Willingness Survey of the Informal Workers in Bangli Regency about
National Health Insurance (JKN) Program
I Komang Peri Sukma Rahmawan, Putu Ayu Indrayathi , Pande Putu Januraga
School of Public Health, Medical Faculty, Udayana University, Denpasar, Indonesia,
Jl.P.B. Sudirman, Kampus Sudirman, Denpasar, Indonesia
Keywords: Willingness, Informal workers, National health insurance (JKN) program.
Abstract: The subsidized members (PBI) dominated the membership of the National Health Insurance Program (JKN)
in Indonesia, including in Bangli Regency. In 2016, the membership of JKN in Bangli Regency was only
42,92% and membership of non wage earners (PBPU) only 4,32%. The low number of PBPU in JKN
program because socialization not yet optimal and also because willingness of informal workers to join JKN
program still very low. This study aims to explore factors which influence to willingness of informal
workers to join JKN program and to find out the reason of postponement to be JKN participant. The study
was observational analytic with cross-sectional design. The subject of this study is informal workers at Selat
and Pengiangan Village Subdistrict Susut in Bangli Regency who have not join JKN yet, this study was
setted up by multi stage random sampling (96 respondents) and they were selected proportionally. The data
was collected with questionnaire and analyzed with quantitative method approaches (univariate, bivariate
used chi square and multivariate used Poisson Regression). Research found that 66,67% respondents want
to participate in JKN program. While based on Poisson Regression, indicate that the main factor which
influenced participation on JKN is education (Adjusted PR=5.15, 95%CI=1.57-16.92) and benefit
perception (Adjusted PR=2.41, 95%CI=1.20-4.823). Furthermore, and the most reason of respondents tend
to postpone membership are busy working and no time to register in BPJS Kesehatan Office. Education and
benefits perception altogether influenced the willingness to participate JKN program. Therefore, it is
necessary to provide information by emphasizing the benefits perception of JKN programs in various
education level, as well as registration and payment of JKN program with “jemput bola system” (BPJS
Kesehatan’s officer should actively gain the premium from the participants).
1 INTRODUCTION
Health development is an effort to be implemented
by all components of the Indonesian nation. It aims
to increase awareness, willingness, and healthy
living ability for everyone to achieve the highest
degree of public health, as an investment for human
resources development that are productive socially
and economically. Therefore, the government held a
program called national health insurance (JKN)
1
.
The membership of JKN in Indonesia is dominated
by the subsidized members (PBI) category is
67.75%, while the non wage earners (PBPU)
membership is least than other members
2
, similar
conditions also apply in Bangli Regency, Bali
Provincial. The membership of JKN PBPU category
is 4.36%
3
. In Bangli Regency, the lowest number of
JKN participations is in Susut Sub district with only
35.50% participation
3
. The low participation of JKN
indicates that there is no willingness to follow JKN
program
4
. Willingness determines a person's ability
to participate in community activities or programs in
the community, including the JKN program
5
.
Willingness can be only to form if society has
awareness of the program, awareness is the
possession of knowledge or be aware of the situation
and something
6
. According to the behaviour change
theory of Health Belief Model (HBM) describes that
attitudes of individuals to adopt new behaviours that
are preceded by the formation of willingness,
willingness is used as a predictor factor of
behaviour, so if you want to predict individual
behaviour then it should be assessed willingness,
thus the higher the individual wants so that the easier
it will be for the individual to adopt new behaviors
5
.
According to King in Surharyat (2015) states that
Rahmawan, I., Indrayathi, P. and Januraga, P.
Willingness Survey of the Informal Workers in Bangli Regency about National Health Insurance (JKN) Program.
In Proceedings of the 4th Annual Meeting of the Indonesian Health Economics Association (INAHEA 2017), pages 319-324
ISBN: 978-989-758-335-3
Copyright © 2018 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
319

the willingness with action should be consistent, so
that what will become indifference willingness be
reflected in his behaviour, but if there is
inconsistency between the willingness and action
means there is an outside inhibiting factor of the
individual concerned that causes to delay in making
decisions to adopt new behaviors
7
.
