Pengaruh Biaya Transportasi, Jarak ke Fasilitas Kesehatan, dan Intensitas Pengguna PBI JKN terhadap Beban Out-Of-Pocket Masyarakat Miskin di Kabupaten Lebak
DOI:
https://doi.org/10.55606/jempper.v5i1.5810Keywords:
Transportation Costs, Distance to Healthcare Facilities, JKN-PBI Utilization Intensity, Out-of-Pocket Expenditure, Kabupaten LebakAbstract
Health is a fundamental right guaranteed by the state; however, poor communities still face significant challenges in financing healthcare due to high out-of-pocket (OOP) expenditures. According to the 2022 National Health Accounts (NHA) data, the OOP proportion in Indonesia reached 30.6% of total national health expenditures—exceeding the World Health Organization (WHO) safety threshold of 20%. This condition indicates that the financial burden of healthcare remains heavy, particularly for low-income groups, even though they are beneficiaries of the National Health Insurance – Contribution Assistance Recipients (Jaminan Kesehatan Nasional – Penerima Bantuan Iuran or JKN-PBI). The National Socioeconomic Survey (SUSENAS) of March 2024 revealed that 51.20% of residents in Banten Province who experienced health complaints chose not to seek treatment, citing transportation costs and the long distance to healthcare facilities as primary reasons. These non-medical barriers further exacerbate the OOP burden among the poor. This study aims to analyze the influence of transportation costs, distance to healthcare facilities, and the intensity of JKN-PBI utilization on the out-of-pocket burden of poor households in Lebak Regency. The study population consists of JKN-PBI participants in Guradog Village, Curugbitung District, with a total sample of 160 respondents selected through purposive sampling. Data were analyzed using multiple linear regression with the SPSS software. The results show that, simultaneously, transportation costs, distance, and JKN-PBI utilization intensity have a significant effect on OOP. Partially, transportation costs and distance have a positive and significant effect, while JKN-PBI utilization intensity has a negative and significant effect. This study emphasizes the importance of equitable access to healthcare facilities, transportation subsidies for JKN-PBI participants in remote areas, and the enhancement of JKN utilization.
References
Adisasmito, W., Gross, D. P., Hapsari, D., & Yuniarti, K. W. (2020). Health system strengthening and equity in Indonesia: A case study of policy implementation and health service disparities. Health Policy and Planning, 35(Supplement_1), i103–i112.
Akseer, N., Wigley, S., MacDonald, K., & Bhutta, Z. A. (2019). Accelerating progress in early childhood development through quality health and nutrition services. BMJ, 366, l4713.
Amalia, R., Suryadarma, D., & Kusuma, D. (2022). Jarak terhadap fasilitas kesehatan dan akses layanan di Indonesia. Jurnal Kesehatan Masyarakat Indonesia, 17(2), 142–152.
Andersen, R. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36(1), 1–10.
Andersen, R., & Newman, J. F. (2005). Societal and individual determinants of medical care utilization in the United States. Milbank Quarterly, 83(4), 1–28.
Andriani, L., & Suryadarma, D. (2021). Utilization of health services among PBI participants in Indonesia. Indonesian Journal of Health Economics, 6(2), 55–70.
Badan Litbangkes. (2020). Laporan akses kesehatan dan ketersediaan SDM kesehatan di Indonesia. Kementerian Kesehatan RI.
Badan Penelitian dan Pengembangan Kesehatan. (2020). Profil kesehatan Kabupaten Lebak 2020. Kementerian Kesehatan RI.
Bappenas. (2023). Evaluasi pelaksanaan program perlindungan sosial tahun 2023. Bappenas.
Boenjamin, A., & Puspandari, D. A. (2022). Faktor-faktor penggunaan out-of-pocket pada peserta BPJS PBI di Klinik “Asih Sasama.” Jurnal Manajemen Pelayanan Kesehatan, 25(1), 1–7. https://doi.org/10.22146/jmpk.v25i01.4209
BPJS Watch. (2020). Pemanfaatan JKN oleh peserta PBI: Tantangan dan solusi. BPJS Watch.
Dewan Jaminan Sosial Nasional. (2018). Laporan kinerja DJSN tahun 2018. DJSN.
Dewi, A. A. I. K., & Sutrisna, M. (2012). Indeks pembangunan manusia dan pembangunan daerah. Jurnal Ekonomi dan Pembangunan, 20(1), 73–82.
Erlita, D. I., Azizah, A. N., & Sundaya, Y. (2022). Analisis ekonomi kesehatan rumah tangga Indonesia pada masa pandemi COVID-19. Jurnal Ekonomi Pembangunan, 11(2), 95–106. https://doi.org/10.23960/jep.v11i2.486
Fadhila, Y. (2024). Determinan belanja kesehatan rumah tangga di Pulau Jawa menggunakan geographically weighted regression. Jurnal Ekonomi Kesehatan Indonesia, 9(1). https://doi.org/10.7454/eki.v9i1.1116
Fajri, R. H. (2021). Analisis faktor-faktor yang mempengaruhi indeks pembangunan manusia di Provinsi Riau. Economics, Accounting and Business Journal, 1(1), 212–222.
