Articles

Service Quality, Citizen Satisfaction, and Citizen Participation: Evidence from Independent (PBPU) Members of Indonesia’s National Health Insurance Program

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Universal health coverage schemes in developing countries face a recurring sustainability problem: keeping voluntarily enrolled members active once they have joined. This study investigates how the five dimensions of service quality proposed in the SERVQUAL framework, namely tangibles, reliability, responsiveness, assurance, and empathy, shape the satisfaction of independent participants (Pekerja Bukan Penerima Upah/PBPU) of Indonesia’s Jaminan Kesehatan Nasional (JKN) programme administered by BPJS Kesehatan, and whether this satisfaction subsequently drives citizen participation. Data were obtained from 180 PBPU participants who had used BPJS Kesehatan services at least twice, selected through purposive sampling, and analyzed with Partial Least Squares Structural Equation Modeling (PLS-SEM) in SmartPLS. All five service-quality dimensions were found to exert a significant positive effect on citizen satisfaction, with responsiveness and empathy showing the strongest influence, while citizen satisfaction in turn had a strong positive effect on citizen participation and fully mediated the link between each service-quality dimension and participatory behavior. The measurement model satisfied established criteria for convergent and discriminant validity, and the structural model showed adequate explanatory and predictive relevance. The findings extend the SERVQUAL framework and expectation confirmation theory into the domain of participatory behavior and provide BPJS Kesehatan with practical direction for strengthening service delivery to sustain long-term member engagement.

Factor Analysis Which Influential on Compliance Paying Contributions to Independent BPJS Participants in the Working Area of The Kolono Community Health Center South Konawe Regency in 2025

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Background: The National Health Insurance (JKN) program organized by the Social Security Agency (BPJS) Health has a strategic role in ensuring fair, equitable, and sustainable access to health services for all Indonesians. However, the level of compliance with BPJS Mandiri participant contributions remains a problem, especially in areas with limited access to health services and diverse socio-economic conditions. Low compliance with contribution payments can impact the sustainability of the national health insurance system financing.

Objective: This study aims to analyze the factors that influence compliance with BPJS Mandiri participant contributions in the Kolono Community Health Center working area, South Konawe Regency, in 2025.

Method: The study used a quantitative approach with a cross-sectional design. The research sample consisted of 48 respondents selected through a non-probability sampling technique. Data collection was carried out using a structured questionnaire that measured motivation variables, perceptions of BPJS Kesehatan, distance to health care facilities, and income levels. Data were analyzed using statistical tests to see the relationship between independent variables and compliance with contribution payments. Results: The study showed that motivation had a significant relationship with compliance with premium payments (p = 0.046; r = 0.246), although with a weak relationship strength. Participant perceptions were significantly related to compliance (p = 0.000; r = 0.566) with a moderate level of relationship. Distance to health service facilities also showed a significant relationship (p = 0.000; r = 0.576), confirming the importance of service accessibility. In addition, income was significantly related to compliance with premium payments (p = 0.003; r = 0.374).

Discussion: Simultaneously, these four variables contributed 52.8% to compliance with BPJS Mandiri premium payments.

Conclusion: These findings indicate that increasing compliance requires a comprehensive approach through education, improving service quality, and policies that expand access and financial support for low-income communities.