Based on the results of descriptive research
conducted by Wisudarma et al (2015) stated that the
low level of willingness of the community to follow
the JKN program with percentage is 25%, the study
explained that the head of the family who has a
family member > 4 peoples known not agree to
register all members his family in the JKN program,
the negative perception of the head of the household
related to the membership aspect and the
contribution of the program has low willingness to
register as JKN participant
8
. Based on that, the
researcher wanted to study about willingness survey
of the informal sector workers to follow JKN
program in Bangli Regency.
2 METHODS
This study is quantitative analytical with cross
sectional design. This research is done at Selat and
Pengiangan Village Subdistrict Susut in Bangli
Regency from April to May 2017. The sample in
this research is 96 respondents. Respondents in this
research are those who work in informal sector at
Selat and Pengiangan Village with the inclusion
criteria: family head who have not been a participant
of JKN, and willing to fill out the questionnaire.
Sample selected through multi stage random
sampling technique. The research instrument used is
questionnaires that have been tested before the
research is done. The data was collected and
analyzed be using STATA SE 12 software. The
analysis was univariate analysis which resulted the
frequency distribution and proportion of each
dependent and independent variable, bivariate
analysis with chi square to find out the relation of
independent variables with dependent variable and
multivariate analysis with Poisson regression test to
find out the most influential variable. This research
had been approved by the ethical commission with
ethical clearance number 1015/UN.14.2/KEP/2017
from Research Ethical Commission Udayana
University Medicine Faculty/Sanglah Hospital,
Denpasar.
3 RESULTS
3.1 Respondent’s Characteristic
Based on the socio-demographic characteristics, the
majority (53.13%) of respondents has age >40 years
old, with the average of age is 40 years and the age
of the respondent between 21 years to 63 years, most
of respondents (88.54%) are female, most
respondents had graduated the lower senior high
school with percentage is 64,58%, most of them
(47,92%) have professions as artisans of wood
carvings of Balinese Catton, based income most of
respondents (54,17%) have less minimum payment
of Bangli Regency, based on family size indicate
most respondents (54,20%) have family members
bigger than 4 peoples, and most respondents
(66.67%) want to join JKN program.
3.2 Perceptions Of Respondents About
JKN
Based on the perception variable, there are 5
perception variables studied in this research, namely
perception of susceptibility, perception of severity,
perception of threat, perception of benefit and
perception of barriers, obtained result that most
(62,50%) respondents feel high susceptibility,
Which is high if suffering from disease as much as
68.75%, besides respondents who have high
perception of threat as much as 54.17% , in addition
most (68.75%) of respondents who have high
perceived benefits if joining JKN program, this is
expected to increase the chance of willingness of
respondents to follow JKN program, the possibility
is also reinforced with findings that most
respondents have low barriers perception if follow
JKN program as much 56.25%.
3.3 Socialization about JKN Which
Accepted by Respondents
Based on the description of socialization most
(38.54%) of respondents often get information about
JKN, from source of information mostly (78.13%)
respondents receive information from peers or
family, the rest of them receive information from
media (TV, radio and newspaper), primary care
providers, and other sources, such as the internet and
hospitals.
INAHEA 2017 - 4th Annual Meeting of the Indonesian Health Economics Association
320

Table 1 Result of bivariate analysis about relation of socio-demographic factor, perception, and socialization with
willingness to follow JKN program (n=96)
Independent variable
Willin
g
ness to follow JKN Crude
PR
95% CI p value
Willin
g
Unwillin
g
Age groups
> 40 years
21-40 years
Sex
Female
Male
Education
> Senior high school
< Senior high school
Occupation
Do a business
Free workers
Income
High
Low
Family size
Little
Many
Susceptibility
perception
High
Low
Seriousness perception
High
Low
Threat perception
High
Low
Benefit perception
High
Low
Barrier perception
Low
High
Socialization
Often
Seldo
m
37
27
7
57
31
33
18
46
35
29
27
37
43
21
52
12
41
23
51
13
40
24
47
17
14
18
4
28
3
29
5
27
9
23
9
23
17
15
14
18
11
21
14
18
14
18
11
21
1.457
Ref
0.9058
Ref
5.302
Ref
1.7014
Ref
2,1623
Ref
1.53333
Ref
1.4705
Ref
2.825
Ref
2.2562
Ref
2.4933
Ref
1.6530
Ref
2.9138
R
e
f
0.822-4.150
0.391-2.095
1.742-16.128
0.7041-3.906
1.1201-4.175
0.800-2,938
0.741-2,569
1.696-4.898
1.227-4.148
1.477-4.2952
0.935-2.9283
1.592-5.3300
0.1931
0.8210
0.001
0.176
0.0138
0.1800
0.1800
0. 0001
0. 0059
0.0001
0.0810
0.0001
Based on the result of bivariate analysis showed
that there are six variables related to willingness to
follow JKN program, namely education (Crude
PR=5,3 and 95% CI=1,742-16,120), income (Crude
PR= 2,1623 and 95%CI=1.1201-4.175), seriousness
perception (Crude PR = 2,825, and 95% CI=1,696-
4,898), threat perception (Crude PR = 2.2562, and
95% CI=1.227-4.148), benefits perception (Crude
PR=2.4933, and 95% CI=1477-4.2952),
socialization about JKN (Crude PR = 2,9138, and
95% CI =1,592-5,330).
