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The Urgency of Health Insurance Literacy for Indonesian People: Between Smoking and Paying JKN Premium

1School of Population and Global Health, University of Melbourne, , Australia

2Australia, Australia

3Research Center for Population, Badan Riset dan Inovasi Nasional, Indonesia

Received: 27 Feb 2022; Published: 28 Dec 2022.
Open Access Copyright (c) 2022 The authors. Published by Faculty of Public Health, Universitas Diponegoro
Creative Commons License This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

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Abstract

Introduction: Declining the rates of smoking among the poor still becomes a challenge for the health sector. Ideally, they can use the money for smoking to pay for their family health insurance premium. This research aimed to analyze how the poor in the informal sector perceived the payment of National Health Insurance (NHI/ JKN) using the cigarette cost.

Methods: Data were collected from focus group discussions (FGD) in three different locations, Deli Serdang, Sumedang Districts and Medan City. Thirty-three informal sector workers with low financial capabilities participated in these FGDs. Health Belief Model was used as the framework for analyzing the data and information. Data analysis was conducted through the content analysis method.

Results: The finding showed that poor people who work in the informal sector gave two different responses regarding the use of cigarette costs for paying the NHI/JKN program premium. The respondents had already an excellent perceived susceptibility and severity both on smoking habits and their low finance condition. They believed that the NHI/JKN benefit was to protect them financially if their family members need medical treatment. However, they had low self-efficacy and high perceived barriers that hinder them from replacing the money for buying cigarettes into paying for NHI/JKN premium.

Conclusion: An approach to the poor people in the informal sector within their local context, is urgently needed to increase their health insurance literacy and knowledge about smoking. 

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Keywords: Health Belief Model, health insurance, the poor, informal worker, smoking

