Relationship between Types of Work with the Use of Health
Insurance Cards in Village Area
Anif Prasetyorini
Institute of Health Science, Dr. Soetomo Regional General Hospital, Mayjend Prof. Dr. Moestopo Street, Surabaya,
Indonesia
Keywords: Antecedent, Job, Utilization, Insurance card, Village.
Abstract: World Health Organization encourages all countries to develop a health insurance for Universal Health
Coverage. The fact showed that most people in Wotan Hamlet, Lamongan worked as farmers. They mostly
worked until the evening; unfortunately the health facility was closed already by then. Therefore, if one
caught an illness, they chose midwives and made payment out-of-pocket. The utilization of insurance card
was triggered by an antecedent factor (occupation). This study aimed to examine the relation between
occupation and the utilization of insurance card in Wotan Hamlet. This was an analytical research. The
cross-sectional design was used in this study. The sample in this study was taken by using simple random
sampling for as many as 71 heads of family. Data were collected using a questionnaire which was then
analyzed by contingency coefficient. The result of this study showed that the majority occupation of THE
insurance card users was farmer (66.7%). The number of people who made use of the card was 12.7% of the
population. There was a relation between occupation and insurance card utilization with significance level
of 0.022. The utilization of insurance card was influenced by occupation. Additional time of health service
through Mobile Community Health Centre was good ways.
1 INTRODUCTION
World Health Organization encourages all countries
to develop a health insurance for every citizen of
theirs (Universal Health Coverage). Under the health
insurance, all citizen within the countries which
develop this health insurance are included as the
members of the health insurance (Syaputra, 2015). A
universal coverage is a health system where each
citizen has a fair access to promotive, preventive,
curative, and rehabilitative health services, which
are of high quality and needed, within affordable
range of price (Ministry of Health Republic of
Indonesia, 2013).
The Law of the Republic of Indonesia Number
24 Year 2011 on the Social Security Administering
Body states that every company is required to
register its employees as a member of BPJS while
the person or family not working at the company
must register themselves and their family members
on BPJS and pay the contribution in accordance with
the desired level of benefit.
Wotan Hamlet of Slaharwotan Village is one of
the hamlets where the residents have not made use
of insurance card. This village is a valley area which
only has 1 midwife, 1 nurse. The Ngimbang
Community Health Centre is five kilometres away.
Besides, the transportation available in this village is
only motorcycle taxi which is decreasing in number
recently. Most of the people in this village work as
farmers. Farming activities are always done in the
morning, while Health Centre’s outpatient services
cannot be done in the afternoon. This causes many
citizens have to pay straight away or out of pocket to
the nearest health services when they are sick. This
condition has been declared by one of the staff in
Wotan Hamlet Slaharwotan Village Ngimbang Sub-
District.
The use of insurance card by the people of
Wotan Hamlet Slaharwotan Village can be identified
using Antecedent behaviour Consequence behaviour
model. Antecedent behaviour Consequence model
states that behaviours are triggered by antecedent
(something that precedes behaviour and causally
234
Prasetyorini, A.
Relationship between Types of Work with the Use of Health Insurance Cards in Village Area.
In Proceedings of the 4th Annual Meeting of the Indonesian Health Economics Association (INAHEA 2017), pages 234-237
ISBN: 978-989-758-335-3
Copyright © 2018 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved

related to it) and followed by consequences (the
behaviour result for the individual) which will add
or reduce the chance of repetition. The type of
occupation is one of the variables included in
antecedent factor categories besides age, sex,
education degree and salary (Wati, 2015).
This is the background to set off a research on
the relation between the type of occupation and the
behaviour of insurance card utilization in Wotan
Hamlet Slaharwotan Village Ngimbang Sub-District
Lamongan Regency.
2 METHODS
The type and design of this research is observational
research. The characteristic of this research is
analytical research. The design of this research is
cross-sectional. In a cross-sectional research, risk or
causal variable and consequence or case that
happens to the object of research are measured or
collected simultaneously (at the same time).
This research was held from June to August
2016 in Wotan Hamlet Slaharwotan Village
Ngimbang Sub-District Lamongan Regency.
Slaharwotan is a rural part of Lamongan City, East
Java, Indonesia. The population was all the 270
heads of the family in Wotan Hamlet Slaharwotan
Village Ngimbang Sub-District Lamongan Regency
and the sample was 71 of them.
Sampling technique used was simple random
sampling. According to Notoatmodjo (2012),
sampling technique using simple random sampling
is divided into two, by drawing the members of
population or lottery technique and by using number
table or random numbers. However, the sampling
technique used in this research was by drawing
heads of the family’s names in Wotan Hamlet
Slaharwotan Village. This research used a
questionnaire as the instrument. Data were analyzed
using coefficient contingency. The signification
result of each variable is considered relational if α ≤
0.05.
3 RESULT
The occupation of the respondents is their daily job.
