The Effectiveness of National Health Insurance
Membership Services at Social Security Agency Office
in South-East Sulawesi Province
Suhadi Suhadi
1
, Alimin Maidin
2
, Sukri Palutturi
2
, Esti Astuti
4
1
Faculty of Public Health, Universitas Haluoleo, Anduonou, Kendari, Indonesia
2
Faculty of Public Health, Universitas Hasannuddin, Tamanlarea, Makassar, Indonesia
3
Bahteramas Hospital, Baruga, Kendari, Indonesia
Keywords: Effectiveness, Membership services, National health insurance.
Abstract: Health Financing in Indonesia is still a major health problem especially for the poor. Through the National
Health Insurance program, it is expected that all of the Indonesian people can access health services without
constrained by the cost. Analyze the effectiveness of Health Insurance membership services at Social
Security Agency office in Southeast Sulawesi Province. This study used survey approach with a qualitative
design. This study conducted at Social Security Agency office in Southeast Sulawesi Province. Respondents
were selected purposively, consist of Social Security Agency Officials and member. Data was collected by
triangulation method and data analysis used content analysis matrix. Even though the perspective about
National Health Insurance services was viewed from the patient said that it has been effective generally, but
there still ineffectiveness factors. Mostly, because of the complicated service mechanism, the difficulty of
service requirements, the length of waiting time for services, and less of facilities due to a limited staff of
Social Security Agency office in South Sulawesi Province. This, it can be concluded that there is still lack
of administrative mechanism and human resources aspect of membership service in Social Security Agency
office, South Sulawesi Province. Therefore, the Social Security Agency expected to develop policy and
services management to improve the effectiveness of National Health Insurance membership services.
1 INTRODUCTION
"Health is a Fundamental Human Right" is the
concept of the World Health Organization (WHO) to
ensure for each people can live healthy to more
productive. The rights of each people obviously
reflect two absolute obligations for each individual
or institution who seek and provide health services
for being healthy and maintain healthily. Therefore,
every country has the obligation to ensure these
rights are fulfilled and also accepted by the entire
population (Maidin,2013).
Health insurance is a guarantee in the form of
health protection for participants to get the benefit of
health care and protection to meet the basic health
needs are given to every person who has paid
contributions or dues paid by the government. This
guarantee is called the National Health Insurance for
all residents of Indonesia shall be insured people
managed by BPJS including foreigners who have
worked for a minimum of six months in Indonesia
and have paid contributions (MoHRI,2013).
The National Health Insurance is a financing
scheme pre-effort, which means that health
financing was issued before or in a state hospital.
The pattern of financing pre-effort embracing the
law of large numbers and risk collective. So that
risks can be disseminated widely and effectively
reduced, then this financing pattern requires a large
number of participants. Therefore, in practice, the
National Health Insurance requires all residents of
Indonesia participated in such large numbers that the
law can be met. Risk embrace occurs when a number
of individuals at risk have agreed to raise the risk of
loss with the aim of reducing the burden (including
the cost-loss/claims) are to be borne by each
individual (Azwar,1996; Murti,2000).
Suhadi, ., Maidin, A., Palutturi, S. and Astuti, E.
The Effectiveness of National Health Insurance Membership Services at Social Security Agency Office in South-East Sulawesi Province.
In Proceedings of the 4th Annual Meeting of the Indonesian Health Economics Association (INAHEA 2017), pages 303-309
ISBN: 978-989-758-335-3
Copyright © 2018 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
303

The National Health Insurance (JKN)
participants are divided into 2 groups: (1) The
beneficiary contribution (PBI), which includes the
poor communities; and (2) Not beneficiary
contributions (Non-PBI), which include formal and
informal workers and their families. Health
insurance contributions are the amount of money
paid regularly by the participant, employer and/or
the government's health insurance program. On the
basis of contributions paid each participant is
entitled to receive the benefits of health insurance
that is both personal health services, including
promotion, preventive, curative, and rehabilitative
services including drug services and medical
materials consumables in accordance with the
medical needs required (MoHRI,2013).
Effectiveness is range effort a program as a
system with limited resources and means to
accomplish its goals and objectives without crippling
it means and resources and without giving any
unnatural pressure on its implementation
(Steers,2005). According to book Behaviour,
Structure, Processes mentions that measurement of
the organization effectiveness including; 1).
Production is an organization's ability to produce the
quantity and quality of output according to
environmental demands. 2). Efficiency is the ratio
between the output to the input.3). Satisfaction is a
measurement to show the extent to which the
organization can meet the needs of the community.
