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.

#CondomEmoji: Are urban Indonesians receptive to a social media-based campaign for safer sex?

Abstract Purpose
The purpose of this paper is to explore participants’ attitudes and receptivity to a #CondomEmoji campaign insofar as investigating whether attitudes and receptivity were important predictors for brand impression and intention to buy. Design/methodology/approach – This study involved 206 research participants who live in Jakarta and Surabaya and who answered online questionnaires to measure attitudes, receptivity to #CondomEmoji advertising, brand impression and intention to buy condoms. Questionnaires were circulated on several social media platforms and instant messaging apps. The participants were asked to watch the #CondomEmoji advertising video before proceeding to fill out the questionnaires. Findings – Research findings suggested that participants mostly held negative attitudes and receptivity to the campaign. Non-sexually active participants were more likely to perceive the advertising as offensive. Attitudes and receptivity were good predictors for brand impression, yet attitude was not significantly attributed to intention to buy condoms. The result was stronger in sexually active participants. Research limitations/implications – Non-sexually active young people need to be more informed about healthy sexual behavior so that they would not feel embarrassed to discuss and ask about sexual behavior. A socially acceptable condom-use advertising campaign needs to be conducted to lessen the resistance of conservative audiences.
This paper offers an insight into how conservative audiences may respond to social-media-based campaign of safer sex.
Keywords: Social marketing, Attitudes, Health media
Paper type: Research paper

Protecting those who care: The characteristics of occupational Tuberculosis risk in health care workers

Nosocomial TB infection remains an urgent public health problem that requires relentless efforts to overcome. In general, health care workers (HCWs) have a significantly higher risk of suffering from active and latent TB owing to their daily occupational TB risk exposure. The risk is indeed more severe in high TB burden countries, such as Indonesia. In this research, we aimed to: (1) investigate the underlying factor structure of risk characteristics, specifically the risk of nosocomial TB transmission in health care facilities; (2) estimate the effects of work-related determinants and risk characteristics on risk perception; and (3) compare occupational risk perception of contracting TB with expert risk assessment. A paper-based questionnaire was administered to 179 HCWs working for ten public health centres and two hospitals in Surabaya, Indonesia. An exploratory factor analysis of nine risk characteristics revealed a two-factor solution (knowledge-evoked dread and controllability of damage). Structural equation modelling indicated a piece of suggestive evidence that controllability of damage positively affected risk perception, while knowledge-evoked dread did not. Perceived safety conditions yielded a positive and moderate association to controllability of damage, implying that safety infrastructure could be perceived as ‘a cue’ to the presence of a dangerous hazard. The intensity of exposure to TB patients was negatively correlated with the controllability of damage. This indicates that more experience in handling TB patients could lead to underestimation of risk. Our research showed that HCWs tended to accurately estimate the risk of contracting TB based on their specific profession/duties, yet overestimated the risk of contracting TB when it was aggregated to the health care facility level. Although further research is necessary, to include the prevalence of latent/active TB as a part of risk assessments, our research highlights the importance of addressing risk perception, especially encouraging HCWs to become more active in advocating for the required allocation resources for their workplaces or even aiding in raising communities’ awareness of TB transmission.

Do Justice and Trust Affect Acceptability of Indonesian Social Health Insurance Policy? A cross-sectional survey of laypeople and health care workers

After two bills passed in 2004 and 2011, a nation-wide social insurance in Indonesia has formally established. Aiming at a universal health coverage in 2019, the Jaminan Kesehatan Nasional (JKN) will cover almost 260 million Indonesians and be one of the biggest single payer national health insurance scheme in the world. Our research attempted to investigate whether justice, trust to health care services, confidence level of health system, political party support and evaluation of health care services post-JKN affected policy acceptability in our health workers (N=95) and laypeople (N=308) sample. A-two level multilevel modelling in our health worker sample revealed that justice negatively correlated to policy acceptability, while confidence to health system and institutions as well as evaluation of health care service post-JKN yielded positive correlation. In our laypeople sample, trust to health care service and evaluation of health care service post-JKN were positively affected policy acceptability. In this paper, we discussed why justice matters to a positive policy acceptability for health workers, but not for laypeople. We also discussed the possibility of laypeople’s pragmatic motives of joining JKN scheme.