Analysis of Participant Behavior towards Late Payment of BPJS Kesehatan Contributions at the Manado Main Branch

Abstract

This study analyzes the behavior of Non-Wage-Earning Participants (Peserta Bukan Penerima Upah/PBPU) toward late payment of BPJS Kesehatan (National Health Insurance) contributions at the Manado Main Branch. Using a qualitative, descriptive-analytical method combined with a phenomenological approach, and integrating the Theory of Planned Behavior (TPB) with the Health Belief Model (HBM), the study examines participant behavior through three dimensions: psychological, health-risk perception, and socio-economic. Primary data were collected through in-depth, semi-structured interviews with six purposively selected informants — two PBPU participants who had experienced late payment, two BPJS Kesehatan staff members handling participant registration, and two local community leaders — supplemented by field observation and documentation. Data were analyzed using the interactive model of Miles, Huberman, and Saldaña (data collection, condensation, display, and conclusion drawing), and validity was established through source and technique triangulation and member checking, following Lincoln and Guba's criteria of credibility, transferability, dependability, and confirmability. The findings show that participants generally hold a positive attitude toward the obligation to pay contributions and receive supportive subjective norms from their families, yet their perceived behavioral control remains weak because of unstable income as informal-sector workers. Participants are aware of health risks and value the benefits of active membership, but economic barriers and a reactive mindset — treating BPJS Kesehatan as relevant only when ill — continue to delay payment, even though reminders from telecollecting staff and JKN cadres are effective in prompting repayment. Socio-economically, unstable income is the most dominant factor behind late payment, financial and health literacy still varies among participants, and institutional trust, although relatively high, does not fully translate into consistent compliance. The study concludes that late payment among PBPU participants stems more from constrained financial capability and weak behavioral control than from a lack of knowledge of, or distrust in, BPJS Kesehatan, and it offers practical recommendations for BPJS Kesehatan, participants, and future researchers.