Payment compliance of informal sector workers in Indonesia National Health Insurance: a study on ability and willingness to pay

The ability to pay the premium among enrolees was generally below the current premium level, except for active enrolees in the third class. While active enrolees expressed a willingness to pay about 10% more than the existing premium, inactive enrolees were only willing to pay about 50% of it. Compliance to pay the premium was influenced by non-food and tobacco expenditures, willingness to pay, risk aversion, catastrophic illness, healthcare utilization, size of household members, and patient satisfaction. Additional factors positively influencing compliance included food and non-food expenditures, NHI literacy, and enrolee class. CONCLUSION AND RECOMMENDATION: To enhance health care access, policy efforts must address the disparity between current premium levels and informal sector workers' financial capacity and willingness to pay. Given constrained government budgets, cross-sector collaboration is necessary to support stable incomes for these workers. Furthermore, strategies that foster risk awareness and payment commitment, through targeted outreach and improved health insurance literacy, may enhance long-term compliance and coverage.