Proceedings of the Asia Pacific Industrial Engineering & Management Systems Conference 2014

Willingness to pay for BPJS Health Insurance: Findings from an

Exploratory Study
Nia Budi Puspitasari, Purnawan Adi Wicaksono, Aries Susanty, Petty Pimatury A. P.
Department of Industrial Engineering
Diponegoro University, Semarang, Indonesia
Tel: (+62) 8-572-747-5744, Email: niabudipuspitasari@gmail.com; ariessusanty@gmail.com, nawanadi@gmail.com;
petty.anjani@gmail.com

Abstract. Badan Penyelenggara Jaminan Sosial /National Social Security Agency (BPJS) is a public agency
established to implement the social security program. It consists of the BPJS for Health and the BPJS for
Manpower. The BPJS for Health is expected to commence on 1 January 2014. The health insurance prepared
through BPJS is in the form health protection for participants to get health care benefits and protection to meet
the basic needs of health care. It is provided to every person who has paid fees or whose contributions are paid
by the government. This study is performed to assess the willingness of Indonesian to participate in a BPJS
health. A cross-sectional study was performed between April and May 2014 with 246 randomly selected
respondents using the two-stage cluster sampling method. The respondents were asked the person’s willingness
to pay for the described BPJS plan and then assessed using the contingent valuation method in an ex-ante
bidding game approach until the maximum amount they would be willing to pay to obtain such a service was
agreed upon. In the conclusion, our study findings suggest that slightly most of the participants (36.6%)
preferred to pay the premium rate at 25,500 IDR. This study also found that the average monthly amount of the
Indonesian people to join BPJS for Health program were willing to pay was estimated to be 77,437.50 IDR for
group 1 participants, 47,946.43 IDR for the group 2 participants and 30,450 IDR for the group 3 participants for
BPJS for Health program. Based on the likelihood ratio test, the result shown that all the hypothesized factors
simultaneously and significantly affected the willingness of Indonesian to pay the premium rate of BPJS for
health program. Those who have attained higher education and have occupation would be more likely to join
BPJS for Health program.

Keywords: Badan Penyelenggara Jaminan Sosial /National Social Security Agencies (BPJS); Willingness
to Pay, Contingent Valuation Method; Services Promised

1. INTRODUCTION protection to meet the basic needs of health care. It is

Based on WHO definition, health is a state of complete
physical, mental, and social wellbeing, and not merely the
absence of disease or infirmity. A person can’t be
considered as a healthy person once he or she does not
suffer from mental or physical illness (Slamet, 2009).
Indonesia is one of developing country that concern about
its people health problem. One of the government ways that
provide Indonesian peoples' health has established an
institution called National Social Security Agency/ Badan
Penyelenggara Jaminan Sosial (BPJS).
BPJS is a public agency established to implement the
social security program. It consists of the BPJS for Health
and the BPJS for Manpower. The BPJS for Health is
expected to commence on 1 January 2014. The health
insurance prepared through BPJS is in the form health
protection for participants to get health care benefits and
provided to every person who has paid fees or whose
contributions are paid by the government. All Indonesian
citizens must become the participants of health insurance
managed by BPJS. This also applies to foreigners who have
worked in Indonesia at least for 6 months and already paid
health insurance fees. BPJS participants are divided into
two groups, i.e.:
1. Contribution Assistance Recipients (PBI) including the
poor, near poor and totally disabled persons as stipulated
in SJSN Law whose contributions are paid by the
government.
2. Non PBI participants, consisting of wage workers and
their family members, as well as non-wage workers and
their family members.
Wage workers are people who work and receive wages
or salaries, such as: civil servants, members of the
Indonesian Armed Forces, police, state officials, and others