Table 2 Final model of multivariate analysis of socio-demographic factors, and perceptions and socialization of JKN with
willingness to follow JKN (n = 96)
Variable Adjusted PR 95% Confidence Interval p value
Lower Upper
Education
High (> Senior high school) 5.15 1.57 16.92 0,007
Low (< Senior high school) Ref
Perception of Benefit
Willingness Survey of the Informal Workers in Bangli Regency about National Health Insurance (JKN) Program
321

Variable Adjusted PR 95% Confidence Interval p value
Lower Upper
High (If total score > 12) 2.41 1.20 4.823 0,013
Low (If total score < 12) Ref
Based on the result of multivariate analysis
showed that there are only two variables which
altogether influenced the willingness to join JKN
program that is education (Adjusted PR = 5.15, 95%
CI = 1.57-16.92) and variable of perception of
benefit (Adjusted PR = 2.41, 95% CI = 1.20-4.823).
3.6 Cause of Delay Joining JKN
Based on the reason to delay, most of them 34.38%
have not registered as JKN participants because they
are busy working so limited time and opportunity to
register to BPJS Health Office. Additionally, other
respondents have not registered due to negative
perception on the quality of service had been heard
by respondents from friends who have used health
services with JKN cards such as a convoluted
referral system and the length of the queue into
consideration of respondents have not signed up to
be participant of JKN.
4 DISCUSSION
Based on the results of willingness survey, found
that most (66.67%) respondents want to join the
JKN program. Multivariate analysis showed that
educational variable was the most influencing factor
on willingness to join JKN program with Adjusted
PR= 5.15 and p value <0.05, it shows that
respondents who have higher education have a
chance to join JKN program 5.15 times higher than
less educated person.
According to Kumar et al (2011), the level of
education affects the level of awareness of crop
insurance in India, as a form of risk transfer
9
.
Research on Litbang Kompas (2014) in Sakinah
(2014) also proves that the higher of education
person have awareness of the importance insurance
is better than less educated person, in other words
the higher education will have better knowledge
about being healthy, by becoming a participant of
health insurance
10
. The results of finding in the field
revealed that the respondents who have higher
education have better knowledge or understanding
of the importance of JKN program in order to
prevent catastrophic health expenditure. It is proven
from the survey results revealed that there are some
respondents who are highly education already have
private insurance. Therefore, it is necessary to
provide information about the importance of JKN
program at various levels of education level from
primary, secondary, to university to form positive
and permanent attitude about the program and
expected students are able to inform to the parents or
guardians who will indirectly affect membership in
JKN program especially PBPU category.
This research also found that there is no
significant relationship between age and willingness
to follow JKN, this is also found in research by Affi
(2014) states that there is no relationship between
the age of consciousness insurance
11
, and there is no
relationship between the sex with willingness to
follow JKN, similarly Litik (2007) states that there is
no relationship between sex and community-based
insurance ownership
12
. The work is also not related
to the willingness to join JKN, this finding also
found in the study of Lestari (2016) states that there
is no job relationship with JKN membership
13
.
Furthermore, income also unrelated to the
willingness to join JKN this is also found in the
Mhere (2013) study in Zimbabe found that
household income does not affect the public health
insurance disposal
14
, in addition the number of
family members is also not related to the willingness
to follow the JKN, this is in line with research from
Siloho (2016) which is states that the number of
families is not a determinant factor willingness to
pay JKN
15
.
