Application of Health Belief Model on Factors Affecting Participation in the National Health Insurance Scheme among Informal Sector Workers in Kudus, Central Java


  • Anom Dwi Prakoso Masters Program in Public Health, Universitas Sebelas Maret
  • Endang Sutisna Sulaeman Masters Program in Public Health, Universitas Sebelas Maret
  • Arief Suryono


Background: Universal Health Coverage is the mandate of the Pancasila and 1945 Constitution. UHC's target on January 1st, 2019 is that all Indonesians are covered by the National Health In­su­ran­ce (JKN). Meanwhile, the participation of informal workers as of May 1, 2019 only reached 57%. The cross subsidy system is not optimal and the budget deficit will continue to be experienced because the­re are still many citizens who have not joined JKN. This study aimed to analyze the de­ter­mi­nants of the participation of informal workers in the national health insurance program in Kudus using the Health Belief Model.

Subjects and Method: This was case control study,conducted in 5 sub-districts in Kudus Re­gen­cy, Cen­tral Java from September to October 2019. Total of 200 informal workers were selected by pur­posive sampling, it were devided into two groups including 100 in case group and a 100 in con­trol group. The dependent variable was the participation of informal workers in the JKN program. The independent variables were perception of vulnerability, perception of seriousness, perspective of be­nefits, family support, self-efficacy, and social environment. The data collection was per­for­med using a questionnaire and data analysis with logistic regression using stata 13.

Results: The participation of informal workers in the JKN program increased with knowledge of ≥Senior high school (b = 5.09; 95% CI = 0.32 to 9.87; p = 0.036), high perception of vulnerability (b = 3.01; 95% CI = 0.26 to 5.75; p = 0.031), high perceived seriousness (b= 5.38; 95% CI = 2.14 to 8.61; p= 0.001), high perceived benefit (b= 3.86; 95% CI= 0.39 to 7.34; p= 0.029), strong family support (b= 7.26; 95% CI= 2.69 to 11.82; p= 0.002), strong self-efficacy (b = 3.98; 95% CI = 0.98 to 6.98; p= 0.009) and a supportive social environment (b = 4.51; 95% CI= 1.61 to 7.40; p= 0.002).

Conclusion:Knowledge, perception of vulnerability, perception of seriousness, perceived use­ful­ness, family support and social environment influence the participation of informal workers in the JKN program.

Keywords: universal health coverage, national health insurance, health belief model

Anom Dwi Prakoso, Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: Mobile: +62­895363­054­393.

Journal of Health Policy and Management (2020), 5(1): 61-73


Adewole DA, Adebayo AM, Udeh EI, Shaahu VN, Dairo MD (2015). Payment for health care and perception of the national health insurance scheme in a rural area in Southwest Nigeria, Am J Trop Med Hyg, 93(3): 648–654. doi: 10.4269/ajtmh.14-0245 [Crossref] [PubMed] [Google Scholar]

Adewole DA, Akanbi SA, Osungbade KO, Bello S (2017). Expanding health insurance scheme in the informal sector in Nigeria: awareness as a potential demand-side tool. Pan Afr Med J, 27(52): 1–11. doi: 10.11604/pamj.2017.27.52.11092 [Crossref] [PubMed] [Google Scholar]

Alkhamis A (2017). Knowledge of health insurance benefits among male. Saudi Med J, 38(6): 642–653. doi: 10.15537/smj.2017.6.18177 [Crossref] [PubMed] [Google Scholar]

Central Bureau of Statistics (2018). Keadaan ketenagakerjaan Indonesia februari 2018 (The situation of Indonesian employment in February 2018). [Website]

Badan Pusat Statistik Kabupaten Kudus (2018). Kudus dalam angka 2018. [Website]

Boerma T, Eozenou P, Evans D, Evans T, Kieny M, Wagstaff A (2014). Monitoring progress towards universal health coverage at country and global levels, PLoS Med, 11(9): 1-8. doi: 10.1371/journal.pmed.1001731 [Crossref] [PubMed] [Google Scholar]