4). Excellence is the level where the organization
can and really responsive to internal and external
changes. 5). Development is a measure the ability of
the organization to improve its capacity to cope with
the demands of society. Factors that influence the
effectiveness is 1). Characteristics of the
organization. 2). Characteristics environment. 3).
Feature workers. 4). Policies and management
practices (Gibson,2006).
Membership problem of National Health
Insurance PBI still are in some areas one in South-
East Sulawesi registered as participants PBI as many
as 253 157 Life (74%), while the number of poor
according to BPS data in 2014 as many as 342 263
of peoples, in this case, shows that as many as 89
106 people (26 %) have not joined the PBI (BPS
Sultra,2014). This is in line with research findings in
the early study file, that there are still many poor and
underprivileged patients who came for treatment to
the General Hospital BLUDs Bahteramas South-east
Sulawesi, the outpatient services have not been
registered for the PBI for some reason in the service
of membership JKN complexity, lack of knowledge
of the patient, and is recommended by the hospital to
become a participant JKN.
In connection with the participation of patients
JKN PBI, acquired a reality are still many problems
as the testimony of General Hospital BLUDs officer
Bahteramas South-east Sulawesi Province who say
the problem of membership PBI because the patient
does not understand, and there are still many patients
who do not have a card of JKN from poor families
because they have not been recorded by social
Security Agency (BPJS) of Health.
Problems of health insurance membership can be
seen from several studies including research Triyono
and Soewartoyo says that the majority of informal
workers untouched from social security programs
employment (Triyono, 2013; Soewartoyo,2013). In
addition to health care referral issues, other issues
that need to be prepared to welcome the National
Health Insurance is membership (Yuningsih,2013).
Therefore, the purpose of this study was to analyze
the effectiveness of the services the Health Insurance
Participation In Social Security Agency Office
(BPJS) of Health Southeast Sulawesi province.
2 METHODS
The study using survey approach, with using
qualitative designed, a cross-sectional study is one
form of observational studies (non-experimental).
Informants in this study were participants JKN,
BPJS Officers and employees of the Bank in
Kendari (South-East Sulawesi). Selection of
informants using a purposive technique. Data
collection using literature, observations, review
documents and also interview. Data analysis using
matrix content analysis.
3 RESULTS
Results of in-depth interviews will then be
elaborated into the formulation of the problem points
that have been determined as follow:
3.1 How Terms of Service in Registration
Process of National Health
Insurance Membership by Society
There are still some problems based on the findings
of in-depth interviews showed that the process of
self-service membership card given to participants.
There is still a denial of service because the
candidates of the participants are not able to meet
the terms of service in the process registration
according to the terms that have been required by the
BPJS provisions.
In terms of ease of servicing the membership
independently, participants complained about the
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complexity of the registration file. For example the
candidate have to written statement from both
parents (difficult for candidates who have parents
who are far away in a different area), are required to
have an ATM/bank, are required to have a certificate
of domicile (difficult for candidates who are outside
the area of origin identity card or KTP), separation
of service BPJS and banks (office service is not the
roof) made it difficult for service payment of dues
beginning BPJS as proof of registration of
membership. Separation of BPJS services and Bank
services will the presence of service for participants.
Bank in BPJS office depends on the availability of
human resources BPJS Bank itself, the length of
time, the time that card is active about two weeks so
that the card would not be used immediately in the
health service, as well as statements from the
following informant;
,,, in that time I came mismanagement, not
accepted because there is what it is, the less ,,,
Family Identity card(RTA, 28 Years)
,,, the requirement is not ease to pack, should
have Family Identity card, ID cards, photos,
turning then to the bank again and again to
BPJS, bother to pack ,,,(THI, 35 Years)
,,, the requirements are complicated, because
many of the conditions, then the distance BPJS to
the bank, after paying must return to BPJS, then
wait for the lifetime of the card about 2 weeks ,,
,(AHL, 23 Years)
3.2 How Terms of Dues Service for NHI’s
Member by Social Security Agency
Another problem of the findings of in-depth
interviews showed that participants were not
burdened with a number of dues BPJS because every
person is free to choose the class of service in
accordance with the rates they can cover. On the
other hand, participants who classified able to state
is not an issue size of contributions throughout the
service obtainment health meet or exceed the
expectations of the participants. But for participants
who are less able to feel burdened with dues main
BPJS families who have many dependents. In the
case where payment of dues BPJS participants felt
easy because BPJS dues payment systems are now
using an auto-debit system that costs taken directly
through the account so that participants do not need
to bank/post and with auto-debit services can
prevent participants forget the payment of dues.