The majority of respondents have a high
perception in terms of susceptibility, seriousness,
threats of disease, with each proportion is 62.50%;
68.75%; and 54.17%. the most (68.75%) of
respondents have high benefit perception if follow
JKN program, while perception of low barrier is
56,25%. The result of multivariate analysis of
perceptual variables in this study shows that only the
benefits perception that have a significant influence
on willingness to follow the JKN program, high
benefit perception has the opportunity to encourage
the willingness of respondents to join the program
JKN 2.41 times bigger than the respondents who
have low benefit perception. Research by Elviera
and Siswi (2013) states that the perception of
benefits has the strongest effect is 2.94 times higher
to encourage a person to conduct preventive
behaviors
16
, besides Tiaraningrum research (2014)
on the motivation of JKN Mandiri membership in
Surakarta City get the result that 80% realized the
INAHEA 2017 - 4th Annual Meeting of the Indonesian Health Economics Association
322

benefits of the importance of health in life and is
86% said participation in JKN
17
. Finding of this
study also in line with Health Belief Model (HBM)
theory in which the intention (willingness) and
changes of individual behavior is influenced by the
belief in the benefits and perceived barrier.
Perceptions of high benefits and low barriers
perceptions are likely to be dominant factors that
encourage respondents to have willingness to follow
JKN program, the change is supported by finding
high vulnerability, threat, and severity, and most
respondents have been informed about JKN.
According to Kurt Lewin in Subari (2014) states that
the willingness or change in person's behavior is
influenced by the driving factors and inhibitors, if
the perception of benefits on a program is high, then
this will lead to the formation of willingness and
behavioral changes desire
18
.
The findings in this study indicate that JKN
program is already quite popular in the community,
it is proved that most respondents have often
received information about JKN. The source of
information on the JKN program most received by
respondents came from friends or family, this
finding is in line with research by Tiaranigrum
(2014) stated that the culture of Indonesian society
such as still the family as the first place to obtain
health information and the study also explain the
respondents who received information from 35,50%
more families to participate in JKN Mandiri
18
, but to
increase the willingness to follow JKN program
needs to be educated by cooperating education
sector and community leaders through the delivery
of messages more specifically such as the magnitude
of the risk of disease and the cost of treatment if
suffering disease and various information about the
importance of JKN program need to be packed more
interesting so that people have enthusiasm and high
willingness to join JKN program. Most of the causes
of the respondents have not signed up to be a JKN
participant because they are busy working so there is
no time or opportunity to go to BPJS Kesehatan
Office, therefore it needs closer registration system
and payment of premium JKN with “jemput bola”
system means that BPJS Kesehatan officers has
collect the premium directly to community or
cooperating with LPD and cooperation in local
village. Indrayathi et.al (2015) found that Informal
workers stated that the registration system at BPJS
Kesehatan office seem to be one of the obstacles
them to register as a participant JKN. Informal
sector workers generally want to be a participant and
collection premium of participants using “jemput
bola” system or working with the village institution
for example LPD (Village Credit Institutions is one
institution that has been attached to the traditions of
the people in Bali) and Koperasi Unit Desa because
many do not know where is the BPJS Kesehatan
(Indrayathi, et al., 2015). Furthermore, information
about JKN obtained by respondents was not
complete therefore it is important to invite potential
group in society like community leaders and
religious leaders to participate in socialization about
JKN program. This is because of cultural belief that
people in rural area tend to imitate the behavior of
their community leader. Bad experience of
respondent friend about quality services when using
JKN also hamper their willingness to join JKN.
5 CONCLUSIONS
Most of the informal sector workers are willing to
join the JKN. Factors that influence the willingness
to follow the JKN program are the level of education
followed by perception of benefits of JKN.
Respondents mostly delay to join the program
because of busy with their jobs and no time or
opportunity to go to BPJS Kesehatan Office. It is
expected that BPJS Kesehatan can be socialized the
program to various level of education starting from
primary, middle, to university institutions to form a
positive and permanent attitude about the
importance of JKN program. Additionally, BPJS
Kesehatan in Bali should working closely with LPD
and Koperasi Unit Desa since this institution
available in every village in the province of Bali and
highly developed and trusted by local communities
.
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