National Health Security as an Effort to Increase Social Welfare: Challenges on Informal Sector Participants in Yogyakarta Special Region

Abstract

— Health insurance ownership is one of the efforts to reduce poverty to achieve social welfare. Health insurance also becomes a social safety net in a labor market towards old-age benefits. Health security is one of the social protection that aims to support people in facing various stressors regarding health conditions. The Indonesia Government has created an effort to increase the coverage of health insurance membership by starting a Universal Health Coverage policy in 2004 through the National Health Insurance (JKN) program. However, this program faces many challenges, especially for the independent member participation in informal sector workers. Most informal sector workers could not afford the premium regularly, which causes their membership not to use it if they need it—this research focuses on informal sector workers. This paper aims to identify the factors influencing membership participation in the independent scheme (non-subsidy) in the JKN program. Data of this paper is based on research that combination of mix-match methods. The quantitative approach through surveys was conducted using purposive sampling. Meanwhile, qualitative data collection was carried out through interviews, focus group discussions, and observations. The results show 18.90 percent of respondents participated in the JKN program as independent scheme members. Several reasons cause the stagnant membership participation, such as economic factors related to the premium for all household members, feeling unnecessary to have health insurance, trust in the JKN program, and disappointment with health services used. Moreover, it is essential to ensure the informal sector workers can afford and access the JKN program as health security due to their vulnerabilities. Health security has become a requirement that is related to increasing the social welfare of citizens.