What is more, there are still obstacles in the payment
of membership dues because participants can only
make payment of dues BPJS when experiencing
pain. Therefore, BPJS inform participant data
delinquent BPJS in the primary healthcare with the
purpose of facilitating controlling /denial of patient
care before entering the health care basic level
advanced, as well as statements from the following
informant;
,,, my husband's just a driver, it is hard for us
because we are five people on my family (SMI,
48 Years)
,,, not a problem for me about the charges,
the most important is the hospital services good
,,,(THI, 35 Years)
,,, about the contribution are later adjusted,,,,
actually it was not burdensome but affordable
because accordance with the service and can
choose the tariff class suit for everyone ,,,(SRI,
43 Years)
Similarly, other findings from in-depth
interviews found that in card services BPJS
participants felt obstacles in the form of domicile of
those who came from outside the region. The
statement of the parents, within the banks-BPJS
route, are quite far, the lifetime of the old card,
mandatory unbanked /ATM so that these complaints
would be a material improvement for the BPJS
service quality improvement. In terms of efforts
officer helps service participation, participants stated
that no effort was good and clear of personnel in
dealing with complaints of participants, although the
complaint submitted directly. In terms of ease of
service complaints, response channel officers carried
out either directly or through email, post, hotline is
always on standby, as well as statements from the
following informant;
,,,the obstacles are, turns the first payment in
the bank, the bank no longer take care of us in
order affidavit that I take care of BPJS stamp
duty, must use a statement that the father and
mother of this entry, must open an account using
an ATM card, and I had to return the from BPJS
office in to the Bank again, must ask for a letter
of domicile ,,,(NBH, 24 Years)
,,, old card active period, a period of one
month can only be active ,,,(RYD35 Years)
,,, the barriers of distance to the bank, then
the conditions convoluted so procedures required
to the bank,,,,(DMN, 29 Years)
The Effectiveness of National Health Insurance Membership Services at Social Security Agency Office in South-East Sulawesi Province
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3.3 How Terms of Service by Social
Security Agency Officers for NHI’s
Member
In-depth interview findings obtained also that in
terms of the attitude of the officers, the facilities, the
number of officers, waiting time and information
services officer attitude participants felt good, the
wait time service good, easy information services,
but some things that become problems such as
cramped waiting room service, seating is limited, the
number of officers is less, means and facilities are
still lacking, and this time BPJS office continues
developing balustrades service resources, as well as
statements from the following informant;
,,,the attitude is very response, timeouts nice,
the facilities are still lacking in the waiting room
,,,(DPI, 30 Years)
,,, the number of officers seems pretty lacking
,,,(LNA, 30Years)
,,, fast service, Just waiting room small
,,,(TJO, 28Years).
4 DISCUSSIONS
BPJS as a public service, in service BPJS
membership, requires the convenience of the service
management and the accomplish of the public
interest as well without the injured party in the
service including avoiding their rejection of
membership services. By doing the refusal of service
member it will hinder the achievement of good
public services.
the coveted public service is the ease of taking
care of the interest of getting a reasonable service,
the same behaviour without partial and treatment
honest and forthright (Moenir,2001). In addition, he
also added that the smooth running of the service
rights depends on the willingness of workers to the
obligations imposed, systems, procedures, and
methods are inadequate, the organization of the
ministry was completed, the revenue officer or
employee sufficient for their needs, abilities or skills
employees, and adequate working facilities.
Still the problems of service membership
independent in terms of denial of service the
membership for their inability to applicants meet the
requirement file services of membership in a short
time, this shows that the service system of
membership BPJS in particular the requirements of
membership still needs to be evaluated by the entire
stakeholder to take appropriate measures and the
need to build a service model that is easy, fast and
connected to government agencies related to the
membership management BPJS, for example, the
need for a realignment of the length of active time
card BPJS (long wait for active cards for two weeks
so that the card would not be used as soon as
possible in healthcare) with a view side benefits to
participants and the benefits for institutions
manager. The need to develop the integration /
connectivity services registry offices (services KTP,
KK) with the BPJS, and the bank it is intended that
the entire data service needs to be monitored
together easily without force/charge to people who
forget to bring a file requirements or incompetence
communities meet the requirements of membership
file in quick time. In another sense that the people
who come to the registration service of the
membership did not experience difficulties or delays
service membership in both the accomplish of the
requirements, including other requirements such as
having to have a written statement from both parents
(for candidates who have parents who are far away),
the obligation to have a letter of domicile (for
candidates who are outside the area of origin KTP)
and others. This is in line with research Lestari that
the administrative services are considered
complicated, convoluted, and less information
(Lestari,2010).
