Factors Affecting Payment Compliance of the Indonesia National Health Insurance Participants

Deni Kurniadi Sunjaya; Dewi Marhaeni Diah Herawati; Estro Dariatno Sihaloho; Donny Hardiawan; Riki Relaksana; Adiatma Yudistira Manogar Siregar

doi:10.2147/RMHP.S347823

Factors Affecting Payment Compliance of the Indonesia National Health Insurance Participants

Risk Manag Healthc Policy. 2022 Feb 22:15:277-288. doi: 10.2147/RMHP.S347823. eCollection 2022.

Authors

Deni Kurniadi Sunjaya¹, Dewi Marhaeni Diah Herawati¹, Estro Dariatno Sihaloho², Donny Hardiawan², Riki Relaksana², Adiatma Yudistira Manogar Siregar²

Affiliations

¹ Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.
² Center for Economics and Development Studies, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, Indonesia.

Abstract

Background: The study aims to explore factors that affect the compliance of Indonesia National Health Insurance (INHI) in paying the premiums.

Methods: The study design was qualitative with grounded theory research approach and constructivism paradigm. The study was conducted in 2018 and carried out for 3 months. We recruited 22 respondents from four different cities/districts. Triangulation was carried out through 26 informants from various stakeholders. Data were analyzed through coding, categorizing and pattern matching to obtain substantive theory.

Results: The resulting substantive theory consists of 6 constructs and 14 categories. Compliance with paying insurance premium depends on the intention to pay for contribution. Meanwhile, the intention to pay is related to internal and external factors of INHI participants. To improve payment contribution of independent participants, INHI program has to pay attention for factors originating internally from the participants themselves (understanding of INHI program, financial ability and self-attitude) and also externally such as operational system and the quality of health care.

Conclusion: Compliance of paying insurance premium is related to internal and external factors of participants. Thus, interventions to improve compliance to pay premium should take these factors into account, and not merely on increasing the knowledge of participants.

Keywords: compliance; independent membership; premium contribution; social health insurance.

Grants and funding

This study was funded by Badan Penyelenggara Jaminan Sosial Kesehatan (BPJSK) under the contract no. 230/KTR/0618. BPJSK only had limited role in the conduct of the study and did not interfere with the objectivity of the study.