Assessing the Determinants of Compliance with Contribution Payments to the National Health Insurance Scheme among Informal Workers in Indonesia

Int J Environ Res Public Health. 2023 Nov 30;20(23):7130. doi: 10.3390/ijerph20237130.

Abstract

This study aimed to investigate the determinants of compliance with contribution payments to the National Health Insurance (NHI) scheme among informal workers in Bogor Regency, West Java Province, Indonesia. Surveys of 418 informal workers in Bogor Regency from April to May 2023 were conducted. Multivariate logistic regression analyses were performed to assess the factors associated with informal workers' compliance with NHI contribution payments. The results revealed that being female, having lower secondary education or below, perceiving good health of family members, having negative attitudes toward and poor knowledge of the NHI, experiencing financial difficulties, preferring to visit health facilities other than public ones, and utilizing fewer outpatient services were significantly associated with the noncompliance of informal workers with NHI contribution payments. It was concluded that economic factors alone cannot contribute to informal workers' payment compliance and that motivational factors (knowledge, attitudes toward the insurance system, and self-related health status) also encourage them to comply with contribution payments. Improving people's knowledge, especially on the risk-sharing concept of the NHI, should be done through extensive health insurance education using methods that are appropriate for the population's characteristics.

Keywords: National Health Insurance; informal workers; payment compliance; social health protection; universal health coverage.

MeSH terms

  • Family
  • Female
  • Health Facilities*
  • Humans
  • Indonesia
  • Insurance, Health*
  • Male
  • National Health Programs

Grants and funding

This study was supported by the International Labor Organization (Basic Research Fund: fiscal year 2022).