Behavioral determinants of retention in Indonesia’s national health insurance: a retrospective cohort study of informal workers
Abstract
Purpose: This study aimed to examine factors influencing enrollment continuity among self-enrolled members of Indonesia’s National Health Insurance (JKN) from 2018 to 2023.
Methods: This study used data from BPJS Kesehatan, a longitudinal cohort of 124,486 active members in 2018, and followed up to assess participation status in 2023.
Results: About 38.1% of participants became inactive, and those who had never used primary or hospital care were over four times as likely to drop out (OR 4.27; 95% CI 4.25–4.28). Inactivity was also more common among rural residents and members living outside the Java–Bali region.
Conclusion: These findings suggest a risk of adverse selection, where low-utilizers exit while high-need members remain. Retention depends not only on affordability but also on perceived value, highlighting the need for preventive outreach, service quality improvements, and simplified administrative processes.
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