The sustainability of premium payment of national health insurance's self-enrolled members in Jakarta Greater Area.

Abstract

Background: The sustainability of the National Health Insurance (NHI) program heavily relies on the premium of its member. The negligence of a large number of members at pay the premium lead to the failure of the Social Security Agency for Health (SSAH) to deliver its services. This study aims at analyzing important factors that influence the sustainability of premium payment of NHI’s self-enrolled members in the Jakarta Greater Area.Design and methods: This study performed an econometric analysis from the panel and the same respondent’s data in 2015 and 2017. The population of the study was NHI’s self-enrolled members who lived in the City of Jakarta, Bogor, Depok, Tangerang, Bekasi, (Jakarta Greater Area) and it represents the urban area of Indonesia. The ordinal logistic regression model was used to determine the type of sustainability NHI premium payment.Results: The survey shows that around 28.3% of self-enrolled members do not pay the NHI insurance premium regularly. Applying ordered logit this study statistically confirms that age of household head, income per month, never experience economic hardship, 1st/2nd class registration, and benefits of SSAH are positively correlated with compliance rate to pay NHI insurance premium. Whereas tobacco consumption, health-seeking behavior, and the 2016 increase of premium are negatively correlated with regular premium payment.Conclusions: This study calls for policy intervention to improve compliance of premium payment such as i) massive promotion of insurance literacy and benefits of insurance through a health professional, internet, and government officer; ii) expanding auto-debit and installment premium payment; iii) incentive for paying premium regularly and not smoking; and iv) improving access and quality of health services. Significance for public health The innovation of National Health Insurance (NHI) organized by the Social Security Agency for Health (SSAH) is an essential step for the Indonesian government in its goal of achieving Universal Health Coverage (UHC). The existence of the NHI can improve access and quality of health services for the community. The community gets access to the comprehensive health service guarantees, starting from improving health (promotive), preventing illness (preventive), treating diseases (curative), and restoring health (rehabilitative). Therefore, it is important to regularly pay NHI premium, especially for the self-enrolled member/informal sector workers (Pekerja Bukan Penerima Upah) for the continuation of the NHI program which become a global problem, especially in developing countries where the majority of the population is working in the informal sector.