Compliance with National Health Insurance Contribution Payments among Non-Wage Workers

Abstract

National Health Insurance (JKN) contribution compliance among Non-Wage Workers (PBPU) is crucial for maintaining sustainable access to healthcare services; however, 16,182 (58.14%) PBPU members in Tanggamus Regency remain inactive. This study aimed to identify factors associated with JKN contribution compliance among PBPU members. A quantitative cross-sectional study was conducted among 124 Non-Wage Workers selected using simple random sampling. Data were collected using structured questionnaires and analyzed using univariate, bivariate, and multivariate analyses to assess compliance, self-efficacy, and Health Belief Model constructs. The results showed that 60.5% of respondents were non-compliant with JKN contribution payments. Most respondents reported low perceived vulnerability (57.3%), perceived seriousness (58.1%), and cues to action (53.2%), but high perceived benefits (57.3%), perceived barriers (61.3%), and self-efficacy (54.8%). Significant associations were found between JKN contribution compliance and perceived vulnerability, perceived benefits, perceived seriousness, perceived barriers, cues to action, and self-efficacy (all p < 0.05). In the multivariate analysis, perceived vulnerability emerged as the dominant factor associated with compliance (p < 0.001; adjusted OR = 13.481; 95% CI: 5.017–36.219), although the wide confidence interval indicates that the magnitude of the association should be interpreted with caution. These findings suggest that interventions to improve PBPU contribution compliance should prioritize risk-based health education emphasizing the potential financial consequences of high healthcare costs without JKN coverage. Such interventions could be integrated through JKN cadres, the Mobile JKN platform, and targeted social media campaigns to strengthen participants’ perceptions of health vulnerability and encourage sustained contribution compliance.