Navigating access to Indonesia’s National Health Insurance: determinants and barriers among informal sector workers in West Sumatra

Shelvy Haria Roza, Ayulia Fardila Sari — Fri, 11 Jul 2025 10:42:13 +0700

Purpose: This study aimed to identify the factors that influence and barriers to the utilization of JKN for informal sector workers in West Sumatra Province.

Methods: The study employed a quantitative cross-sectional design. The data used are secondary data from the 2022 Susenas. The population of this study consisted of informal workers aged 15-64 years, comprising approximately 10,909 people. The sample consisted of informal workers with health complaints and a history of outpatient care, specifically 4,606 individuals. This study uses JKN utilization as the dependent variable. Meanwhile, there are several independent variables: JKN ownership, age, gender, economic status, region of residence, education, and employment. Data were analyzed using the STATA application in univariate, bivariate analyses with the Chi-Squared test, and multivariate analyses with binary logistic regression.

Results: The results showed that most respondents (59.12%) did not use JKN due to various barriers, including a preference for self-medication (76%), lack of knowledge on how to use JKN (10%), and difficulties with procedures (5%). The productive age group was significantly more likely to use JKN (OR 4.653; 95% CI 1.837 - 11.784). The poor are more likely to use JKN than those in the lower-middle income groups (OR 6.955; 95% CI 1.444-33.497).

Conclusion: The wealth status and age had a significant influence on the use of JKN. Expand access to affordable health services for low-income individuals and older adults. Barriers to using JKN are practical and require policy interventions. Insurance subsidies, development of mobile-based services, and strategies for the dissemination of information and benefits of JKN.

Disparities in basic immunization coverage: a case study of supply and demand factors in two community health centers in Bogor, Indonesia

Hermadi, Mardiati Nadjib — Mon, 14 Jul 2025 00:00:00 +0700

Purpose: To identify and analyze the factors influencing complete basic immunization (CBI) coverage at two community health centers (CHCs) with contrasting coverage levels.

Methods: This study employed a qualitative approach with a case study design. Informants were purposively selected and included health workers, community health volunteers, and parents. We collected data through in-depth interviews and document review, then analyzed it using a qualitative thematic approach.

Results: Supply-side factors included the number and competence of health workers, availability of facilities and infrastructure, and funding support. Demand-side factors comprised community knowledge and awareness, sociodemographic characteristics, and trust in vaccines. Ciapus faced shortages of health personnel and community resistance to immunization, while Bojong Nangka demonstrated active collaboration between health workers and the community.

Conclusion: The disparity in CBI coverage between Bojong Nangka and Ciapus CHC is caused by an imbalance between supply and demand factors. In Ciapus, low coverage was driven by limited human resources, inadequate infrastructure, and insufficient funding (supply-side), as well as poor public knowledge, awareness, and trust in vaccines, and the minimal involvement of local leaders (demand-side). In contrast, Bojong Nangka succeeded by strengthening its supply and demand components. Comprehensive interventions are necessary to enhance immunization services, increase public awareness and participation, and thereby achieve equitable CBI coverage.

BKM Public Health and Community Medicine

Navigating access to Indonesia’s National Health Insurance: determinants and barriers among informal sector workers in West Sumatra

Disparities in basic immunization coverage: a case study of supply and demand factors in two community health centers in Bogor, Indonesia