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  1. Boerma T, Eozenou P, Evans D, Evans T, Kieny MP, Wagstaff A. Monitoring Progress towards Universal Health Coverage at Country and Global Levels. PLoS Med. 2014;11(9)
  2. Hogan DR, Stevens GA, Hosseinpoor AR, Boerma T. Monitoring universal health coverage within the Sustainable Development Goals: development and baseline data for an index of essential health services. Lancet Glob Heal [Internet]. 2018;6(2):e152–68. Available from: http://dx.doi.org/10.1016/S2214-109X(17)30472-2
  3. Cendekia DG. Apakah Jaminan Kesehatan Diminati Pekerja Sektor Informal. J Kebijak Kesehat Indones. 2019;08(04):191–5
  4. Finance M of. Sustainable Financing for National Health Insurance to Achieve Universal Health Coverage in Indonesia. Jakarta; 2019
  5. Lagomarsino G, Garabrant A, Adyas A, Muga R, Otoo N. Moving towards universal health coverage: health insurance reforms in nine developing countries in Africa and Asia. Lancet (London, England) [Internet]. 2012 Sep 8 [cited 2019 Mar 19];380(9845):933–43. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22959390
  6. Sparrow R, Poel E Van De, Hadiwidjaja G, Yumna A, Warda N, Suryahadi A. Coping With The Economic Consequences of Ill Health in Indonesia. Health Econ. 2014;23:719–28
  7. Harfina D, Purwaningsih SS, Vibriyanti D, Rahadian AS, Prasetyoputra P, Seftiani S, et al. Pemanfaatan Jaminan Kesehatan Nasional dalam Upaya Meningkatkan Produktivitas Pekerja Sektor Informal. Jakarta; 2019
  8. Dartanto T, Rezki JF, Pramono W, Siregar CH, Usman, Bintara H. National Health Insurance System Participation of Informal Sector Workers in Indonesia ’ s National Health Insurance System. J Southeast Asian Econ. 2016;33(3):317–42
  9. WHO. Tobacco increases the poverty of individuals and families. WHO. 2004
  10. Hiscock R, Judge K, Bauld L. Social inequalities in quitting smoking: What factors mediate the relationship between socioeconomic position and smoking cessation? J Public Health (Bangkok). 2011;33(1):39–47
  11. Hosseinpoor AR, Parker LA, Tursan d’Espaignet E, Chatterji S. Social determinants of smoking in low- and middle-income countries: Results from the world health survey. PLoS One. 2011;6(5)
  12. Amalia B, Cadogan SL, Prabandari YS, Filippidis FT. Socio-demographic inequalities in cigarette smoking in Indonesia, 2007 to 2014. Prev Med (Baltim) [Internet]. 2019;123(May 2018):27–33. Available from: https://doi.org/10.1016/j.ypmed.2019.02.025
  13. van der Eijk Y. Children and vulnerability to tobacco: Emerging issues in Asia. Asian Bioeth Rev. 2015;7(2):164–78
  14. Pribadi ET, Devy SR. Application of the Health Belief Model on the intention to stop smoking behavior among young adult women. J Public health Res. 2020;9(1817):121–4
  15. Sandel M, Renee Boynton-Jarrett. Why do poor people smoke more? [Internet]. CNN. 2014 [cited 2020 Jul 31]. Available from: https://edition.cnn.com/2014/03/26/opinion/sandel-poverty-smoking/index.html
  16. Humpreys K. Why the wealthy stopped smoking, but the poor didn’t [Internet]. The Washington Post. 2015 [cited 2020 Jul 31]. Available from: https://www.washingtonpost.com/news/wonk/wp/2015/01/14/why-the-wealthy-stopped-smoking-but-the-poor-didnt/
  17. Peretti-Watel P, Constance J. “It’s all we got left”. why poor smokers are less sensitive to cigarette price increases. Int J Environ Res Public Health. 2009;6(2):608–21
  18. DeBarr KA. Review of Current Health Education Theories. Californian J Health Promot. 2004;2(1):74–87
  19. Glanz K, Bishop DB. The role of behavioral science theory in development and implementation of public health interventions. Annu Rev Public Health. 2010;31:399–418
  20. Scarinci IC, Bandura L, Hidalgo B, Cherrington A. Development of a Theory-Based (PEN-3 and Health Belief Model), Culturally Relevant Intervention on Cervical Cancer Prevention Among Latina Immigrants Using Intervention Mapping. Health Promot Pract [Internet]. 2012;13(1):29–40. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3624763/pdf/nihms412728.pdf
  21. Renuka P, Pushpanjali K. Effectiveness of Health Belief Model in Motivating for Tobacco Cessation and to Improving Knowledge, Attitude and Behavior of Tobacco Users. Cancer Oncol Res [Internet]. 2014;2(4):43–50. Available from: http://www.hrpub.org
  22. Balbach ED, Smith EA, Malone RE. How the health belief model helps the tobacco industry: Individuals, choice, and “information.” Tob Control. 2006;15(SUPPL. 4):37–43
  23. Champion VL, Skinner CS. The Health Belief Model. In: Glanz K, Rimer B k., Viswanath K, editors. HEALTH BEHAVIOR AND HEALTH EDUCATION Theory, Research, and Practice. 4th ed. John Wiley & Sons, Inc; 2008. p. 45–62
  24. Jones CL, Jensen JD, Scherr CL, Brown NR, Christy K, Weaver J. The health belief model as an explanatory framework in communication research. Health Commun. 2015;30(6):566–76
  25. Creswell JW, Poth CN. Qualitative Inquiry and Research Design Choosing Among Five Approaches [Internet]. Fourth. SAGE Publications, Inc; 2017 [cited 2020 Aug 5]. Available from: https://us.sagepub.com/en-us/nam/qualitative-inquiry-and-research-design/book246896#contents
  26. Castleberry A, Nolen A. Thematic analysis of qualitative research data: Is it as easy as it sounds? Curr Pharm Teach Learn [Internet]. 2018;10(6):807–15. Available from: http://dx.doi.org/10.1016/j.cptl.2018.03.019
  27. Bärnighausen T, Liu Y, Zhang X, Sauerborn R. Willingness to pay for social health insurance among informal sector workers in Wuhan, China: A contingent valuation study. BMC Health Serv Res. 2007;7:1–16
  28. Intiasari AD, Aji B, Masfiah S, Trisnantoro L, Hendrartini J. A study of ability to pay and willingness to pay of national health insurance voluntaryparticipant in rural area. Ann Trop Med Public Heal. 2019;22(11)
  29. Memon A, Rogers I, Sidebotham J, Sundin J, Rumsby E, Parker S. Which personal, behavioural, environmental, and social factors are important in smoking cessation and relapse in male manual workers? A qualitative study in southeast England. Lancet. 2018 Nov;392:S64
  30. Lydon DM, Howard MC, Wilson SJ, Geier CF. The perceived causal structures of smoking: Smoker and non-smoker comparisons. J Health Psychol. 2016;21(9):2042–51
  31. Thabrany H. Jaminan Kesehatan Nasional. Jakarta: PT Raja Grafindo Persada; 2014
  32. Hidayat B, Thabrany H. Cigarette smoking in Indonesia: Examination of a myopic model of addictive behaviour. Int J Environ Res Public Health. 2010;7(6):2473–85
  33. Delmerico J, Hyland A, Celestino P, Reid M, Cummings KM. Patient willingness and barriers to receiving a CT scan for lung cancer screening. Lung Cancer. 2014;84(3):307–9
  34. Kaufman AR, Dwyer LA, Land SR, Klein WMP, Park ER. Smoking-related health beliefs and smoking behavior in the National Lung Screening Trial. Addict Behav [Internet]. 2018;84:27–32. Available from: https://doi.org/10.1016/j.addbeh.2018.03.015
  35. Milcarz K, Polańska K, Balwicki Ł, Makowiec-Dąbrowska T, Hanke W, Bąk-Romaniszyn L, et al. Perceived barriers and motivators to smoking cessation among socially-disadvantaged populations in Poland. Int J Occup Med Environ Health. 2019;32(3):363–77
  36. Wekke IS, Cahaya A. Fishermen Poverty and Survival Strategy: Research on Poor Households in Bone Indonesia. Procedia Econ Financ. 2015;26:7–11
  37. Septiono, W., Kuipers, M. A., Ng, N., & Kunst, A. E. (2020). Changes in adolescent smoking with implementation of local smoke-free policies in Indonesia: Quasi-experimental repeat cross-sectional analysis of national surveys of 2007 and 2013. Drug and Alcohol Dependence, 209, 107954
  38. Abidin, L. S., Fitriyani, P., & Setiawan, A. (2019). Correlations between adolescents’ perceptions of family health tasks and adolescents’ smoking behaviors in Indonesia. Enfermería Clínica. doi: 10.1016/j.enfcli.2019.04.0
  39. Berkman, D Nancy., C. Davis, Tery., McCormack, Lauren. (2010) Health Literacy: What Is It?, Journal of Health Communication, 15:S2, 9-19, DOI: 10.1080/10810730.2010.499985
  40. Aryanty. (2019). Kesehatan, Reproduksi, Ibu, Neonata, Anak dan Remaja. https://flexiwork.bappenas.go.id/docs/pub/67f5d869d553c27458e41373a8bae512/default/?&. Kementrian PPN / Bappenas
  41. KEMENTERIAN PEMBERDAYAAN PEREMPUAN DAN PERLINDUNGAN ANAK dengan BADAN PUSAT STATISTIK. (2019). Profil Anak Indonesia. https://www.kemenpppa.go.id/lib/uploads/list/15242-profil-anak-indonesia_-2019.pdf

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