Grossman, M. (1972). On the concept of health capital and the demand for health. Journal of Political Economy, 80(2), 223–255.
Hardiani, H., et al. (2017). Peran kesehatan dalam pembangunan sumber daya manusia. Jurnal Ekonomi Pembangunan, 18(1), 1–10.
Hidayat, B., et al. (2018). Determinants of household out-of-pocket expenditure on health in Indonesia. Health Economics Review, 8(1), 10.
Kemenkes RI. (2022). Evaluasi program Jaminan Kesehatan Nasional (JKN). Pusat Pembiayaan dan Jaminan Kesehatan.
Kementerian Kesehatan RI. (2019). Profil kesehatan Indonesia tahun 2019. Kementerian Kesehatan RI.
Kementerian Kesehatan RI. (2021). Sistem Jaminan Kesehatan Nasional dan upaya penguatan akses. Pusdatin Kemenkes RI.
Kuncoro, M. (2013). Metode kuantitatif: Teori dan aplikasi untuk bisnis dan ekonomi. UPP STIM YKPN.
Listiani, P., Hendrartini, J., & Pramono, D. (2019). Perbandingan hambatan finansial pada sebelum dan setelah jaminan kesehatan di Indonesia. Jurnal Manajemen Pelayanan Kesehatan, 22(2), 38–44.
Mahendradhata, Y., et al. (2017). The Republic of Indonesia health system review. Health Systems in Transition, 7(1).
Maulana, M. I., et al. (2022). Pengaruh kepesertaan JKN terhadap pengeluaran OOP. Jurnal Kesehatan Indonesia, 11(1), 45–55.
Misra, R., Rahardjo, T., & Supriyadi, D. (2020). Analisis biaya transportasi dan beban OOP. Jurnal Ekonomi Kesehatan Indonesia, 4(2), 34–45.
Nazli, N., & Usman, H. (2024). Kepemilikan jaminan kesehatan di kalangan penduduk miskin Indonesia tahun 2023. Jurnal Kebijakan Kesehatan Indonesia, 13(4), 180–190.
Penchansky, R., & Thomas, J. W. (1981). The concept of access: Definition and relationship to consumer satisfaction. Medical Care, 19(2), 127–140.
Pramono, J. S., et al. (2021). Jaminan kesehatan nasional: Strategi, implementasi dan transformasi kesehatan. Penerbit Adab.
Sampoerno, A. (2008). Kesehatan adalah aset. Gramedia Pustaka Utama.
Savitri, A. W., Sulistyowati, T., & Sulismadi. (2025). Analisis kebijakan BPJS Kesehatan dan pemerintah untuk pelayanan yang optimal. Sosial.
Siregar, P. P., Bhuwana, S. C., & Toniara, S. (2025). Faktor yang mempengaruhi masyarakat terhadap akses menuju Puskesmas Lubuk Pakam. Jurnal Pandu Husada, 6(3), 21–29.
SMERU. (2018). Evaluasi dampak program JKN terhadap rumah tangga miskin. The SMERU Research Institute.
SMERU. (2023). Out-of-pocket (OOP) expenditure analysis in Indonesia. The SMERU Research Institute.
Sugiyono. (2017). Metode penelitian kuantitatif, kualitatif, dan R&D. Alfabeta.
Sungkono, J., & Wulandari, A. A. (2022). Pembelajaran teorema limit pusat melalui simulasi. Absis: Mathematics Education Journal, 4(2), 69–76. https://doi.org/10.32585/absis.v4i2.2520
Tanahashi, T. (1978). Health service coverage and its evaluation. Bulletin of the World Health Organization, 56(2), 295–303.
Todaro, M. P., & Smith, S. C. (2020). Economic development (13th ed.). Pearson Education.
Trisnantoro, L. (2019). Pengeluaran OOP dalam konteks JKN. Jurnal Kebijakan Kesehatan Indonesia, 8(1), 20–28.
Trisnantoro, L., et al. (2020). Efektivitas JKN dalam menurunkan OOP. Jurnal Administrasi Kesehatan Indonesia, 6(2), 55–68.
Wagstaff, A., & van Doorslaer, E. (2003). Catastrophe and impoverishment in paying for health care. Health Economics, 12(11), 921–934.
Wagstaff, A., Flores, G., Hsu, J., Smitz, M.-F., Chepynoga, K., Buisman, L. R., ... & Eozenou, P. (2018). Progress on catastrophic health spending in 133 countries. The Lancet Global Health, 6(2), e169–e179.
World Bank. (2021). Indonesia economic prospects: Boosting the recovery. World Bank.
World Health Organization. (2010). Health systems financing: The path to universal coverage. WHO.
World Health Organization. (2022). Global spending on health: Rising to the pandemic’s challenges. WHO.
Xu, K., Evans, D. B., Kawabata, K., Zeramdini, R., Klavus, J., & Murray, C. J. L. (2007). Household catastrophic health expenditure: A multicountry analysis. The Lancet, 362(9378), 111–117.
