, Universitas Airlangga, Mulyorejo, Surabaya, Indonesia
Keywords: Jaminan kesehatan nasional, Health insurance, Membership, Community, Inhibiting factors.
Abstract: Health is a basic need of society. Both low and upper-middle class people are required to meet their health
needs. However, many people still are not able to access the health services available. Therefore, the
Indonesian Government has launched a compulsive health insurance programme named JKN (Jaminan
Kesehatan Nasional). This programme aims to improve the access of the whole community to the available
health services, but there are many people who still have not yet registered as participants. The purpose of
this study is to see what factors are preventing people from becoming JKN participants through previous
study literatures from textbooks, program evaluations, and previous research studies. The results show that
there are several inhibiting factors for the community members to register themselves as JKN participants,
including internal factors such as education level, occupation, amount of income, residence, and external
factors such as the administrative process, easiness of access to the health services, workforce situation, the
influence of others, and so on.
1 INTRODUCTION
The National Health Insurance Program (Jaminan
Kesehatan Nasional or JKN), which may be referred
to as Social Health Insurance in Indonesia, is a
program under the Social Security Administering
Agency (Badan Penyelenggara Jaminan Sosial or
BPJS) as a manifestation of the enactment of Law
No. 40 of 2004 on the National Health Insurance
System. The first program run through Healthy
Indonesia Card aims to meet the needs of the
community as one of the indicators of improving the
quality of life, namely the increasing degree of
public health. BPJS is a legal entity formed to
organise the social security program, which is a
transformation of PT Askes as it was before January
1st, 2014.
Social insurance is a compulsory program which
collects the participants’ contributions in order to
provide protection to the participants from the
socioeconomic risks that affect them and/or their
family members (UU SJSN No.40 of 2004).
The National Social Security System is the
procedure of the implementation of the Social
Security program by Badan Penyelenggara Jaminan
Sosial (BPJS) of Health and BPJS of Labour. Social
Security is a form of social protection to ensure that
all people are able to fulfil their basic needs.
JKN membership itself is mandatory, with the
intended participants having to register in the JKN
program including foreigners who have worked at
least 6 (six) months in Indonesia, who have paid
their dues.
According to JKN's manual starting on January
1st, 2014, JKN participants are health insurance
program participants who are transferred to the JKN
program. They are Jamkesmas (PBI JKN) program
participants, members of the TNI/PNS within the
Ministry of Defence and their families, members of
Polri/PNS within Polri and members of his family
(PPU), PT Askes participants, and JPK Jamsostek
participants which in total is estimated to be 110.4
million people (43.78% of the population).
Up to August 2017, the JKN program
participants throughout Indonesia has reached
180,735,289 inhabitants out of the 237.6 million
total population of Indonesia. This figure is
considered to be a large number considering it
Isnaini, A.
Analysis of Factors Inhibiting the Community to be the National Health Insurance Participants (Jaminan Kesehatan Nasional Indonesia).
In Proceedings of the 4th Annual Meeting of the Indonesian Health Economics Association (INAHEA 2017), pages 139-143
ISBN: 978-989-758-335-3
Copyright © 2018 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
139

already consists of more than half of the people of
Indonesia. It also indicates the enthusiasm of the
community itself by having evidence of them
participating in the success of the government
program.
The participation rate of the community in the
membership of JKN apparently still cannot be said
to be the maximum, considering that JKN has a
compulsory membership and should be able to cover
the entirety of society. By the end of 2016, the target
of the membership set by BPJS could not be
fulfilled. Out of the 188 million targeted citizens
registered with the Health Insurance program
National-Healthy Indonesia Card (JKN-KIS), only
171.67 million participated in JKN-KIS; 91% of the
target. This can be a problem because the
Government has already set up the goals that 95% of
the Indonesian citizenship has been targeted to
participate in JKN-KIS by January 1st, 2019. BPJS
Kesehatan only has two years until that date to add
around 80 million residents as new participants so
that the membership targets can be achieved.
The achievement of the JKN membership targets
has a high level of importance in order to see in the
success of the JKN program. This is because the
participants are one of the determinants of the
direction in which the program will run.
Be advised that papers in a technically unsuitable
form will be returned for retyping. After returned the
manuscript must be appropriately modified.
2 METHODS
The type of data used was secondary data, in which
the data to be analysed in this study is data derived
from the literature that discusses the researched topic
such as the data from government agencies,
scientific articles, textbooks, journals, and previous
research studies. The author composed this paper by
using 9 various sources. These sources include some
articles that could be found on scientific sites by
inputting the exacts keywords, government
regulations, previous study that published on public
health journals, etc.
