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

Abstract
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

Journal
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. https://doi.org/10.1108/IJHG-05-2019-0028

Pre-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 https://doi.org/10.31227/osf.io/fvtjg

Transparency
All data generated or analysed during the current study are available at https://osf.io/gsd5t/

Acknowledgements
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.

Teliti tentang Gender Leadership, Peneliti ACeHAP Terpilih Menjadi WHO-SEARO Research Fellow

Nuzulul (Berjilbab) berpose bersama para peneliti gender dan feminist India.

Nuzulul Kusuma Putri, salah satu peneliti di ACEHAP, terpilih menjadi research fellow pada program WHO-SEARO research fellowship program “Strengthening gender equity and intersectionality in Health Policy and Systems Research”. Program ini telah memilih sembilan orang peneliti dari berbagai negara seperti Indonesia, India, Bangladesh, Srilanka, dan Nepal melalui seleksi yang ketat terhadap lebih dari 50 peneliti yang mengajukan ketertarikannya pada isu ini.

Program ini merupakan hasil kerjasama WHO-SEARO dengan Public Health Foundation of India yang dilaksanakan mulai 2019 hingga 2020. Tujuan program ini adalah memberikan penguatan kapasitas peneliti kesehatan dalam menggunakan kerangka berpikir gender intersectionality dalam menganalisis sistem kesehatan. Setiap research fellow selanjutnya mendapatkan research grant untuk mengkaji isu gender dalam sistem kesehatan.

Penelitian sebelumnya yang telah dilakukan oleh Nuzulul menunjukkan bahwa glass ceiling terjadi di dalam suksesi para manajer kesehatan di Indonesia. Banyak tenaga kesehatan maupun manajer kesehatan di Indonesia adalah seorang perempuan namun hanya sedikit yang akhirnya dipromosikan menjadi jenjang pengambil kebijakan yang lebih tinggi. Hasil penelitian inilah yang ditawarkan oleh Nuzulul untuk dijadikan bahan kajian dalam research fellowship program ini. Nuzulul menawarkan ide untuk menganalisis pengaruh glass-ceiling dan keterwakilan gender ini terhadap responsivitas program kesehatan dalam mengatasi masalah gender. Hingga saat ini, perencanaan program kesehatan masyarakat masih sangat minim dianalisis menggunakan lensa gender, padahal mayoritas masalah kesehatan masyarakat tidak gender-neutral.

Kajian Nuzulul ini terhadap isu akan disajikan dalam website ACEHAP selanjutnya.

Diseminasi Hasil Penelitian, ACeHAP dan CISDI Sepakati Joint Research

Sebagai tindak lanjut penelitian tahun 2018 tentang collaborative leadership skills pada gerakan sosial berbasis tim di Indonesia, ACeHAP diwakili oleh Nuzulul Kusuma Putri, initiative leader ACeHAPuntuk healthcare leadership issue, mendiseminasikan hasil penelitiannya (4/4/2019) kepada Center for Indonesia’s Strategic Development Initiatives (CISDI).

CISDI merupakan organisasi yang mencetuskan inovasi gerakan Pencerah Nusantara. Hingga April 2019, CISDI setidaknya telah mengelola enam angkatan Pencerah Nusantara yang telah tersebar di Daerah Terpencil Perbatasan dan Kepulauan yang ada di Indonesia.

Tenaga kesehatan dalam gerakan ini bekerja dalam tim lintas profesi. Dalam kajian cross-professional team working, tim sangat rentan memiliki perbedaan pendapat antar anggota. Self-leadership dibutuhkan agar setiap individu dalam tim dapat menyesuaikan diri berkinerja sesuai dengan budaya tim. Sudah menjadi rahasia umum juga bahwa pengelolaan tenaga kesehatan di DTPK selalu dihantui oleh turnover rate tenaga kesehatan yang cukup tinggi. Oleh karena itu, konsep gerakan sosial untuk penataan sumber daya kesehatan di DTPK seperti Pencerah Nusantara ini mulai banyak direplikasi, salah satunya oleh Nusantara Sehat yang dibesut Kementerian Kesehatan.

ACeHAP menggandeng CISDI untuk melakukan analisis menjawab tantangan tersebut. Setidaknya 80% dari tenaga kesehatan yang tergabung dalam Pencerah Nusantara angkatan 5 berpartisipasi dalam penelitian yang telah dilakukan di tahun 2018.

