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GSJ: Volume 8, Issue 8, August 2020, Online: ISSN 2320-9186

www.globalscientificjournal.com

THE EFFECTS OF THE SOCIALIZATION OF PRESIDENTIAL REGULATION NO. 82 OF 2018 AND THE NON-WAGE WORKER PARTICIPANTS’S COMPREHENSION TOWARDS THE OBEDIENCE AND IMPACT OF BPJS SUBSCRIPTION PAYMENT: A CONCEPTUAL MODEL Mohamad Rizal Idris1, Dwi Sunu Kanto2, Kabul Wahyu Utomo3

1.2.3 Department of Management, Faculty of Economic and Business, Trilogi University, Jakarta, Indonesia ABSTRACT Health insurance is a security in the form of health protection so that participants receive the benefits of health care and protection in meeting basic health needs. This is regulated in Presidential Regulation No. 82 of 2018 as the health insurance program is socialized by the Health Social Security Agency (BPJS Kesehatan). This paper discusses the conceptual model to test the effect of socialization of Presidential Regulation No. 82 of 2018 and the comprehension of non-wage worker participants on obedience as well as its impact on BPJS subscription payments. Literature review, conceptual models, hypotheses of development and research methodology are discussed. Practicing this paper instantly would provide information about the relationship of socialization of regulations, comprehension non-wage worker participants, obedience and payment of BPJS subscription. KeyWords Socialization, Comprehension, Obedience, Subscription Payment, Conceptual Model

GSJ: Volume 8, Issue 8, August 2020 ISSN 2320-9186 279

GSJ© 2020 www.globalscientificjournal.com

INTRODUCTIONThe Presidential Regulation No. 82 of 2018 stated that Health Insurance is a security in the form of health protection so that

participants receive health care benefits and protection in meeting basic health needs. The designated agency in implementing this program is the Health Social Security Agency (BPJS Kesehatan), which is a public legal entity formed to organize the Health Insurance program.

Many people or participants have used the Health Insurance facility but do not want to bear the burden of subscriptions. In the last three years there has been an increase in the number of Non-Wage Worker Participants (Pekerja Bukan Penerima Upah or PBPU) but the number of participants in arrears has also increased. PBPU membership data and the number of PBPU participants who are in arrears in BPJS Kesehatan – Tasikmalaya Branch in 2017 amounted to 150,673 participants until 2019 totaling 204,999 participants.

BPJS Kesehatan has a socialization program that aims to increase public awareness of the importance of paying subscrip-tions regularly. With this socialization, it is expected that the public will understand about sanctions and regulations in using health BPJS cards, as well as lead to obedience and compliance of the community in fulfilling obligations including in payment of BPJS Kese-hatan subscriptions/premiums.

LITERATURE REVIEW

Health Social Security Agency (BPJS Kesehatan) The Regulation of the President of the Republic of Indonesia (Perpres) No. 82 of 2018 concerning Health Insurance is stipu-

lated based on consideration of the provisions of article 15 verse (2) of Regulation No. 40 of 2004 concerning the National Social Se-curity System and the provisions of article 19 verse (5) part (a) of Regulation No. 24 of 2011 concerning the Social Security Body (BPJS). The designated agency in implementing this program is the Health Social Security Administration Agency, hereinafter abbre-viated as BPJS Kesehatan.

The Health Social Security Agency (BPJS Kesehatan) is a Public Legal Entity that is directly responsible to the President and has the duty to organize National Health Insurance for all Indonesian citizens. Based on Regulation No. 24 of 2011, the Social Security Agency is a legal entity formed to organize a social security program that aims to realize the provision of securities to meet the basic needs of a decent life for each participant and/or family members.