The data analysis technique used in this research
study was started by analysing the most relevant
research results until reaching the least relevant. It
can also be done by looking at the research time;
based on sequence of the year of research, starting
from the most recent research study and then
progressing until the oldest research study. The
analytical process is also continued by reading the
summary of the literatures used and making notes of
the important sections that are relevant to the issues
raised in the study. Any sources of information used
in the literature studies should also be included to
avoid any form of plagiarism if the information
comes from the ideas of others.
3 RESULTS
Jaminan Kesehatan Nasional (JKN) participation in
Indonesia cannot be separated from the
government's goal to realize Universal health
Coverage (UHC) that can provide comprehensive
health services to all Indonesian people. DJSN has
arranged a roadmap toward JKN and agreed that
Universal Health Coverage will be achieved
completely in the end of 2019, where every single
citizens will have a health insurance and get the
same medical benefits (DJSN, 2012).
Those ambitious plans have some targets to
realize its objectives, that is:
1. All Health Insurance participants from Civil
Employee, Jamkesmas, Jamsostek,
Army/Police and partly Jamkesda totalling
around 121.6 million people will be managed
by BPJS Kesehatan as of January 1, 2014.
2. All of Jamkesda participants have joined as
BPJS participants at the latest by the end of
2016.
3. Employers have been gradually registering
their workers and their families to BPJS
Kesehatan during the period 2014-2019.
4. Self-employed workers who earn income from
their own businesses have registered
membership to BPJS Kesehatan during the
period 2014- 2019.
5. In 2019 no more workers are not registered in
BPJS Kesehatan.
6. By the end of 2019 universal health coverage
achieved. (TNP2K, 2015)
In achieving these targets to realize UHC, then
BPJS Kesehatan requires a maximum effort in
performing performance BPJS Kesehatan
performance progress in realizing UHC that should
be achieved by the end of 2019 can be seen in table
1 which shows the amount of participants JKN until
August 2017.
The number of Indonesian citizens registered as
JKN participants up to August 2017 has reached
180,735,289 people out of Indonesia's total
population of 237.6 million people. Details of the
type of membership that JKN has in 3 years of the
program can be seen in the table below:
INAHEA 2017 - 4th Annual Meeting of the Indonesian Health Economics Association
140

Table 1: Number of JKN participants according to the
membership type
Membershi
p
T
yp
es Number of Partici
p
ants
PBI APBN 92.216.825
PBI APBD 17.371.580
PPU-PNS 13.683.735
PPU-TNI 1.571.034
PPU-POLRI 1.238.914
PPU-BUMN 1.360.945
PPU-BMUD 171.651
PPU-Private 24.868.339
PPU-Self Em
p
lo
y
e
d
23.215.895
Non-Worke
r
5.036.371
Total 180.735.289
Source: Number of Health Facilities and Participants
(BPJS Kesehatan, 2017)
Based on the data showed above, it can be seen
that some of the JKN participants are beneficiaries
of contributions from APBN, and that the number of
PPU and non-PNS membership is also quite low.
According to the data from BPJS, efforts to increase
JKN membership itself, to achieve the goal oh
Universal Health Coverage, have been implemented
since the era of Askes, or before the transformation
of Askes in to BPJS Kesehatan. In order to achieve
the 100% target by 2019, participants who can be
upgraded are only wage-paying and self-employed
groups. The participation of both groups continues
to increase, including in Bali Province and Denpasar
City, but to accelerate the achievement of universal
coverage target is required maximum effort
(Widiastuti et. al, 2015).
According to Bappenas’ data, there are several
factors causing the low coverage of non-PNS PPU
membership, some of which are:
1. Business Entities’ lack of trust in the quality of
JKN services.
2. Business Entities in general already have other
health insurance that are considered to be better
than JKN.
3. The absence of sanctions and law enforcement
for Business Entities who do not register as
participants of BPJS Kesehatan.
4. The lack of marketing staff at the BPJS
Kesehatan office. In every branch of BPJS
Kesehatan, on average there are only 1-3
marketing staff, while the target to be achieved
is very large.
5. Some Business Entities have their own
sufficient healthcare.
6. The low commitment of Business Entities that
belong to several foreign countries to join JKN.
Meanwhile, regardless of the type of
membership of JKN, according to the monitoring
and evaluation results of the Dewan Jaminan Sosial
Nasional (DJSN), factors that underlie the low
number of JKN membership consists of:
1. Many residents have not registered with JKN-
KIS because they do not have social number
(Nomor Induk Kependudukan or NIK) which is
the main requirement of JKN-KIS registration.
2. Many people cannot afford JKN-KIS
contributions.