In terms of barriers, understaffed bank services is
the management of banks need to adapt to the
conditions and needs of the service, with the
intention that the service does not make it difficult
for the ministry of membership dues and
registration. Similarly, in terms of service, the bank
should not impose the will of the applicants to have
had an ATM/bank, but the need for the bank giving
a service to applicants, whether the service payment
of contributions made directly through auto-debit or
through payment in cash, or through other methods
e.g. union dues BPJS integrated with payment of
electricity bills/water / or union account payment of
other taxes. This is in line with research that there
are obstacles in the form of procedural
administrative services, technical constraints,
constraints of human resources, and socio-cultural
community (Haeruddin,2010).
When the BPJS cooperating with the bank as
collecting fund membership dues, the aspects of ease
and speed of services should be tailored to the local
community. This is important so that dues payments
service is not a barrier in service members. As the
results to concerning Analysis attitude Informal
Workers Non PBI Not Yet Registered Program
National Health Insurance (JKN) 2014 In Brebes
city found that of 347 respondents showed with 90,
5% of informal workers non-PBI Brebes city states
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agree with their cooperation with banks and BPJS in
BPJS dues payment services (Purwandari,2014).
Dues BPJS is the tariff to be paid by each
participant to the BPJS independently of each
month, the amount of its contribution based on the
class selection of service desired by someone.
According to the Presidential Regulation No. 19 The
year 2016 regarding the Second Amendment to
Presidential Regulation No. 12 The year 2013 on
Health Insurance. The regulation stipulated in
change fees for participants Not Receiver Wage
Workers (PBPU) with details: Class 1 the amounts
of fees of Rp 59,500 rose to Rp 80,000, class 2
amounts of fees from Rp 42,500 to Rp 51,000 and
Grade 3 amounts of fees did not increase.
Participants are required to pay health insurance
contributions to BPJS later than 10 (ten) each month.
If the date ten (10) falls on a holiday, then the dues
payable on the next working day (PP Regulation No.
12,2013).
Non-burdened participants with the amounts of
fees BPJS, this is in line with the principle of mutual
cooperation BPJS, in the sense of mutual subsidy
among those who fall into the category of the rich to
the poor category, between the patient's rich and
poor patient so that the model sharing
service/financing will help to accomplish the
operationalization of health services the main burden
of financing by the government. With insufficient
health funding both from the public and the
government it is becoming one measure of the
success of programs BPJS current health and future,
because historically travel health insurance (health
insurance) in Indonesia still face key problems
adequacy of health funding, so that with the JKN
now then access, quality of care, equity and
availability of health resources are expected to work
better towards the future towards achieving health
coverage 2019.
BJPS service fare classes are varied, the concept
is very profitable government and society, because
by itself participant will choose a suitable tariffs for
himself and his family in accordance with the
existing financial capability, on the other hand, the
absence of coercion to the people to choose a higher
class of service of its capabilities, it also will give
freedom to the people to conduct mutation of
membership to various levels as desired class of
service and good economic conditions to class and
non-PBI.
This is consistent with research that 87.1% states
are willing to become a participant of health
insurance, total premiums 93.3% want the maximum
amount of Rp 25,000 / month/person, as much as
93.3% want the amount of the premium inpatient
unit 3 the maximum class 25.000 / month/person
(Djuhaeni;Gondodiputro;Setiawati,2010). There are
83.3% of informal workers agree with the
Participation of non-PBI. And 73.2% of non-PBI
informal workers agree with Membership required.
While 59, 4% agreed with 25,500 premium class for
the inpatient unit 3. A total of 55% agreed with
49,500 premium class for the inpatient unit 2. A total
of 56, 2% agree with 59,500 premia for inpatient
room class 1 (Purwandari,2014). The factors
affecting the health insurance program participation
are factor income, knowledge and education
(Triyono;Soewartoyo,2013). ILO study that 22.04%
of informal workers are willing to pay social
insurance premiums, 8.07% found the national social
insurance premium is the responsibility of the
employer; 34.39% believe the responsibility of the
state and 18.86% found premium pay social security
is the responsibility of workers, employers, and
governments (ILO,2004).
However, the problems that occur in the field
there are participants complained fees are mainly
families who have many dependents, if it is
constantly happening then chances are that the
participants and their families will do the arrears-
arrears payment of dues BPJS, and should it need to
do education, and advocacy to the community to
provide an understanding of the mutation to ease the
burden of membership dues BPJS.