Pursuant to Regulation No. 24 of 2011, the Health Social Security Agency functions to administer a health insurance pro-gram with the duty to:

1. Provide information about the implementation of social security programs to participants and the public 2. Accept or register participant 3. Collect subscriptions from participants and employers 4. Manage social security funds for the benefit of participants 5. Receive subscriptions aid from the government 6. Collect / manage data on social security program participants 7. Make payments or fund health service funds in accordance with the provisions of the social security program. Socialization Socialization is an individual learning process in terms of forming one's personality through the comprehension of the

awareness of the role of self that will be lived and the role carried out by other individuals. Socialization can also be interpreted as a process in which a person begins to understand, accept and make adjustments to the prevailing cultural elements such as behavior, habits, language and traditions in the community environment, usually starting from the educational process within the individual's family environment and subsequently developing towards the community environment. With a gradual process until the success of the adjustment, so that individuals will feel part of a family in a community environment. Basically, every human being always needs a learning process from birth to death. Humans are social beings who have a tendency to live side by side and need competitiveness in a form of environment called society. In social life, humans are required to be able to adjust to their social environment through a process. The process of adjusting to society in sociology is called the process of socialization (Hesti et al, 2013).

The word socialization means the learning process of an individual to get to know and understand the culture of the com-munity in his environment. Socialization can also mean efforts to socialize something, so that it can be understood and known and internalized by the community or correctional facilities. According to Goode (2007), socialization is a process that must be passed by humans since young in gaining knowledge and values about their environment and learning how social roles are suited to their posi-tion in the social environment.

The socialization process that is relevant for personality formation can be distinguished by:



1. The socialization process is done intentionally through a process of learning and education taken by each individual 2. The process of socialization is done accidentally through a process of social interaction with the surrounding environ-

ment. According to Maclever (2013), socialization is the process of learning norms, values, roles and all other requirements

needed to enable effective participation in social life. Meanwhile, according to Samudera (2004), the socialization process requires an appropriate strategy or procedure so that the process runs well, such as: activities, publications, community involvement, report-ing, identity inclusion, and a personal approach.

In providing health services that can be reached by the community, the National Health Insurance Program under the aus-pices of the BPJS Kesehatan is a new program created by the government so that it still requires communication and improvements that build and influence the creation of social change in society. Communication is the most important part of a socialization activity whose function is to convey or disseminate information to the wider community. Health is the most basic need for every individual and the BPJS Kesehatan program is to provide health insurance to all levels of society without differentiating the social status of the individual. This is in accordance with the Regulation of the Minister of Health of the Republic of Indonesia Number 28 of 2014 con-cerning Guidelines for the Implementation of the National Health Insurance Program, so the government organizes the National Health Insurance Program under the auspices of the Health BPJS.

Based on the understanding of socialization from some of the experts above, it can be concluded that the socialization of the BPJS Kesehatan is an action and effort of the BPJS Kesehatan to build understanding, learning, information and knowledge to the wider community about the national health insurance program.

Comprehension The word comprehension, in Bahasa Indonesia, comes from the word comprehend, which means truly understand, while

comrpehension is interpreted as a process of action and way of understanding (Em Zul & Senja, 2008). According to Sudaryono (2012), comprehension is the ability of a person to capture the understanding and meaning of what

is learned and can be stated by decomposing the main content or can change the data available in a particular form into another form.

According to Arikunto (2009), comprehension is a way for someone to explain, suspect, maintain, expand, differentiate, ge-neralize, make conclusions and give examples, then explain or write back, and make estimates.

According to Daryanto (2008) comprehension ability can be divided into three, namely: 1. Translation, 2. Interpretation, and 3. Extrapolation. Based on some of the opinions above, the researcher concludes that comprehension is the ability of a person to grasp un-

derstanding, explain again about the understanding it receives, give an opinion either in the form of classification or comparison and then generalize from the information that has been obtained.

Obedience Niven (2012) stated that obedience, in Bahasa Indonesia, comes from the word obedient which means discipline and com-

pliance. Obedience is defined as a change in behavior or attitude of someone to follow the requests or rules of others. Someone can be called obedient to others if that person can accept, believe, and then do something command or request from that other person (Arifiyani, 2012).