3. The residents are rarely sick, and so they feel no
need to register.
4. Not registered by the workplace of the citizens
concerned.
5. BPJS Health services are poorly rated.
6. Residents already have private insurance.
(Kepmenkes RI, 2013)
4 DISCUSSION
Health is a basic need of society which is also one of
the welfare indicators of the community. Every layer
of society, from the rich to the poor, from high to the
lower class, deserves proper health care. Based on
the principle of sustainable health development, the
government reformed the national health system by
requiring all citizens to become national health
insurance participants in order to meet the needs of
the community as one of the indicators improving
the quality of life, namely the improvement of the
country’s overall health status.
Jaminan Kesehatan Nasional, in order to
actualize Universal Health Coverage (UHC), should
be held with well preparation. Although the
Government has tried to provide the well-organized
system, its undeniable that until now the system still
burdened with many problem in Indonesia (Widjaja,
2014). It has been proved from the experience in
other countries who want to achieve the UHC, that
the process to accomplish the goal has several
obstacles, especially when it has to reach certain
segments of the population (TNP2K, 2015).
The implementation of JKN, which has been
running for 3 years up to and including 2017, has a
lot of comprehensive problems, including the
participants, health facilities, government, through to
BPJS itself. As described in the previous section, the
community participation in JKN membership seems
to still not be maximised even considering the nature
of the compulsory membership and that it should be
able to cover the entireity of society. The data has
proven that the trend of the number of JKN
Analysis of Factors Inhibiting the Community to be the National Health Insurance Participants (Jaminan Kesehatan Nasional Indonesia)
141

participants continues to decline over time.
Especially in the community included in the non-
civil wage recipient worker group (PPU non-PNS),
the membership rate is still quite low. That is due to
the lack of trust of the business entity towards the
services provided by BPJS. In this case, the business
entities usually have other insurance that is
considered to provide a maximum service which
they feel is better than BPJS.
In addition, the lack of socialisation of the BPJS
employees also becomes one of the factors that
affects why many people have not registered
themselves as JKN participants. It will also relate to
people's ignorance of what the benefits of JKN are,
and what the sanctions are if they do not register, so
therefore they will feel no need to register as
participants. Residents who tend to be healthy or
rarely ill will feel that they have no interest in the
membership and that they would not benefit if they
had it. Communities can also be influenced by the
surrounding environment that may have a counter to
the JKN system. This kind of mind-set should be
able to be straightened by BPJS officers by
conducting deep socialisation within the community.
Another factor is that many residents have not
registered with JKN because they do not have a
social number (NIK), which is the main requirement
of JKN registration. Every citizen has a NIK listed
on the family card, so this should not be a problem.
In fact, many residents do not have a resident
registration number due to various factors, one of
which is that the population does not have a family
card because it has not been updated, has been lost,
and so on, or because it has been hampered by
administrative processes in connection to difficult
government agencies. The solution of this problem
is the need for easier access for the public to obtain
public administration services.
Finally, the factor inhibiting the community to
become a member of JKN is the number of people
unable to pay the JKN premium. The payment of
premiums that each month must be done by the
community based on their respective class is still a
barrier. Some people still object to paying the
premium every month according to the tariff that is
pre-determined. To overcome this, the government
has implemented a policy of beneficiaries of
contributions for people who cannot afford the JKN
premiums. Seeing the existence of underprivileged
people who have not been covered in the
membership of beneficiaries of contributions, it can
be a correction for the government to further
improve their performance in relation to equity,
especially for the middle to lower classes in society.
5 CONCLUSIONS
1. The implementation of JKN still has a lot of
comprehensive problems, including the
participants, health facilities, government, and
BPJS itself. In the terms of participation, the
data has proven that the trend in the number of
JKN participation continues to decline over
time.
2. There are many factors that affect the lack of
participation, such as that business entities
cannot believe in the services provided by
BPJS, they have another insurance that is better
than BPJS, the lack of socialisation from the
BPJS side, and so on.
3. Another factor is that many residents have not
registered with JKN because they do not have a
social number (NIK) which is the main
requirement of JKN registration. One of cause is
that the population segment does not have a
family card because it has not been updated, has
been lost, and so on, or because it has been
hampered by administrative processes in
connection with difficult government agencies.
4. The factors that also inhibiting the community
to become a member of JKN are that some
people still object to paying the premium every
month according to the tariff of the premium
pre-determined by their class.
5. In order to resolve the problems above, the
government has given some solutions, such as
implementing a policy of beneficiaries of
contributions for people who cannot afford JKN
premiums.
6. The achievement of the JKN membership
targets has a high level of importance in order to
see in the success of the JKN program.
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