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who meet the criteria as wage workers. Non-wage workers
are people who work outside employment relations or
independent workers. Nonworkers are people who don’t
work, but are able to pay health insurance tuition. Including
in this group are investors, employers, pension recipients,
veterans, and pioneers of independence) or other non-
workers who can meet the criteria as wage workers. The
membership of Health BPJS for all Indonesian citizens is
compulsory even if they already have other health
insurance. According to the agreement and decisions of the
Indonesian government for wage worker participants and
non-wage worker ones who have family members more
than five persons, including the participants themselves, the
rate of health insurance’s tuition or the amount of money
that must be paid regularly by participants, employers,
and/or the government for the health insurance’s program
can be described as follows:
1. 25,500 IDR per person per month, for participants who
wish to have healthcare treatment in class III
2. 42,500 IDR per person per month, for participants who
wish to have healthcare treatment in class II
3. 59,500 IDR per person per month, for participants who
wish to have healthcare treatment in class I
The rate of health insurance’s tuition or the amount of
money that must be paid regularly by participants is an
important thing that influenced the success of the BPJS
program. One of the causes of the country budget
increasing for health insurance programs each year is the
lack of people participating in paying the premium for
health insurance programs (Handayani, 2013).
People participations in paying the premium rates
depend on their willingness to pay (WTP). WTP amount
always affected by some factors. Research in Malaysia
showed that marital status and education are some factors
that affected the Malaysia WTP for voluntary community-
based health insurance (VCHI) Plan. Those who are
married and have attained higher education levels would be
more likely to choose VCHI those others. The WTP amount
is higher for those who have current health insurance,
higher incomes and are of Chinese ethnicity, but decreases
for those who are married (Shafie and Hasali, 2013). Other
factors that affected the WTP for health insurance is
monthly income, so that the premium needs to be adjusted
for monthly income (Dong et al., 2005). As income
increases, or the proportion of unemployed household
members drop, people are willing to pay higher premiums
for health insurance (Okyere et al., 1997). Another research
conducted in developing country, India, showed the result
that Nominal WTP correlates positively with income and
household composition did not affect WTP. However, HHs
that experienced a high-cost health event and male
respondents reported slightly higher WTP (Dror et al.,
2006).
This study’s primary objective was to explore the
willingness of Indonesian to pay the premium rate of BPJS
for Health program and the factors that affect their
willingness to pay (WTP).
2. LITERATURE REVIEW
2.1 Willingness to Pay
WTP would be individuals willing to pay for a particular
product or good. In Health insurance case, WTP is the
amount of money an individual is willing to pay as a
premium (Wright et al., 2009).
2.1 Contingent Valuation Method
Establishing a price for a product is not always as
straight forward as finding the intersection point of the
supply and demand curves as taught in Microeconomics
101. One may run into particular difficulties when
attempting to price a product which is a public or non-
market good. Numerous methods have attempted to solve
this problem, e.g. hedonic pricing, cost-benefit analysis,
travel cost and cost-effectiveness to name a few (Asfaw and
von Braun, 2005). Much of the current WTP literature uses
CV method which elicits directly what individuals would be
willing to pay for a particular product or good (Wright et al.,
2009). Most researchers, however, agree that if prevailed
preferences or market situations cannot be directly observed
or if the item under consideration is not traded in a real
market, CV methods are the best alternative to assess the
value of public or non-traded goods and services. It is
argued that in spite of the fact that the CV methods have
their own limitations, there is no sufficient evidence to
reject the results of carefully designed and executed CV
experiments and the results can be proven to be consistent
with economic theory and other requirements (Cameron,
1991; Carson, 1997; Hanemann et al., 1991; Kristrӧm, 1990;
Neumann and Johannesson, 1994; Randall, 1997).
2.3 Multinomial Logit Regression
Multinomial logistic regression is used to predict the
categorical placement in or the probability of category
membership on a dependent variable based on multiple
independent variables. The independent variables can be
either dichotomous (i.e., binary) or continuous (i.e., interval
or ratio in scale). Multinomial logistic regression is a simple
extension of binary logistic regression that allows for more
than two categories of the dependent or outcome variable.
Like binary logistic regression, multinomial logistic
regression uses maximum likelihood estimation to evaluate
the probability of categorical membership. Multinomial
logistic regression does necessitate careful consideration of
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the sample size and examination for outlying cases. Like (b) No Chronic Disease
other data analysis procedures, initial data analysis should 6. Household composition
be thorough and include careful univariate, bivariate, and (a) 1-2
multivariate assessment. Specifically, multicollinearity
(b) 3-5
should be evaluated with simple correlations among the
independent variables. Also, multivariate diagnostics (i.e. (c) >5
standard multiple regression) can be used to assess for 7. Health Insurance Status
multivariate outliers and for the exclusion of outliers or (a) Have/ Ever Have Current Health Insurance
influential cases. Sample size guidelines for multinomial (b) No Current Health Insurance
logistic regression indicate a minimum of 10 cases per
independent variable (Schwab, 2002). 3.2 Data Collection