Obedience is defined as a disciplined behavior or compliance to a rule or rules that have been set, with full awareness. Ob-edience is a positive behavior and this behavior is considered a choice. This means that individuals can choose to obey, perform, or respond critically to social norms and the rule of law, wishes or requests from other individuals who have an important role or higher authority (Morselli and Passini, 2012).

In the dimension of obedience education, it is considered as a form of a person's willingness to act towards the commands and wishes of the authority owner or teacher (Normasari, et al, 2013).

Based on the opinions of some experts, the researcher concludes that the definition of obedience is the obedient behavior and discipline attitude of a person or group in carrying out the obligations that have been imposed to be the responsibility of the individual or group.

Subscription Payment Regulation No. 23 of 1999 on Bank Indonesia states that the payment system is a system that covers all the rules, institu-

tions and mechanisms used to carry out the transfer of funds in fulfilling an obligation that occurs from an economic activity. Pay-ment system is a system that has a relationship with a process of transferring a number of funds from one party to another party.

The media used for the transfer of funds/value for money have many kinds, ranging from simple payment instruments to



the use of sophisticated tools/systems and involve several other institutions with their respective regulations. Who has the authority to regulate and maintain the flow of the payment system in Indonesia is implemented by Bank Indonesia as outlined in the Regula-tion on Bank Indonesia.

Health Insurance Subscription is a sum of funds/money that is deposited/paid regularly by participants, employers and the government for the Health Insurance Program (Presidential Regulation No. 82 of 2018).

From some of the above opinions, it can be concluded that the payment of subscriptions is the amount of funds or money paid regularly with a nominal that has been determined or agreed upon in advance.

CONCEPTUAL MODEL

This study will explain and test how much influence the socialization of the Presidential Regulation and the comprehension of Non-Wage Worker Participants on obedience and its impact on payment of subscriptions to the BPJS Kesehatan – Tasikmalaya Branch office. The framework of this research can be seen in the following figure.

Figure 1 Framework

Source: adapted from Nurfaidatil Laili (2014), Mokolomban (2019), and Adani (2019) HYPOTHESIS DEVELOPMENT 1. The impact of the socialization of the presidential regulation towards comprehension

Laili's research results (2014) showed that there was a relationship between Socialization and Comprehension as it was con-cluded that the socialization related to BPJS Kesehatan was very influential on the comprehension of participants' rights. Socialization is communication that can instill understanding, shaping and changing attitudes. Comprehension is the level of ability that expects someone to be able to understand the meaning and concept, the situation and the facts he knows. Likewise, research conducted by Rejeki (2015) shows that patient knowledge has increased after socialization. Novya's research (2016) states that the knowledge pos-sessed by BPJS Kesehatan participants at the Puskesmas Sukadana regarding National Health Insurance is mostly at the Fair level. Based on the results of the description, the following hypothesis can be formulated:



H1: The Presidential Regulation socialization affected the comprehension of Non-Wage Worker Participants 2. The impact of the socialization of the presidential regulation towards obedience

Socialization is as a process of planting or transferring habits or values or rules from one generation to another in a group or community (Sari, 2009). According to Johan (2010) in the collective sense of knowledge is a collection of information possessed by a person or group or certain culture. Whereas knowledge in general is mental components that are generated from any process, whether born from innate or achieved through experience. Information obtained by a person can increase understanding of the in-formation, as well as participants who have health insurance, and have obtained information about obligations as a participant in health insurance so that participants 'knowledge will increase and this can also increase participants' desire to pay subscriptions in accordance with the provisions from the organizer because the participant already has knowledge of his obligations as a health in-surance participant. Conversely, participants who have low knowledge of information about obligations as a health insurance owner can reduce the participants' desire to fulfill their obligations as well as in paying subscriptions because participants still do not get enough knowledge about health insurance ownership. BPJS Kesehatan must increase the quantity of socialization to increase aware-ness and compliance of BPJS Kesehatan participants. Based on the description above, the hypothesis can be formulated as follows:

H2: The Presidential Regulation socialization affected the obedience of Non-Wage Worker Participants 3. The impact of non-wage worker participants’s comprehension towards obedience Knowledge/information received by the public about the National Health Insurance is still very minimal, especially in areas

that require follow up with certain stages. To resolve the constraints related to information knowledge, the health policy adopted by the government must be careful so that investments that have been achieved so far are not in vain. Research from Wijaya (2016) states that there is a relationship between people's understanding of obedience with obligations as Health Insurance participants. The public claimed not to comprehend or did not understand about sanctions and regulations in using BPJS Kesehatan cards. Hence, they do not know what their obligations and rights are as BPJS Kesehatan participants. Likewise, research conducted by Pangestika (2017) states that most have poor knowledge about BPJS Kesehatan due to lack of information and education about the importance of being BPJS Kesehatan participants. Based on the description above, the following hypotheses can be formulated:

H3: The comprehension of Non-Wage Worker Participants’s comprehension affected on its obedience 4. The impact of the socialization of the presidential regulation towards subscription payment BPJS Kesehatan in each region is also obliged to disseminate the health insurance program. This is intended so that National

Health Security (Jaminan Kesehatan Nasional or JKN) can run evenly in each region. The main purpose of the socialization is to create target public awareness of the organization concerned. Hence, effective communication is needed to realize these goals. Effective communication should lead to at least 5 things, namely: pleasure, understanding, can affect attitudes and actions and good social relationships. Generating concrete actions is the most important indicator of effectiveness because the implementers of socialization must succeed in first instilling understanding, forming and changing attitudes or fostering good relations with the community (Rach-mat, 2009). Research conducted by Mokolomban (2019) states that there is a relationship between knowledge and the obedience of independent participants in paying JKN subscriptions in the working area of the Ranotana Weru Public Health Center in Manado. Based on the description above, then the hypothesis can be formulated as follows:

H4: The Presidential Regulation socialization affected the subscription payment 5. The impact of non-wage worker participants’s comprehension towards subscription payment Comprehension according to Arikunto (2009), is how someone is able to distinguish, explain, suspect, expand, generalize,

maintain, give examples, and write back and can make estimates. Meanwhile, according to Daryanto (2008) comprehension ability can be translated into 3 things, namely: Translation, Interpretation, and Extrapolation. Marzuki's research (2019) which states that the willingness of respondents to pay more than those who do not want to pay on the grounds that they want to pay arrears, namely the card can be used. Based on the description above, then the hypothesis can be formulated as follows:

H5: The comprehension of Non-Wage Worker Participants’s comprehension affected on their subscription payment 6. The impact of obedience towards subscription payment Each Employer must deduct susbcriptions from his employees, pay employee subscriptions to the company, and pay

monthly subscriptions to BPJS Kesehatan regularly (no later than the 10th of every month). If the 10th (tenth) day falls on a holiday, then the subscription is paid on the next working day (Presidential Regulation No. 111 of 2013). Research from Husni (2016) states that the implementation of the National Health Insurance through health BPJS is not without obstacles. One of the obstacles that occurs in the city of Padang and needs to be highlighted is the problem of the Number of Claims requested from the BPJS Kesehatan is higher than the amount of susbcriptions paid by participants each month. The result of this high claim certainly harms all parties, including BPJS Kesehatan participants. This is influenced by the low obedience of participants in paying premiums. Based on the de-scription above, then the hypothesis can be formulated as follows:

H6: Obedience affected subscription payment 7. Obedience mediated the relationship between the Presidential Regulation socialization towards subscription payment The results of Safitri's research (2017) stated that socialization had an effect on BPJS participant obedience. Nopiyani et al’s

study (2015) also stated that obedience of insurance participants to pay susbcriptions was very important for the continuation of



health insurance schemes. Based on the description above, then the hypothesis can be formulated as follows: H7: Obedience mediated the relationship between the Presidential Regulation socialization towards subscription payment 8. Obedience mediated the relationship between the non-wage worker participants’s comprehension towards subscrip-tion payment The results of Laili's research (2014) stated that community's comprehension of their rights and obligations as BPJS partici-

pants influences obedience in carrying out obligations as participants. Husni et al (2016) states that business entity obedience has a significant effect on subscription payments and fee payments have a significant effect on employee health services. Based on the description above, the hypothesis can be formulated as follows:

H8: Obedience mediated the relationship between the non-wage worker participants’s comprehension towards subscription payment 9. The non-wage worker participants’s comprehension mediated the Presidential Regulation socialization towards partic-ipants’s obedience The results of Apriani’s research (2018) shows that the knowledge of BPJS participants about late BPJS subscription penalties

are still low due to the lack of information regarding fines due to late BPJS subscriptions. Based on the results of research conducted by Hasyim (2019) about factors related to the arrears of payment of BPJS independent health subscriptions in the working area of the Abeli Health Center in Kendari City, the result can be a strong relationship between knowledge and arrears in payment of BPJS susbcriptions in the work area Abeli Health Center, Kendari City. Based on the description above, the hypothesis can be formulated as follows:

H9: The non-wage worker participants’s comprehension mediated the Presidential Regulation socialization towards partici-pants’s obedience 10. The non-wage worker participants’s comprehension mediated the Presidential Regulation socialization towards sub-scription payment The results of the research by Kusuma (2016) shows that the community’s comprehension of the rights and obligations as

BPJS participants affect the obedience in carrying out the obligations as a participant. This can only be realized if the community is able to receive information, especially about the JKN – BPJS Kesehatan. Understanding of the poor in Lau District, Maros Regency, about the information on the JKN Program (BPJS Kesehatan) in the excellent category. Meanwhile, according to Wulandari's research (2020), factors that were significantly related to obedience with the payment of independent subscriptions of JKN – BPJS Kesehatan program in Solok City in our study were the level of knowledge, income, perception of health services and risks. Based on the de-scription above, the hypothesis can be formulated as follows:

H10: The non-wage worker participants’s comprehension mediated the Presidential Regulation socialization towards sub-scription payment

METHODOLOGY

This study uses quantitative research design. Data sources used in this study consisted of primary data obtained directly by researchers from research objects, namely data obtained from respondents through questionnaire results submitted by researchers (Narimawati, 2008; Sekaran, 2011). The population in this study were all Non-Wage Worker Participants in the Tasikmalaya Branch area totaling 393,193 inhabitants. The sampling technique used was random sampling, in which the samples were taken so that each research unit of the population had the same opportunity to be selected as a sample. The sample size is calculated using the Slovin technique (Sugiyono, 2011: 87). The questionnaire in this study was measured using a Likert scale.

This research uses Structural Equation Modeling (SEM) data analysis method using Smart PLS software or Smart Partial Least Square version 3.0. SEM is built by measurement models and structural models. This study uses a multivariate statistical technique with 3 (three) variables, namely independent variables, intervening variables and dependent variables.

CONCLUSION

The number of BPJS Kesehatan Participants from Non-Wage Workers (PBPU) are rising but the number of participants who are in arrears has also increased. Data on the number of PBPU participants who are in arrears for BPJS Kesehatan – Tasikmalaya Branch in 2017 amounted to 150,673 participants and in 2019 increased to total 204,999 participants. This shows the need for a so-cialization program that aims to increase the comprehension and obedience of BPJS Kesehatan participants in paying BPJS Keseha-tan subscriptions in Tasikmalaya Branch.

Therefore, this paper sets out to develop a conceptual model to investigate the Effect of Socialization of Presidential Regu-lation No. 82 of 2018 and the Comprehension of Non-Wage Worker Participants for Obedience and Its Impact on BPJS Kesehatan Subscription Payments.



A conceptual model was proposed; hypotheses development and research methodology was also made. Practicing this pa-per instantly will provide information about the relationship states among socialization, comprehension, obedience, and susbcrip-tion payment at the BPJS Kesehatan in Tasikmalaya Branch.

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