Darma S, Juanita, Rochadi, RK (2018). BPJS barrier to strategic purchasing of primary care service at public and private health facilities in Subulussalam, Aceh. J Health Policy Manage, 3(2): 81–91. [Google Scholar]

Febriani GA, Rahardjo SS, Murti B (2017). Biopsychosocial determinants of human papilloma virus immunization in women of reproductive age in Surakarta, Central Java. J Health Promot Behav, 3(1): 67–77. doi: 10.26911/thejhpb.2018.03.01.07 [Crossref] [Google Scholar]

Guntari GAS, Hasanbasri M (2019). Hubungan sosiodemografi, sosioekonomi, persepsi kerentanan penyakit, dan kepercayaan (trust) terhadap partisipasi pekerja bukan penerima upah dalam program jaminan kesehatan nasional di Kabupaten Karanganyar, 1–11 (Sociodemographic, socio-economic relations, perception of disease vulnerability, and trust in the participation of non-wage workers in the national health insurance program in Karanganyar Regency, 1–11). [Website]

Hogan DR, Stevens GA, Hosseinpoor AR, Boerma T (2018). Monitoring universal health coverage within the sustainable development goals: development and baseline data for an index of essential health services. Lancet Glob Health, 6(2): e152–e168. doi: 10.1016/S2214-109X(17)30472-2 [Crossref] [PubMed] [Google Scholar]

Indonesian Government. Undang-Undang Dasar Negara Republik Indonesia Tahun 1945, 4,(1945). [Website]

Indonesian Government. Undang-Undang Republik Indonesia Nomor 40 Tahun 2004 tentang sistem jaminan sosial nasional (2004). [Website]

James TG, Sullivan MK, Dumeny L, Lindsey K, Cheong J, Nicolette G, Dumeny L (2018). Health insurance literacy and health service utilization among college students. J Am Coll Health, 0(0): 1–7. doi: 10.1080/07448481.2018.1538151 [Crossref] [PubMed] [Google Scholar]

Kan K, Barnes AJ, Hanoch Y, Federman AD (2015). Self-Efficacy in insurance decision making. Am J Manag Care, 21(4): 247–254. [Google Scholar]

Kusumaningrum A, Azinar M (2018). Kepesertaan masyarakat dalam jaminan kesehatan nasional secara mandiri (Community participation in national health insurance independently). HIGEIA, 2(1) 149–160. [Google Scholar]

Lattof SR. (2018). Health insurance and care-seeking behaviours of female migrants in Accra, Ghana. Health Policy Plan, 0(0): 1–11. doi: 10.1093/heapol/czy012 [Crossref] [PubMed] [Google Scholar]

Melinda, Suparwati A, Suryoputro A (2016). Faktor-faktor yang berhubungan dengan minat masyarakat dalam keikutsertaan BPJS mandiri di Kecamatan Bener Kabupaten Purworejo (Factors related to community interest in the participation of independent bpjs in Bener Subdistrict, Purworejo Regency). Jurnal Kesehatan Masyarakat, 4(4): 86–93. [Google Scholar]

National Social Security Board (2019). Cakupan kepesertaan jaminan kesehatan nasional (Coverage of national health insurance membership). [Website]

Noubiap JJN, Joko, WYA, Obama JMN, Bigna JJR (2013). Community-based health insurance knowledge, concern, preferences, and financial planning for health care among informal sector workers in a health district of Douala, Cameroon. Pan Afr Med J, 8688(09): 1–9. doi: 10.11604/pamj.2013.16.17.2279 [Crossref] [PubMed] [Google Scholar]

Obse A, Hailemariam D, Normand C (2015). Knowledge of and preferences for health insurance among formal sector employees in Addis Ababa: A qualitative study. BMC Health Serv Res, 15(318): 1–11. doi: 10.1186/s12913-015-0988-8 [Crossref] [PubMed] [Google Scholar]

