Informal Workers and Its
Role in JKN in Denpasar City
: feasible model for collecting
revenue to the achievement of
universal health coverage
Ind ra ya thi, P.A., Kusum a d e w i, M.D,
Frid a ya nti Ira m a , M.D
Pro g ra m Stud i Ilm u Ke se ha ta n Ma sya ra ka t,
Fa kulta s Ke d o kte ra n, UNUD
Introduction
Healthy behaviors and the ability of people to choose
and obtain quality health services determine the success
of health development
To improve community’s health status, government
launched Jaminan Kesehatan Nasional (JKN) program.
One of the challenge in the achievement of universal
coverage is reaching informal workers sector.
Therefore, it is important to identify informal sector workers
The perception and knowledge level of informal sector
Aims
•
To Id e ntify info rm a l w o rke rs jo b
•
To find o ut info rm a l w o rke rs kno w le d g e a b o ut JKN
Methods
Mix methods
Quantitative data
collection : questionnaire
survey to informal
workers
were
analyzed using uni
variate & multivariate
analysis
qualitative data
collection : in-depth
interviews
were
analyzed using thematic
Results
1. Ide ntific a tio n o f Info rm a l Wo rke rs in De npa sa r
•
Da ta s o f wo rke rs
in De np a sa r we re o b ta ine d fro m BPS using SA KERNA S Ko ta
De npa sa r
•
The re a re 7 c a te g o rie s/ sta tus o f wo rke rs a c c o rding to BPS (Supro b o ,2007):
1. Be rusa ha se nd iri;
2. Be rusa ha d ib a ntu b uruh tid a k te ta p a ta u b uruh ta k d ib a ya r;
3. Be rusa ha d ib a ntu b uruh te ta p a ta u b uruh d ib a ya r;
4. Buruh a ta u ka rya w a n a ta u p e g a w a i;
5. Pe ke rja b e b a s d i p e rta nia n;
Results
Info rm a l w o rke rs id e ntific a tio n a c c o rd ing to Sa nto so (2012) a re the
c o m b ina tio n o f :
o
sta tus
p e ke rja a n
b e rusa ha
se nd iri
d e ng a n
te na g a
usa ha
p e rta nia n, p e rke b una n, p e te rna ka n, p e rika na n, ke huta na n, d a n
p e rb urua n;
o
b e rusa ha
se nd iri d e ng a n te na g a
p ro d uksi o p e ra sio na l a la t
a ng kuta n d a n p e ke rja a n ka sa r;
o
b e rusa ha
d ib a ntu b uruh tid a k te ta p / tid a k d ib a ya r d e ng a n
te na g a usa ha p e rta nia n, p e rke b una n, p e te rna ka n, p e rika na n,
ke huta na n, d a n p e rb urua n;
o
b e rusa ha
d ib a ntu b uruh tid a k te ta p / tid a k d ib a ya r d e ng a n
te na g a p ro d uksi o p e ra sio na l a la t a ng kuta n d a n p e ke rja ka sa r;
o
b uruh/ ka rya w a n/ p e g a w a i d e ng a n
te na g a
usa ha
p e rta nia n,
p e rke b una n, p e te rna ka n, p e rika na n, ke huta na n, d a n p e rb urua n;
Id e ntific a tio n o f Info rm a l Wo rke rs in De np a sa r :
Status Pekerjaan
Jenis Pekerjaan Utama
Pertanian
Pertambangan
dan
penggalian
Industri
pengolahan
Listrik, gas,
dan air
minum
Konstruksi
Perdagangan,
hotel, dan restoran
Pengangkutan
dan komunikasi
Keuangan,
persewaan, dan
jasa perusahaan
Berusaha sendiri
INF
INF
INF
INF
INF
INF
INF
INF
Berusaha dibantu buruh tidak
tetap/ tidak dibayar
INF
F
INF
F
INF
F
F
F
Berusaha
dibantu
buruh
tetap/dibayar
2. Info rm a l wo rke rs kno wle dg e a b o ut JKN
Ta b le 2. Distrib usi Ting ka t Pe ng e ta hua n Me ng e na i Ja m ina n Ke se ha ta n Na sio na l se c a ra um um
•
Fro m Biva ria te a na lysis, it wa s fo und tha t o nly tw o o f the c ha ra c te ristic s o f the
p a rtic ip a nts ha ve
a sig nific a nt re la tio nship w ith
the
le ve l o f kno wle d g e
na m e ly
e duc a tio n a nd re so urc e s to o b ta in info rm a tio n a b o ut JKN.
•
Ta b le 3. Distrib usi Ke m a kna a n Ha sil Uji Multiva ria t
•
Fro m ta b le 3, it c a n b e se e n tha t o nly e d uc a tio n ha d me a ning ful re la tio nship with the
kno w le d g e o f the re sp o nd e nt w he re p va lue is 0 , 03 ( le ss tha n the va lue o f
α
= 0.05 ).
