Service Quality, Citizen Satisfaction, and Citizen Participation: Evidence from Independent (PBPU) Members of Indonesia's National Health Insurance Program

Abstract : Universal health coverage schemes in developing countries face a recurring sustainability problem: keeping voluntarily enrolled members active once they have joined. This study investigates how the five dimensions of service quality proposed in the SERVQUAL framework, namely tangibles, reliability, responsiveness, assurance, and empathy, shape the satisfaction of independent participants (Pekerja Bukan Penerima Upah/PBPU) of Indonesia’s Jaminan Kesehatan Nasional (JKN) programme administered by BPJS Kesehatan, and whether this satisfaction subsequently drives citizen participation. Data were obtained from 180 PBPU participants who had used BPJS Kesehatan services at least twice, selected through purposive sampling, and analyzed with Partial Least Squares Structural Equation Modeling (PLS-SEM) in SmartPLS. All five service-quality dimensions were found to exert a significant positive effect on citizen satisfaction, with responsiveness and empathy showing the strongest influence, while citizen satisfaction in turn had a strong positive effect on citizen participation and fully mediated the link between each service-quality dimension and participatory behavior. The measurement model satisfied established criteria for convergent and discriminant validity, and the structural model showed adequate explanatory and predictive relevance. The findings extend the SERVQUAL framework and expectation confirmation theory into the domain of participatory behavior and provide BPJS Kesehatan with practical direction for strengthening service delivery to sustain long-term member engagement.