Odeyemi IAO. (2014). Community-based health insurance programmes and the national health insurance scheme of Nigeria: challenges to uptake and integration. Int J Equity Health, 13(20): 1–13. doi: 10.1186/1475-9276-13-20 [Crossref] [PubMed] [Google Scholar]

Oh H, Jung C (2017). Korean immigrants don’t buy health insurance: the influences of culture on self- employed korean immigrants focusing on structure and functions of social networks. Soc Sci Med, 10(191): 194–201. doi: 10.1016/j.socscimed.2017.09.012 [Crossref] [PubMed] [Google Scholar]

Pangestika VF, Jati SP, Sriatmi A (2017). Faktor-faktor yang berhubungan dengan kepesertaan sektor informal dalam bpjs kesehatan mandiri di Kelurahan Poncol, Kecamatan Pekalongan Timur, Kota Pekalongan (Factors related to the participation of the informal sector in independent health bpjs in Poncol Village, East Pekalongan District, Pekalongan City). Jurnal Kesehatan Masyarakat, 5(3): 39–49. [Google Scholar]

Puspitasari Y (2017). Faktor yang memengaruhi partisipasi kepesertaan jaminan kesehatan nasional pada pekerja bukan penerima upah di Desa Kasiyan Timur wilayah kerja Puskesmas Kasiyan Kabupaten Jember tahun 2016 (Factors affecting the participation of national health insurance participation in non-wage workers in the East Kasiyan Village, the working area of the Kasiyan Health Center, Jember Regency in 2016). [Google Scholar]

Sari SA, Indarto D, Wijaya M (2018). Application of Health Belief Model on Preventive Behaviors of Patients with Low Back Pain. J Health Promot Behav, 3(3): 192–198. doi: 10.26911/thejhpb.2018.03.03.06 [Crossref] [Google Scholar]

Setiyaningsih R, Tamtomo D, Suryani N (2016). Health belief model: determinants of hypertension prevention behavior in adults at community health center, Sukoharjo, Central Java, 1,(3): 161–171. J Health Promot Behav. doi: 10.26911/thejhpb.2016.01.03.03 [Crossref] [PubMed] [Google Scholar]

Simpson V (2015). Models and theories to support health behavior intervention and program planning. [Website]

Social Insurance Administration Organization (2019). Data peserta progam JKN (092). [Website]

Sunaryo, Demartoto A, Adriyani RB (2016). Association between knowledge, perceived seriousness, perceived benefit and barrier, and family support on adherence to anti- retrovirus therapy in patients with HIV/AIDS. J Health Promot Behav, 1(1): 55–62.

doi: 10.26911/thejhpb.2016.01.01.08 [Crossref] [Google Scholar]

Thornton RL, Hatt LE, Field EM, Islam M, Gonza MA (2010). Social security health insurance for the informal sector in Nicaragua: a randomized evaluation, Health Econ, 206(6): 181–206. doi: 10.1002/hec.1635 [Crossref] [PubMed] [Google Scholar]

Trisnawan PD (2015). Determinan perilaku pencarian pengobatan mahasiswa fakultas kedokteran dan ilmu kesehatan UIN Syarif Hidayatullah Jakarta. [Google Scholar]

Widhiastuti IAP, Januraga PP, Wirawan DN (2019). Hubungan persepsi manfaat dengan kepesertaan JKN secara mandiri di Puskesmas Denpasar Timur (Relationship of perceived benefits with membership of JKN independently at the East Denpasar Health Center). PHPMA, 3(2): 1–8. [Google Scholar]

Zhai S, Wang P, Dong Q, Ren X, Cai J, Coyte PC (2017). A study on the equality and benefit of China’ s national health care system. Int J Equity Health, 16(155): 1–11. doi: 10.1186/s12939-017-0653-4 [Crossref] [PubMed] [Google Scholar]




How to Cite

Prakoso, A. D., Sulaeman, E. S., & Suryono, A. (2020). Application of Health Belief Model on Factors Affecting Participation in the National Health Insurance Scheme among Informal Sector Workers in Kudus, Central Java. Journal of Health Policy and Management, 5(1), 61–73. Retrieved from