Hasil penelitian menunjukkan bahwa Pencerah Nusantara telah mampu menyediakan sistem kerja yang menjamin  kepuasan kerja tenaga kesehatan. Hampir 75% dari tenaga kesehatan yang saat ini bertugas menyatakan keinginannya untuk kembali bergabung dalam gerakan sosial ini. Penelitian yang dilakukan oleh Nuzulul Kusuma Putri dan Ilham Akhsanu Ridlo ini juga menemukan bahwa kemampuan komunikasi interpersonal merupakan penentu utama keberhasilan kolaborasi lintas profesi. Sementara ada kualitas personal khusus yang ternyata secara signifikan menentukan kemampuan komunikasi ini.

Diseminasi ini dihadiri oleh tim koordinator Pencerah Nusantara dari berbagai divisi. Di akhir diskusi, ACeHAP dan CISDI sepakat untuk melanjutkan kerjasama penelitian menjawab bagaimana membuat komposisi tim yang paling pas untuk menghasilkan outcome yang maksimal. Jalinan kerjasama ini juga direncanakan terus berlanjut dengan kesempatan magang yang diberikan oleh CISDI bagi para research assistants di ACeHAP untuk lebih mengenal pengelolaan Pencerah Nusantara.

Kajian lengkap mengenai penelitian ini dapat disimak dalam publikasi kami selanjutnya. Instrumen dan laporan penelitian dapat diakses melalui permintaan kepada ACeHAP.

The Changing Nature of CampusHealth Insurance: Testing Portability Issues of National Health Insurance

Abstract:
Before National Health Insurance was implemented, the majority of leading universities in Indonesia already covered their studentswith a health insurance scheme. They managed their own campus health insurance independently. Both National Health Insurance in 2014 and single tuition policy in 2015 brought huge change to campus health insurance. This study aims to analyse students’ needsin health insurance after implementation of these policies. This is an exploratory study with cross-sectional design. The sample was taken by voluntary sample through online questionnaire. There were 83 students across different academic degree participated in this study. Most of the students (65.1%) came from various districts outside the campus district and chose to reside in boarder houses around the campus. There were only 52.9% of the students already listed as National Health Insurance participants. Out-of-pocket risk belongs to 35.5% students who were not covered by health insurance at all. Almost all of the students who already participated in National Health Insurance (93.3%) were registered in the primary healthcare in their hometown. The students are already paying for single tuition which does not accommodate health insurance. A real changing need of migrant students for health insurance coverage exists in the National Health Insurance era. 1INTRODUCTIONUniversal Health Coverage swept many countries in the last decade, including Indonesia. Even though Indonesia is the biggest archipelago country with a widely dispersed territory, National Health Insurance is chosen as the health insurance mechanism ratherthan region-based insurance. This decision has consequences in the portability challenges of the preferred health insurance scheme. Previous region-based health insurance mechanisms already implemented by local government should be merged into a national scheme. It should enable not only raising the poolinglevel in local government, but also maintaining the cross-regional participation transfer (Pan et al., 2016).Previously, the majority of universities in Indonesia had institutionally managed health services for their students before the enactment of the National Health Insurance. The provision of this health service is funded through a student health insurance scheme that is managed independently by the university and which is limited only for students in the university. Student health insurance is regulated through the policy of each rector. Generally, this fund pooling is collected through a semi-annual contribution in addition to the tuition fee. These funds are managed to finance the health of students during their education. However, in accordance with the mandate of the Ministry of Education, universities are not permitted to collect additional fees outside the national rate. However, the calculation of this national rate does not accommodatestudent healthcare insurance. The National Health Insurance that was launched one year previously also makes this situation more complicated. The availability of parental health insurance can have significant effects on the probability that a young individual enrols as a full-time student in university (Jung et al., 2013). Unfortunately, there is no individual student membership in National Health Insurance. To be able to be covered by National HealthInsurance, students should be registered with all of their family members. The huge variations of health insurance mechanisms bring many obstacles to the citizens who wish to temporarily move to another region for some years. In Indonesia, young adults from rural regions who have just graduated from senior high

Putri, N. and Ernawaty, .The Changing Nature of Campus Health Insurance: Testing Portability Issues of National Health Insurance.InProceedings of the 4th Annual Meeting of the Indonesian Health Economics Association (INAHEA 2017), pages 14-19ISBN: 978-989-758-335-3Copyright©2018 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved Mark as interesting Comment Delete highlight
(1) (PDF) The Changing Nature of Campus Health Insurance: Testing Portability Issues of National Health Insurance. Available from: https://www.researchgate.net/publication/329217279_The_Changing_Nature_of_Campus_Health_Insurance_Testing_Portability_Issues_of_National_Health_Insurance [accessed Mar 30 2019].

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

Abstract
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.