Factors Related to The Level of Compliance to Pay Contributions of National Health Insurance Participants Non-Wage Earners

Introduction: Nationally, in 2022 there are 15,679,006 participants of Non-Wage Earners in arrears of contributions, while in the working area of BPJS Kesehatan Kambi Branch there are 228,181 participants of Non-Wage Earner Workers in arrears with contributions. The number of participants who are delinquent due to non-compliance of Non-Wage Earner Workers participants in paying contributions. Objective: To measure the relationship between knowledge, number of family members and payment methods with the level of compliance to pay contributions for participants of the National Health Insurance Non-Wage Earner Workers in Jambi City in 2023. Method: This study is a descriptive study with a cross sectional design. Questionnaire research instruments, then univariate and bivariate analysis with chi-square test. Results and Discussion: The results of this study show that there is a significant relationship between knowledge (p-value = 0.000), number of family members (p-value = 0.000) and payment method (p-value = 0.018) with the level of compliance to pay contributions of national health insurance participants non-wage earners workers in Jambi City. Conclusion: there is a relationship between knowledge, number of family members and payment methods with the level of compliance to pay contributions of national health insurance participants non-wage earners workers in Jambi City.


Introduction
Health is one of the human rights that is part of welfare that must be realized in accordance with the ideals of the Indonesian nation as stated in the preamble to the 1945 Constitution (Isriawaty, 2015).In accordance with Law of the Republic of Indonesia Number 36 of 2009, health is defined as an optimal condition in terms of physical, mental, spiritual, and social that allows each individual to lead a productive social and economic life (Anisah, 2020) To reduce the risk of uncertainty, the government has introduced an initiative known as the National Health Insurance Program.The development of National Health Insurance Program participation rates every year continues to increase.According to BPJS Kesehatan records, the number of participants in health insurance programs throughout Indonesia in 2022 will reach 248,771,083 (91.8%) people.In Jambi Province, the total number of participants in the health insurance program was 3,026,329 (83.03%) people.In July 2023, in Jambi City, there are 613,047 (98.56%) people who have participated in the health insurance program.
The increase in the number of participants is not in line with their level of compliance in making contribution payments.At this time, the problem is no longer related to the number of participants but the number of participants who are in arrears in paying contributions (Situmorang, 2022).Based on data from the National Social Security Council (DJSN), nationally in 2022 there are 15,679,006 participants of Non-Wage Earners in arrears of contributions, while in the working area of BPJS Kesehatan Kambi Branch there are 228,181 Non-Wage Earner Workers participants in arrears with contributions (Tampubolon et al., 2023) Based on BPJS Health data in 2022, of the 5 regencies/cities that are the working areas of BPJS Kesehatan Jambi Branch, Jambi City is the area with the highest number of participants who are in arrears, as many as 103,195 participants who are in arrears, or equivalent to 45%.Meanwhile, East Tanjung Jabung Regency is the area with the least number of participants who made arrears, there were 18,978 participants (8.13%) who made arrears.
Non-Wage Worker participants' non-compliance in paying fees led many participants to agile (Fejrini et al., 2021).Predisposing factors, probable or supporting factors, and reinforcing factors are some of the factors that influence human health behavior, according to Lawrence Green's ideas.These factors include behavior related to compliance with National Health Insurance contributions.
Research in Bontomatene sub-district by (Ramadani & Batara, 2021) found that there was a relationship between income levels, knowledge, and perceptions of contribution rates and payment compliance rates.Meanwhile, Jihan Adani's (2019) research found that there is a correlation between the level of knowledge, quality of health services, contribution rates, payment methods, and family support with the level of compliance with National Health Insurance Program contribution payments (Adani et al., 2019).

Factors Related to The Level of Compliance to Pay Contributions of National Health Insurance Participants Non-Wage Earners
Based on an initial survey conducted through interviews with 15 Non-Wage Earner Workers participants, it was found that 10 of them made contribution payments after the 10th of each month.The reason behind non-compliance with the payment of these dues is due to lack of knowledge regarding payment deadlines and the uncertainty of income they experience.In addition, some participants had a fairly large number of dependents.
Non-compliance in payment of contributions can have an impact on participants and for BPJS Kesehatan managers (Lisnah et al., 2023).For participants, the impact is the hampering of health services because the membership status will become inactive starting from the next month after late payment.As a result, health service guarantees will be temporarily suspended.Meanwhile, for BPJS Health managers, the impact is to experience considerable losses (Pratiwi, 2016).Therefore, it is necessary to conduct research on the factors that affect the compliance rate of participants of the National Health Insurance Non-Wage Earner Workers in Jambi City in 2023.