3. METHOD In this paper, the Contingent Valuation method is used

to study the willingness of Indonesian to pay the premium
3.1 Variables rate of BPJS for Health program.
In the first stage of CVM was creating a hypothetical
The variables in this study can be described as follows: market. In this stage, the information should give to
 Dependent Variable respondents about all aspects of the hypothetical market and
The dependent variable is the presumed effect in this place the respondents in a market like the situation to be
study. The values of the dependent variable depend able to purchase the targeted products. The survey
upon another variable, the independent variable. instrument that used in this study is a questionnaire. In the
Dependent variable used in this study are divided into questionnaire, each individual is asked about their WTP.
three categories, i.e.: There are several ways to ask the participants about their
1. For those who pay 59,500 IDR/person/ month. WTP, e.g. bidding game, close ended referendum, payment
2. For those who pay 42,500 IDR/ person/ month. card, and open ended question. After the value of WTP
3. For those who pay 25,500 IDR/ person/ month. obtained, then the average of the WTP value calculated
 Independent Variable using this following equation
The independent variable is the presumed cause in this
study. All other variables that may impact the dependent (1)
variable are controlled. The values of the independent
variable are under experimenter control. Independent This study was performed in one of the islands in
variable in this study consists of seven variables, i.e.: Indonesia, Java Island, between April and May 2014. A
1. Occupation :
sample size of 246 was calculated as optimal based on a 5%
(a) Unoccupied margin of error and a 95% confidence interval. The
(b) Employee participants were randomly selected by two-stage cluster
(c) Entrepreneur sampling because the objects located apart geographically.
2. Monthly Income: In the first stage, based on historical data, Java Island is
(a) < 600,000 IDR chosen because having the largest number of participants
(b) 600,000 IDR-2,000,000 IDR for Jamkesmas (National Health Insurance for the Poor and
(c) 2,000,000 IDR-5,000,000 IDR Near Poor) program in 2010. In the second stage, the
(d) > 5,000,000 IDR respondents collected from each province in the Java Island.
3. Marital Status
4. RESULTS
(a) Single
(b) Married A total of 246 participants were approached, 67
(c) Divorces participants were from East Java, 58 respondents were from
4. Educational Background Central Java, 7 participants were from Yogyakarta, 19
(a) Elementary School participants were from Banten, 77 participants were from
(b) Junior High School West Java, and 18 participants were from DKI Jakarta. Of
(c) Senior High School the 246 participants, 137 (55.7%) were male and 109
(44.3%) were female. The majority of whom had a monthly
(d) University
income of 2,000,000 IDR-5, 000,000 IDR and 64.6%
5. Health status participants were married with the majority of the
(a) Have Chronic Disease household composition were 3-5 (See Table 1).

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Table 2: Sociodemographic characteristic of each