Thus, participants who have registered as
participants Non-PBI and feel unable to make a
payment dues BPJS expected to can perform
mutation of membership as provided in Rule BPJS
No. 1 of 2014 on article 27 paragraph 1 and 2 and
Article 30 on health insurance (BPJS,2014)
The concept of payment of dues through the
system auto-debit will essentially facilitate service
payment of dues each month, with system it also will
benefit the participants of the transport costs because
it does not need to go to the bank counter, from the
time do not need to queue at the bank, in terms of
labour was efficient because participants do not have
to deal with the bank, and most importantly, will
prevent the participant forgets to make payments
including payment arrears prevented the participants
do. In general, an auto-debit system very well is
applied as more BPJS participants in terms of ease
of payment. With the system auto-debit also be
advantageous than the manual system because the
banks and BPJS will easily monitor payment arrears
of participants, so that information can auto-debit
system used to prevent patients get health care and
on the other hand can control the billing process
payment of membership dues.
Still the participants who frequently delinquent
dues BPJS due to intentional factor or other factors,
so the willingness of patients to pay payment
including penalties when sick, show that lack of
awareness or lack of patient understanding of the
The Effectiveness of National Health Insurance Membership Services at Social Security Agency Office in South-East Sulawesi Province
307

importance of health and the importance of the
program JKN for the community, it could be this is
the case because the program has not socialised JKN
well. The need for the role of government and
society, primarily related institutions BPJS manager
to find the right model to address their arrears so that
the future payment of dues BPJS no impact on the
survival JKN program in the future. This is in line
with research that the insurance awareness classified
as moderate 41%, hence the need to done by the
health insurance funds to be able to educate a wider
range of people in order to increase public awareness
in insured healthcare (Sakinah, 2014)
Existence of barriers to the service requirements
of membership either in the form of letter of
domicile for those who come from outside the
region, a statement of the parents, this is effective
only for candidates from outside the area will make
it difficult for participants to complete all
requirements, this condition can lead to potential
participants will choose to continue the service
registration membership or terminate such
registration. When participants chose to discontinue
the registration then when he/she get health care will
be fabricated using BPJS services, by itself it will be
forced to use a common course of patient care dues
health care more expensive. But when he went to the
registration of membership he must incur huge costs
to obtain compliance with requirements such as
having to deal with the urban village office / local
village, must meet with parents for approval, and
could be candidates to commit fraud administrative
completeness of the files in order to avoid the cost of
obtaining file completeness.
In terms of distance bank and office BPJS far
shows that the absence of an agreement or the
absence of integrated services prepared jointly
between the bank and BPJS, if this condition persists
then the efficiency of the time, cost and labour was
detrimental to the applicants because they have
completed all stages of the service will be a delay of
even a membership service when some of the
participants decided to suspend or terminate the
registration on the grounds that it faces the difficulty
of servicing.
The distance between the bank and BPJS
difficult and much will affect the community to
come to the bank because of the distance and cost of
travel. By him that the need for evaluation and repair
service stages and good coordination between BPJS
and the bank to find a suitable service model that can
facilitate the service participants. Similarly, in an
effort to solve the problems attendant care faced by
the participants in order to give a good response so
that the barriers in the service would be solved and
prevent service delays.
In case any officer attitude is good, the wait time
service is good, the service information easily will
be carrying in the service process and add value to
the service personnel, so that the service member
will pass easily and participants will feel
comfortable, relieved, happy even to feel satisfied
for all those services. But if the ministry had
received had the opposite outcome than the
participants will feel upset, uncomfortable even
consider the service received was not in accordance
with expectations is by itself the participants will tell
other potential participants about the quality of those
services.
With the waiting room service cramped, seating
is limited, the number of officers is less, means and
facilities are lacking, will have an impact on the
speed, accuracy, and smooth service, on the other
hand, would be detrimental to the participants
because seating is limited, participants had to stand
waiting queue. With the number of those with less
than, the service will slow this can cause queues.
Likewise with limited means and facilities which
will hamper the service, so that participants feel
annoyed frustrated, stressed, and not be satisfied
because of long service. By him that BPJS parties to
continue to conduct an evaluation to improve service
management and service resources continue to
develop in order to create good customer service and
satisfy the participants. This is consistent with
research that the public service there was limited
because of the facilities inadequate, lack of human
resources and employee discipline
(Musdiansyah,2014).
5 CONCLUSIONS
Services JKN participation in BPJS Office has been
effectively carried out. But there are still many
problems in the implementation both in terms of
regulation, service management, behaviour and
readiness of resources, therefore the need for policy
improvement and service management to improve
the effectiveness of JKN membership services.
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