Do justice and trust affect acceptability of Indonesian social health insurance policy?

Purpose – The purpose of this paper is to investigate whether justice, trust in healthcare services, the confidence level of the health system and institutions, political party support and evaluation of healthcare services post-Jaminan Kesehatan Nasional ( JKN) affected policy acceptability (PA) in the health workers (n¼95) and laypeople (n¼308) sample.
Design/methodology/approach – The authors performed a two-level, linear mixed-effects model to test the hypothesis that trust, perceived justice, confidence in healthcare services and national health system evaluation could impact PA in the health workers and laypeople sample. The authors calculated the effect sizes by comparing Level 2 variances and residuals of the null model and the random intercept model.
Findings – The findings suggested that healthcare workers with high concern for justice would be more likely to hold negative acceptability to JKN. The findings implied that health workers tend to associate JKN with unfairness. Also, JKN acceptability in laypeople sample was found to be positively associated with the evaluation of healthcare service post-JKN, whereas justice or political party support did not affect JKN acceptability. It might indicate that laypeople motives for joining JKN scheme could be essentially pragmatic.
Research limitations/implications – The authors administered the questionnaire using an online platform and circulated it through social media and IMS, so that this research poses a problem of self-selection bias, which potentially leads to biased estimates. The authors also oversampled female participants, especially in laypeople sample.
Originality/value – Aiming at universal health coverage in 2019, JKN will cover almost 300m Indonesians and be one of the biggest single-payer national health insurance scheme in the world. The research might offer insight into how health workers and laypeople respond to the policy.
Keywords- Health policy, Patient perspectives, Quantitative research, Public health regulations,
Determinants of health, Health insurance plans

Zein, R., Putri, N. and Ridlo, I. (2019), “Do justice and trust affect acceptability of Indonesian social health insurance policy?”, International Journal of Health Governance, Vol. ahead-of-print No. ahead-of-print.

Has supplemental materials for Do Justice and Trust Affect Acceptability of Indonesian Social Health Insurance Policy? A cross-sectional survey of laypeople and health care workers on INA-Rxiv at

All data generated or analysed during the current study are available at

No competing interest is declared by the authors. Universitas Airlangga funded this study under University Research Grant Scheme (Grant No. 886/UN3/2018). The research was conducted in accordance with Helsinki Declaration and Indonesian Psychological Association Code of Conduct (2010); however, observational studies are typically not required for ethical clearance in Universitas Airlangga. Before participating, the authors gave prospective participants detailed information about the study and the opportunity to raise questions. Before the participants proceeded to the questionnaire pages, they were required to give consent by clicking on “I agree” button.