Perspectives of Community Health Center Staff on the Provision of Health Services for Inactive BPJS Kesehatan PBI Participants

In early 2026, the Indonesian government implemented a policy to update the National Social and Economic Single Data System (DTSEN), resulting in the deactivation of 11 million Recipients of Contribution Assistance (PBI) members out of a total of 96.8 million participants. This situation placed community health center (Puskesmas) staff in a dilemma between complying with administrative regulations and providing healthcare services to patients. This qualitative study with a phenomenological design was conducted at a Puskesmas, Karawang Regency, due to the high proportion of visits by BPJS Kesehatan participants (70%), particularly PBI beneficiaries, and the presence of cases involving inactive PBI membership. The study was conducted in May 2026 over a two-week period. Informants were selected using purposive sampling. Data were collected through in-depth interviews using a semi-structured interview guide and were analyzed using NVivo software. The findings identify several factors contributing to the deactivation of PBI membership, including economic conditions and welfare deciles, data updating and validation processes, and discrepancies in administrative identify records. Inactive PBI participants continue to receive healthcare services without being denied treatment, and emergency cases remain prioritized regardless of health insurance status. Barriers to healthcare access occur when or experience delays in BPJS reactivation, Universal Health Coverage (UHC) applications, and data updating processes. Strategies and solutions for inactive PBI participants include provision of emergency medical care, reactivation of BPJS membership, and applying for coverage through the UHC scheme. This study recommends improving the data verification system, increasing health insurance literacy, and strengthening cross-sectoral coordination among BPJS Kesehatan, the Social Services Agency, village governments, and Puskesmas, to address the issue of inactive PBI beneficiaries and ensure equitable protection of the right to health.