Table 1: Sociodemographic characteristic of the sample participant group

Marginal Group 1 Group 2 Group 3

Variable N Variable
Percentage N (%) N (%) N (%)
Male 137 55.7% Unoccupied 0 (0%) 1 (1.2%) 11 (12.2%)
Gender Occupation Employee 48 (66.7%) 58 (69.0%) 52 (57.8%)
Female 109 44.3%
Entrepreneur 24 (33.3%) 25 (29.8%) 27 (30.0%)
IDR 59,500 72 29.3% < 600,000 IDR 0 (0%) 3 (3.6%) 15 (16.7%)
Premium Rate 42,500 IDR 84 34.1% 600,000 IDR –
3 (4.2%) 17 (20.2%) 52 (57.8%)
2.000,000 IDR
25,500 IDR 90 36.6%
Monthly 2,000,000 IDR
Unoccupied 12 4.9% Income –5,000,000 26 (36.1%) 62 (73.8%) 21 (23.3%)
Occupation Employee 158 64.2% IDR
>5,000,000
Entrepreneur 76 30.9% 43 (59.7%) 2 (2.4%) 2 (2.2%)
IDR
< 600,000 IDR 18 7.3% Single 14 (19.4%) 25 (29.8%) 32 (35.6%)
Marital
600,000 IDR – 2.000,000 IDR 72 29.3% Married 51 (70.8%) 57 (67.9%) 51 (56.7%)
Monthly Income status
2,000,000 IDR –5,000,000 IDR 109 44.3% Divorced 7 (9.7%) 2 (2.4%) 7 (7.8%)
Elementary
>5,000,000 IDR 47 19.1% 0 (0%) 0 (0%) 8 (8.9%)
School
Single 71 28.9% Last Junior High
0 (0%) 3 (3.6%) 17 (18.9%)
Marital status Married 159 64.6% Educational School
Background Senior High
Divorced 16 6.5% 13 (18.1%) 25 (29.8%) 57 (63.3%)
School
Elementary School 8 3.3% University 59 (81.9%) 56 (66.7%) 8 (8.9%)
Last Educational Junior High School 20 8.1% Have Chronic
19 (26.4%) 21 (25.0%) 25 (27.8%)
Background Health Disease
Senior High School 95 38.6%
Status No Chronic
University 123 50.0% 53 (73.6%) 63 (75.0%) 65 (72.2%)
Disease
Have Chronic Disease 65 26.4% 1-2 26 (36.1%) 38 (45.2%) 41 (45.6%)
Health Status Household
No Chronic Disease 181 73.6% 3-5 32 (44.4%) 30 (35.7%) 44 (48.9%)
Composition
1-2 105 42.7% >5 14 (19.4%) 16 (19.0%) 5 (5.6%)
Household Have/Ever
3-5 106 43.1%
Composition
Health Have Health 47 (65.3%) 40 (47.6%) 22 (24.4%)
>5 35 14.2%
Insurance Insurance
Have/Ever Have Health
Health Insurance Insurance 109 44.3% status No Health
25 (34.7%) 44 (52.4%) 68 (75.6%)
status Insurance
No Health Insurance 137 55.7%
Male 46 (63.9%) 44 (52.4%) 47 (52.2%)
Total 246 100.0% Gender
Female 26 (36.2%) 40 (47.6%) 43 (47.8%)
Total 72 84 90
Of the total 246 participants, there were 72 (29.3%)
participants chose a premium rate at IDR 59,500 and called
From the group participants profile showed that monthly
group 1 participants, 84 (34,1%) participants chose a
income average of the group 1 participants (3.56) was the
premium rate at 42,500 IDR and called group 2 participants,
highest than the others, and then followed by monthly
and 90 (36.6%) participants chose a premium rate at 25,500
income average of the group 2 participants (2.75), and
IDR and called group 3 participants. The majority of group
group 3 participants (2.11). Group 1 participants almost
1 participants was an employee with a monthly income
had the highest average in every variable and group 3
more than 5,000,000 IDR, the majority of group 2
participants almost had the smallest average in every
participants was an employee with a monthly income of
variable. Whereas, in health insurance status variable, group
2,000,000 IDR-5, 000,000 IDR, and the last, the majority of
1 participants had the smallest average, it means that group
group 3 was an employee with a monthly income of
1 participants had at most health insurance or ever had
600,000 IDR-2, 000,000 IDR. Group 1 participants had the
health insurance.
most increase years of schooling, which whom 81.9% were
graduated from university.

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to higher WTP (Okyere et al., 1997; Shafie and Hassali,