Kategori pengetahuan
Frekuensi
%
Baik
0
0
Cukup
16
15,09
Kurang
90
84,91
Total
106
100
Karakteristik
Nilai P
Pendidikan
0,03
3
. Info rm a l Wo rke rs pe rc e ptio n o f JKN : Fe a sib le Mo de l in Re ve nue C o lle c tio n
Ba se d o n ind e p th inte rvie w , in g e ne ra l info rm a l w o rke rs to ta lly a g re e w ith
the im p le m e nta tio n o f JKN a nd w illing to p a rtic ip a te . The p re se nc e o f JKN
c a n a vo id the m fro m c a ta stro p hic he a lth e xp e nd iture .
“
Se tuju. Iy aa, iy aa. Itu kan le b ih jadiny a o rang y ang tidak m am p u itu e e e … b isa dib antu o le h o rang y ang le b ih m am p u. Ya kalau
b e g itu y a dite rusin.
”
(info rm al 7).
In a d d itio n, re sp o nd e nts w e re a lso inte re ste d in b e c o m ing a p a rtic ip a nt
b e c a use JKN is c o nsid e re d to b e d iffe re nt fro m the p riva te insura nc e . The re
a re no m e m b e rship re stric tio ns in it
“
Say a sang at te rtarik, sang at sang at te rtarik lag i b ahkan kan. Kare na ke le b ihanny a b e g ini, JKN dib anding kan p ro duk- p ro duk
y ang lain. Ini y ang dijadikan kata kunc i dari JKN, dalam hal ini adalah jika insuranc e swasta lainny a itu m e lihat b atas um ur, o rang
tua itu le b ih ting g i p re m iny a p e m b ay aranny a, o rang y ang b e risiko se pe rti pe ro ko k dan lain se b ag ainy a le b ih ting g i. Dan JKN itu
tidak ada.
”
(info rm al 3)
Cont…
In te rm s o f m e m b e rship re g istra tio n p ro c e d ure , so m e re sp o nd e nts a g re e d to
c o m e to BPJS Ke se ha a n o ffic e . Ho w e ve r, so m e re sp o nd e nts d id no t a g re e
w ith it
BPJS Ke se ha ta n, sho uld re g iste r pa rtic ipa nt b y using pro a c tive
m e tho ds tha t o ffic e rs we nt to info rm a l se c to r wo rke rs who wish to re g iste r,
a nd re g istra tio n thro ug h the he a d o f the e nviro nm e nt . The re a so n tho se who
disa g re e
c o m e
to
BPJS o ffic e
a re
m a inly
due
to
tim e
a nd
dista nc e
c o nstra ints.
“
Ke ndala JKN itu say a kira adalah pe m e rintah tidak m au m e nje m p ut b o la. Jadiny a m e nung g u aja m asy arakat untuk datang m e ndaftar,
jadi tidak m au datang , m isalny a b e ke rjasam a de ng an ap arat p e m e rintahan te rb awah se p e rti m isalny a ke p ala ling kung an, ke lurahan…
se p e rti itu, ini harus dilib atkan. Yaa.. m e m ang ang g ap lah m e re ka ini se b ag ai te nag a o p e rasio nal dari p e m e rintah… p e m e rintah untuk
m arke ting - ny a g itu y a. Nanti b e rap a m e re ka m e m ang harus m e ndap atkan fe e dan lain se b ag ainy a dib e rikan, se p e rti itu.
”
(info rm al 14)
Mo st o f the re sp o nd e nts a re w illing to jo in a s a m e m b e r o f JKN a nd a ffo rd to
p a y Rp 25.000,-Ho w e ve r, the y a re m o stly re luc ta nt to p a y thro ug h ATM
This
is b e c a use the info rm a l w o rke rs a re no t fa m ilia r w ith Ba nk.
The fe a sib le m o d e l in the re ve nue c o lle c tio n fo r info rm a l w o rke rs is thro ug h
the c o lla b o ra tio n w ith lo c a l b o d y suc h a s
Le m b a g a Pe rkre dita n De sa (LPD) o r
Ko pe ra si Unit De sa .
Discussion
•
This re se a rc h fo und
tha t the m a jo rity o f re sp o nd e nts ha ve le ss kno w le d g e a b o ut
JKN.
Mo re tha n 50% o f re sp o nde nts sta te d no t to kno w m o st o f the sta te m e nts in the
q ue stio nna ire a b o ut JKN. It c a n b e a n indic a to r tha t the disse m ina tio n o f info rm a tio n
re g a rd ing JKN ne e ds to b e im pro ve d, e sp e c ia lly re g a rd ing p a ym e nt pro c e dure s
a nd re g istra tio n pro c e dure s in o rde r to inc re a se p ub lic kno wle d g e a b o ut JKN
Ac c o rd ing to Mub a ra k (2011) in He ria ti (2013) , the re a re se ve ra l fa c to rs tha t a ffe c t
p e o p le in le a rning , suc h a s e d uc a tio n , o c c up a tio n , a g e , inte re sts , e xp e rie nc e s ,
c ultura l e nviro nm e nt , a nd info rm a tio n
•
The re sults o f the stud y ind ic a te tha t the re a re still 39 re sp o nd e nts w ho sta te d tha t
the y we re ne ve r info rm e d a b o ut JKN. The n a ltho ug h 67 re sp o nd e nts ha d re c e ive d
info rm a tio n, b ut no re sp o nd e nts who re c e ive d info rm a tio n fro m JKN g uid e b o o ks
a nd mo re tha n 50 % o f re sp o nd e nts ha ve le ss kno w le d g e fo r e a c h so urc e o f
info rm a tio n
It indic a te s tha t the so c ia liza tio n o f JKN a lso no t o ptim a l.