Method
This study was with a cross sectional design.The population of this study is all participants of the National Health Insurance in the Non-Wage Earner Workers segment in Jambi City.This study involved 106 respondents with a sampling technique using cluster random sampling.Questionnaires were used as instruments in this study, which then carried out univariate and bivariate analysis with chi-square tests.

Result
The frequency distribution on variables, both dependent and independent variables, is obtained from the results of univariate analysis.In Table 2.A p-value of 0.000 was obtained which shows that there is a statistically significant relationship between knowledge and the level of compliance with paying contributions of participants in the National Health Insurance for Non-Wage Earners in Jambi City.Lack of knowledge increased the likelihood of respondents being less compliant by 2,987 times compared to respondents with good knowledge.Based on Table 3. there is a statistically significant relationship between the number of family members and the level of compliance to pay the National Health Insurance payment for Non-Wage Earners in Jambi City in 2023, which is indicated by a p-value of 0.000.A larger number of family members increased respondents the likelihood of being less compliant by 3,120 times compared to respondents with a small number of family members.Based on Table 4. above, it can be concluded that there is a significant relationship between the payment method and compliance with paying contributions with a p-value of 0.018

The Relationship between Knowledge and Dues Compliance
The results of the study found a relationship between knowledge and the level of compliance with paying contributions to participants of the National Health Insurance for Non-Wage Earners in Jambi City in 2023.Based on the results of statistical tests, a pvalue = 0.000 is obtained.In respondents with low knowledge, the proportion of people who are less compliant is higher at 64% compared to respondents who are well informed or 21.4%.
The results of this study are in line with research by Harahap et al ( 2021) which shows that knowledge has a relationship with compliance with National Health Insurance Program contribution payments.Furthermore, Handayani et al (2020) also found a relationship between knowledge and non-compliance of independent participants in paying BPJS health contributions with p-value of 0.002 (Hildayanti et al., 2020).Adila Solida et al. ( 2022) further concluded that knowledge has a relationship with noncompliance with BPJS Kesehatan self-contribution payers after using childbirth services (p-value = 0.000).
The research of Risdayanti and Batara (2021) is not in line with the results of this study which shows that knowledge has no relationship with BPJS Health independent contribution arrears with p-value of 0.118 (Ramadani & Batara, 2021).
Field research shows that most people still do not understand that paying dues is an obligation.In addition, some of them do not know information about the deadline for paying contributions to BPJS Kesehtan, available payment methods, and sanctions for not paying contributions.

Relationship between Number of Family Members and Compliance to Pay Dues
Based on the results of statistical analysis with the chi-square test, a p-value of 0.000 was obtained .In Jambi City in 2023, there is a relationship between the number of family members and the level of compliance to pay contributions for Non-Wage Earner Workers National Health Insurance participants.The proportion of respondents who were less compliant in paying contributions was 87.5%, compared to only 28% in households with fewer members.
The results of this study are supported by Nurlia et al (2021) and Intiasari et al (2019) who found that the number of family members has a relationship with compliance in fulfilling the obligation to pay National Health Insurance.Based on the findings of research by Witati et al (2022), there is a correlation between the number of family members and their tendency to contribute to BPJS Kesehatan as informal workers.

Conclusion
There is a significant relationship between knowledge, number of family members and payment methods with the level of compliance to pay contributions for participants in the National Health Insurance for Non-Wage Earners in Jambi City in 2023.
Wichsy Suspamira, Dwi Noerjoedianto, Andy Amir, Arnild Augina Mekarisce, Rizalia Wardiah/KESANS Factors Related to The Level of Compliance to Pay Contributions of National Health Insurance Participants Non-Wage Earners

Table 1 Frequency Distribution of Dependent Variables and Independent Variables
Based on the data inTable 1, most Non-Wage Earner Workers participants (58.5%) showed compliance in fulfilling National Health Insurance Program contributions.In Wichsy Suspamira, Dwi Noerjoedianto, Andy Amir, Arnild Augina Mekarisce, Rizalia Wardiah/KESANS Factors

Related to The Level of Compliance to Pay Contributions of National Health Insurance Participants Non-Wage Earners KESANS, Vol. 3, No. 3, 2023 208 addition
, more than half of Non-Wage Earner Workers participants (52.8%) had a fairly good level of knowledge.In addition, most Non-Wage Earner Workers participants (77.4%) came from families with relatively few members.Finally, most Non-Wage Earner Workers participants (67.9%) choose the cash payment method when giving contributions