Table 3: Participant profile 2013; Dror et al., 2006; Donfouet et al., 2011; Wright et al.,
2009).
Group 1 Group 2 Group 3
No Variable St. St. St. Table 4: Likelihood Ratio test
Mean Dev Mean Dev Mean Dev
1 Occupation 2.33 0.47 2.29 0.48 2.18 0.63
Model Fitting Criteria Likelihood Ratio Tests
Monthly
2 Income 3.56 0.58 2.75 0.56 2.11 0.69 Model -2Log Likelihood Chi-Square df Sig.
3 Marital Status 1.90 0.53 1.73 0.50 1.72 0.60 Intercept Only 428.270
Last
Final 166.048 262.222 28 .000
Educational
4 Background 3.82 0.39 3.63 0.55 2.72 0.75
5 Health Status 1.74 0.44 1.75 0.44 1.72 0.45 Health insurance status also affected the WTP of
Household group 2 participants. It means that insured people are more
6 Composition 1.83 0.73 1.74 0.76 1.60 0.60 willing to pay for VCHI compared with uninsured people.
Health
This may be due to their experience with the benefits of
Insurance
7 Status 1.35 0.48 1.52 0.50 1.76 0.43 having insurance and their familiarity with its value (Shafie
and Hassali, 2013). The low rate of knowledge of the
The WTP values were obtained after the survey had participants about a health insurance plan potentially
many variations. For group 1 participants the WTP values affected WTP of the participants. It can happen may be due
vary at 50,000 IDR until 100,000 IDR, the group 2 WTP to the lack of information, not only via campaigns, but also
values vary at 40,000 IDR until 72,500 IDR, and the group from other mass media (Donfouet et al., 2011). The low
3 WTP values vary at 20,000 IDR until 50,000 IDR. Then information about BPJS for Health program to many
those values were calculated with formula 1. The average Indonesian people affected the low rate of participation to
monthly amount the participants were willing to pay was BPJS for Health program. Accordingly, policymakers need
estimated with formula 1, and the result shown that the to reinforce and intensify public awareness campaigns in
group 1 participants average amount was estimated to be order to better inform the Indonesian people about BPJS for
77,437.50 IDR, the group 2 participants average amount Health program. This may encourage them to be involved
was estimated to be 47,946.43 IDR, and the group 3 in such scheme and hence improve their well-being
participants average amount was estimated to be 30,450 (Donfouet et al., 2011).
IDR Wald test also shown household composition was one
of the factors that affected the WTP of group 3 participants.
5. DISCUSSION According to profile background, most of group 3
participants came from middle to lower class of the
The primary objectives of this study were to estimate community. It’s indicated that the participants had low
the willingness of Indonesians to pay the premium rate of awareness of the importance of health insurance program
BPJS for Health program. Second, this study explored the because for those people the most important thing in their
factors that affected to the WTP. Slightly most of the life is how to fulfill their primary daily need. So, it’s very
participants (36.6%) preferred to pay the premium rate at common if household composition affected WTP of group 3
25,500 IDR. Based on the likelihood ratio test, the result participants, because the more of a number of the household
shown that all the hypothesized factors simultaneously and compositions the more they have to pay the premium. As
significantly affected the willingness of Indonesian to pay quoted from previous study, as income increases, or the
the premium rate of BPJS for Health program (sig. =.000). proportion of unemployed household members drops,
In other hand, the Wald test result shown that occupation people are willing to pay higher premiums for health
and last educational background affected the value of WTP insurance (Okyere et al., 1997). But, the other previous
of the participants. This result in line with many studies study resulted that Household composition didn’t affect the
about WTP of health insurance, those studies resulted in WTP for health insurance (Dror et al., 2006).
those who have attained higher education levels would be
more likely to join a health insurance plan and would lead