The measuring result of occupation types was
categorized into seven categories; they are
army/police officer, civil servant, state-own
company employee, private company employee,
entrepreneur, farmer and others. The identification
result of the respondent’s occupation type in Wotan
Hamlet Slaharwotan Village Ngimbang Sub-District
Lamongan Regency is shown at table 1
Table 1: The Distribution of Respondent’s Occupation
Type in Wotan Hamlet Slaharwotan Village Ngimbang
Sub-District Lamongan Regency in 2016
Occupation Type
n (%)
Private Company
Employee
7 (9,9)
Entrepreneur
6 (8,5)
Farmer
57 (80,3)
Others
1 (1,4)
Total
71 (100)
Table 1 shows that the identification result of
insurance card utilization behaviour in Wotan
Hamlet Slaharwotan Village Ngimbang Sub-District
Lamongan Regency is shown at table 2.
Table 2: Identification Result of Insurance Card
Utilization Behaviour in Wotan Hamlet Slaharwotan
Village Ngimbang Sub-District Lamongan Regency in
2016
Behaviour
n (%)
Use Insurance Card
9 (12,7)
Not Use Insurance Card
62 (87,3)
Total
71 (100)
Table 2 shows that 87.3% of the respondents did
not make use of insurance card. The distribution of
insurance card utilization based on respondents’
occupation type in Wotan Hamlet Slaharwotan
Village Ngimbang Sub-District Lamongan Regency
is shown at table 3.
Tabel 3: The Distribution of Insurance Card Utilization
According to Respondents’ Occupation Type in Wotan
Hamlet Slaharwotan Village Ngimbang Sub-District
Lamongan Regency in 2016
Occupation
Type
Insurance Card Utilization
Sig.
Use
Insurance
Card
Not Use
Insurance
Card
n (%)
n (%)
Employee
2 (22,2)
5 (8,1)
0,022*
Entrepreneur
0 (0)
6 (9,7)
Farmer
6 (66,7)
51 (82,3)
Others
1 (11,1)
0 (0)
Total
9 (100)
62 (100)
*p<0,05
Table 3 shows that 82.3% citizens who did not
make use of insurance card were farmers, this also
applied to those who made use of their insurance
Relationship between Types of Work with the Use of Health Insurance Cards in Village Area
235

card. Analysis data technique used in this research is
inferential statistic analysis, using coefficient
contingency. Relational analysis result between
occupation type and insurance card utilization shows
significancy number of 0.022. This proves that there
is a relation between occupation type and insurance
card utilization.
4 DISCUSSION
Citizens who have used insurance card 66.7 % work
as farmers while 82.3% of those who have not used
the facility are also farmers. Signification result of
0.022 shows a relation between occupation type and
insurance card utilization. The lack of insurance card
use by farmers is influenced by their job.
Occupations have an impact to one’s knowledge.
Work environment allows someone to get
experience and knowledge whether directly or
indirectly. For instance, someone who works in
health industry certainly will understand how to take
care of health in their environment better
(Notoatmodjo, 2010).
Based on the research of Londo (2017), it can be
concluded that there isi relationship between age and
occupation with utilization of Community Health
Center Service.
According to Health Minister Policy Republic of
Indonesia Number 28 Year 2014, Donation Fee
Recipient of the Health Care is the poor people. This
matches with the research result which shows that
most of the respondents are farmers who have
insurance card type of Donation Fee Recipient. This
also explains that farmers in Slaharwotan Village do
not always own their own field; most of them are
farm workers. Besides, the citizens with insurance
card feel more comfortable visiting the midwife to
get health services, than visiting the Community
Health Centre. The distance between the village and
the Community Health Centre is approximately 5
kilometres away and the lack of public
transportation contributes to the low factor of
insurance card utilization.
Nadjib & Pujiayanto (2002) show that health
service utilization is influenced by many factors,
mostly are geography (distance), social-economy
(ability to pay), high rate of the services, gender
inequality, culture (belief, sick perception), and
service quality (medicine availability, open hours,
and others)
Behaviour is triggered by antecedent (something
that precedes behaviour and causally related to it)
and followed by consequences (behaviour result to
the individual) which add or reduce the chance of
repetition (Wati, 2015). In this case, insurance card
utilization can be caused by one’s occupation.
One of the ways to increase the access,
especially for farmers who need health services, is
by using Mobile Community Health Centre.
However, Mobile Community Health Centre
(Puskesmas Keliling) must be able to receive
payment by using insurance card. As Permenkes No
75 Year 2014 on Community Health Centre Article
40 Sub-section 5 which mentions that Mobile
Community Health Centre provides mobile health
services, to increase the range and the service quality
for the areas which have not been covered by the
main Community Health Centre (Ministry of Health
Republic of Indonesia, 2014).
5 CONCLUSION
The lack of insurance card use by farmers is
influenced by their job. Most of the citizens who did
not make use of insurance card were farmers who
had to visit the midwives and paid in cash in order to
get the health services they needed. Therefore, the
existence of Mobile Community Health Centre that
accepts insurance card will be helpful. It is
suggested that insurance collaborates with local
midwives to find insurance card owners who have
not made use of the card and puts forward a
dissemination regarding the benefits of paying by
insurance card for the card owners, especially
farmers which are categorized as mid-low class
financially.
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