Cont…
•
The info rm a nts sta te d tha t b e fo re JKN e ra tho se w ho g e t he a lth insura nc e o nly e m p lo ye d , w hile
tra d e rs d o no t g e t he a lth insura nc e .
•
The re fo re , the re sp o nd e nts stro ng ly a g re e d with the JKN w hic h c o ve rs the w ho le o f so c ie ty.
The y a lso w a nt tha t g o ve rnm e nt re a lly c o nc e rn a b o ut info rm a l w o rke rs b e c a use info rm a l se c to r
w o rke rs in De np a sa r w a nting to se c ure the ir he a lth sta tus
This is c o nsiste nt with the re sults o f
re se a rc h a b o ut the o p inio n o f info rm a l se c to r wo rke rs a b o ut he a lth fina nc ing o n So c ia l He a lth
Insura nc e Ba li (JKSB) in 2006, the info rm a l se c to r w o rke rs w ho a g re e to p a rtic ip a te b y 61.4%
(Trisna & Muninja ya , 2007).
•
Info rm a l se c to r wo rke rs in De np a sa r sta te d tha t the a ffo rd a b le a m o unt o f c o ntrib utio ns is Rp
22.800,-fo r the e ntire fa m ily. The d a ta is sup p o rte d b y the re sults o f re se a rc h o n the Ab ility To Pa y
(ATP) o r the a b ility to p a y the p e o p le o f Ba li , he ld in 2006 ( Trisna & Muninja ya , 2007)
This ATP
find ing is no t m uc h d iffe re nt fro m the a m o unts o f fe e s tha t a re c o nsid e re d re a so na b le b y the
info rm a l se c to r wo rke rs in the c ity o f De np a sa r . Thus , info rm a l se c to r wo rke rs a re a b le to re a c h
the a m o unt o f fe e s fo r se rvic e s in the tre a tm e nt ro o m o f c la ss III o r Rp 25.500.00 .
Cont…
•
Me tho d o f p a ym e nt is ve ry d iffic ult fo r the m b e c a use no t a ll info rm a l wo rke rs a re "b a nk
m ind e d ".
•
The re fo re , it is im p o rta nt to invo lve lo c a l Villa g e C re d it Institutio ns (LPD) a nd Ko p e ra si Unit
De sa sinc e this institutio n a va ila b le in e ve ry villa g e in the p ro vinc e o f Ba li a nd hig hly
d e ve lo p e d .
•
This stud y fo und tha t 29.8% o f re sp o nd e nts w a nt sa la ry d e d uc tio n, p a y thro ug h ATMs, a nd is
c o lle c te d b y o ffic e rs d ire c tly to ho m e a s m e tho d o f p a ym e nt.
Conclusion
•
Stud y fo und tha t info rm a l se c to r w o rke rs a re a ll kind s o f m a jo r jo b c la ssific a tio ns b y BPS o f
De np a sa r w ith the sta tus o f o w n w o rk, fre e w o rke rs, a nd the w o rke rs fa m ily / no t p a id ; The m a in
typ e s o f wo rk in the fie ld o f a g ric ulture , m a nufa c turing , a nd c o nstruc tio n e m p lo ym e nt sta tus
so ug ht a ssiste d b y te m p o ra ry w o rke rs; a s w e ll a s the m a in typ e o f wo rk in a g ric ulture with
e m p lo ym e nt sta tus o f w o rke rs / e m p lo ye e s / e m p lo ye e .
•
In g e ne ra l m o st o f info rm a l w o rke rs (90 re sp o nd e nts / 84.91%) ha ve le ss kno w le d g e a b o ut JKN.
This la c k o f kno wle d g e is d ue to the la c k o f so c ia liza tio n a nd no t m a ny re sp o nd e nts ha ve
hig he r e d uc a tio n le ve ls.
•
Info rm a l se c to r wo rke rs g e ne ra lly w a nt to b e a p a rtic ip a nt in JKN a nd a b le to p a y fo r c la ss III
tre a tm e nt, b ut so m e ho p e tha t the p ro c e d ure o f re g istra tio n a nd c o lle c tio n p re m ium o f
p a rtic ip a nts using
“
je m p ut b o la
”
syste m o r w o rking with the villa g e institutio n fo r e xa m p le LPD