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Table 5: Wald Test Group 3

Parameter Estimates
Premium Rate B Std. Error Wald df Sig. Exp(B)
Intercept -10.708 2.16 24.582 1 0
[Occupation=1,00] 20.564 9250.127 0 1 0.998 8.53E+08
[Occupation =2,00] 1.157 0.905 1.635 1 0.201 3.18
[Occupation =3,00] 0c . . 0 . .
[Monthly Income =1,00] 4.556 2.184 4.35 1 0.037 95.202
[Monthly Income =2,00] 6.285 1.392 20.372 1 0 536.263
[Monthly Income =3,00] 3.87 1.131 11.704 1 0.001 47.957
[Monthly Income =4,00] 0c . . 0 . .
[Marital Status=1,00] 1.921 1.255 2.343 1 0.126 6.826
[Marital Status=2,00] 1.707 1.181 2.091 1 0.148 5.513
Group [Marital Status =3,00] 0c . . 0 . .
3 [Last Educational Background=1,00] 22.161 1.31E+04 0 1 0.999 4.21E+09
[Last Educational Background=2,00] 21.59 6897.854 0 1 0.998 2.38E+09
[Last Educational Background=3,00] 4.159 0.89 21.846 1 0 63.99
[Last Educational Background=4,00] 0c . . 0 . .
[Health status=1,00] 1.272 0.703 3.272 1 0.07 3.566
[Health status=2,00] 0c . . 0 . .
[HH composition=1,00] 0.167 1.005 0.028 1 0.868 1.182
[HH composition=2,00] 2.551 1.016 6.31 1 0.012 12.82
[HH composition=3,00] 0c . . 0 . .
[Health Insurance Status=1,00] 0.45 0.665 0.459 1 0.498 1.569
[Health Insurance Status =2,00] 0c . . 0 . .
Intercept -5.734 1.582 13.131 1 .000
[Occupation=1,00] 12.086 9250.127 .000 1 .999 1.773E5
[Occupation=2,00] -1.295 .711 3.320 1 .068 .274
[Occupation=3,00] 0c . . 0 . .
[Monthly income=1,00] 8.308 .000 . 1 . 4.057E3
[Monthly income=2,00] 5.769 1.184 23.733 1 .000 320.124
[Monthly income=3,00] 4.474 .850 27.701 1 .000 87.702
[Monthly income=4,00] 0c . . 0 . .
[Marital status=1,00] 3.245 1.268 6.544 1 .011 25.655
[Marital status=2,00] 2.808 1.218 5.316 1 .021 16.577
[Marital status=3,00] 0c . . 0 . .
Group 2
[Last educational background=1,00] -4.302 1.644E4 .000 1 1.000 .014
[Last educational background=2,00] 14.990 6897.854 .000 1 .998 3.236E6
[Last educational background=3,00] -.315 .580 .295 1 .587 .730
[Last educational background=4,00] 0c . . 0 . .
[Health status=1,00] .462 .604 .586 1 .444 1.588
[Health status=2,00] 0c . . 0 . .
[HH composition=1,00] .321 .763 .177 1 .674 1.378
[HH composition=2,00] .622 .750 .688 1 .407 1.863
[HH composition=3,00] 0c . . 0 . .
[Health Insurance Status=1,00] -.100 .534 .035 1 .852 .905
[Health Insurance Status=2,00] 0c . . 0 . .

Price is an important signal of the uptake of the Health
insurance program. In this case, the person's willingness to
pay for health insurance premium should be noticed so the
participant’s financial acceptability can be found. But It is
important to note, however, that the willing to pay amount
should not be equated with the premium, as it is only
reflective of the respondent’s financial acceptability (Shafie
and Hassali, 2013). The participants with a higher monthly
income than the other participants are expected to be willing
to pay more.
6. CONCLUSIONS
This study resulted that the average monthly amount
of the Indonesian people to join BPJS for Health program
were willing to pay was estimated to be 77,437.50 IDR for

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group 1 participants, 47,946.43 IDR for the group 2
participants and 30,450 IDR for the group 3 participants for
BPJS for Health program. Those who have attained higher
education and have occupation would be more likely to join
BPJS for Health program. The other factors that affected
group 2 participants were health insurance status. This may
be due to their experience with the benefits of having
insurance and their familiarity with its value. In other hand,
household composition affected WTP of group 3
participants because the more of a number of household
compositions, the more number they have to pay the
premium of health insurance program. Once again, it’s
important to note that the willing to pay amount should not
be equated with the premium, as it is only reflective of the
respondent’s financial acceptability. This result is expected
to be a reference in determining the ideal premium rate of
BPJS for Health program for both participants and the
executants.
ACKNOWLEDGMENT
This work has been funded by the Direktorat Penelitian dan
Pengabdian Kepada Masyarakat, Directorate General of
Higher Education, Ministry of National Education through
grand for “Hibah Fundamental”. The authors wish to
acknowledge to Directorate General of Higher Education
for giving the author some funds to participate and attend
this international symposium. The authors wish to
acknowledge to the Rector of Diponegoro University, Dean
of Faculty Engineering, and head of the Department of
Industrial Engineering for their support. The authors also
wish to acknowledge our gratitude and appreciation to all
the partners in “Hibah Fundamental” for their contribution
during the development of various ideas and concepts
presented in this paper.
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