Perspectives of Community Health Center Staff on the Provision of Health Services for Inactive BPJS Kesehatan PBI Participants at a Puskesmas, Karawang Regency
DOI:
https://doi.org/10.35451/jkg.v9i1.3685Keywords:
BPJS Kesehatan, inactive PBI participants, healthcare access, community health center staffAbstract
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.
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[1] E. K. Astuti, “Peran BPJS Kesehatan dalam mewujudkan hak atas pelayanan kesehatan bagi warga negara Indonesia,” J-PeHI J. Penelit. Huk. Indones., vol. 01, no. 01, pp. 55–65, 2020.
[2] A. A. Magdalena, “Kepatuhan Membayar Iuran Peserta Jaminan Kesehatan Nasional (JKN) Non Penerima Bantuan Iuran (Non-PBI) di Wilayah Pulau Jawa,” J. Kebijak. Kesehat. Indones., vol. 13, no. 02, pp. 56–63, 2024.
[3] M. Lisa, W. Rialdo, and R. Erwin, “Perlindungan hukum peserta PBI BPJS Nonaktif dalam pemenuhan hak pelayanan kesehatan,” Hum. Care J., vol. 11, no. 1, pp. 74–81, 2026.
[4] A. Fajriani, D. Anggreini, Winda, and F. P. Gurning, “Analisis faktor yang mempengaruhi pemanfaatan pelayanan kesehatan pada peserta BPJS Penerima Bantuan Iuran (PBI),” JIKMH J. Ilm. Kesehat. Media Husada, vol. 13, no. 1, pp. 86–94, 2024.
[5] Budiarsih, Ardiansah, and L. Fitriana, “People’s Right to Health Insurance,” in Analysis of the Implementation of the Health Insurance System in Indonesia, 1st ed., Institute of Research and Community Service University of 17 August 1945, 2021, pp. 9–13.
[6] A. A. Pradana, C. Casman, R. Rohayati, M. Kamal, and Andi, “Universal Health Coverage (UHC) Program in Indonesia,” Endurance, vol. 7, no. 2, pp. 462–473, 2022, doi: https://doi.org/10.22216/jen.v7i2.1363.
[7] A. B. Pratiwi, H. Setiyaningsih, M. O. Kok, T. Hoekstra, A. G. Mukti, and E. Pisani, “Is Indonesia achieving universal health coverage? Secondary analysis of national data on insurance coverage, health spending and service availability,” BMJ Open, vol. 11, no. 10, pp. 1–11, 2021, doi: 10.1136/bmjopen-2021-050565.
[8] D. Susilo et al., “Can Indonesia achieve universal health coverage? Organisational and financing challenges in implementing the national health insurance system,” SSM - Heal. Syst., vol. 5, p. 100138, 2025, doi: https://doi.org/10.1016/j.ssmhs.2025.100138.
[9] K. Anindya, J. T. Lee, S. A. Wilopo, C. Millett, and N. Carvalho, “Impact of Indonesia’s national health insurance scheme on inequality in access to maternal health services : A propensity score matched analysis,” J. Glob. Health, vol. 10, no. 1, pp. 1–12, 2020, doi: 10.7189/jogh.10.010429.
[10] A. Asante et al., “The benefits and burden of health financing in Indonesia : analyses of nationally representative cross-sectional data,” Lancet Glob. Heal., vol. 11, no. 5, pp. e770–e780, 2023, doi: https://doi.org/10.1016/S2214-109X(23)00064-5.
[11] V. R. Munawarah, W. A. Anggraini, D. Azzahra, and F. P. Gurning, “Faktor yang mempengaruhi pemanfaatan Jaminan Kesehatan Nasional pada layanan kesehatan Puskesmas (Literature Review),” J. Kesehat. Tambusai, vol. 4, no. 3, pp. 2229–2237, 2023.
[12] Menteri Sosial Republik Indonesia, Peraturan Menteri Sosial Republik Indonesia nomor 3 tahun 2026 tentang Persyaratan dan tata cara perubahan data Penerima Bantuan Iuran Jaminan Kesehatan. Indonesia, 2026, pp. 1–19.
[13] N. B. Purba and S. Ediyono, “Dampak Kepesertaan BPJS Kesehatan terhadap Akses, Kualitas, Outcome, dan Biaya Pelayanan Kesehatan di Indonesia: A Systematic Review,” J. Lang. Heal., vol. 6, no. 4, pp. 75–82, Dec. 2025, doi: 10.37287/jlh.v6i4.863.
[14] I. Fadli, “Tinjauan Pelayanan Publik atas Penonaktifan 179 Ribu Peserta BPJS PBI-JK Kabupaten Lebak,” J. Ilmu Adm. dan Kebijak. Publik, vol. 1, no. 3, pp. 99–103, 2026.
[15] Apri Amalia, Sahbudi, and Ivan Duna Husada, “Perlindungan Hukum Terhadap Perubahan Data Fakir Miskin Peserta Penerima Bantuan Iuran Yang Dinonaktifkan Menjadi Peserta Non Penerima Bantuan Iuran (Studi Dinas Sosial Kota Medan),” Reformasi Huk., vol. 25, no. 1, pp. 1–20, May 2021, doi: 10.46257/jrh.v25i1.162.
[16] N. N. Aprilian, D. R. Dewi, P. Fannya, and D. H. Putra, “Tinjauan Penyebab Peserta Non Aktif Bpjs di Puskesmas Kecamatan Cengkareng,” J. Siti Rufaidah, vol. 2, no. 3, pp. 120–149, 2024.
[17] S. Wenang et al., “Availability and Accessibility of Primary Care for the Remote, Rural, and Poor Population of Indonesia,” Front. Public Heal., vol. 9, no. September, pp. 1–11, Sep. 2021, doi: 10.3389/fpubh.2021.721886.
[18] Q. Cheng et al., “Determinants of healthcare utilization under the Indonesian national health insurance system – a cross-sectional study,” BMC Health Serv. Res., vol. 25, no. 1, p. 48, Jan. 2025, doi: 10.1186/s12913-024-11951-8.
[19] N. Pitria, “Permasalahan SOP Dalam Etika Administrasi Kesehatan,” JIMU J. Ilm. Multidisipliner, vol. 3, no. 03, pp. 1502–1511, 2025.
[20] M. Haidar, “Karawang Catat Rekor Penonaktifan Peserta BPJS, Ratusan Ribu Jiwa Kehilangan Jaminan Kesehatan,” Karawang Post. [Online]. Available: https://karawangpost.pikiran-rakyat.com/karawangin/pr-1429990860/karawang-catat-rekor-penonaktifan-peserta-bpjs-ratusan-ribu-jiwa-kehilangan-jaminan-kesehatan
[21] N. F. Alayda, C. M. Aulia, E. R. Ritonga, and S. H. Purba, “Literature Review : Analisis Dampak Kebijakan Jaminan Kesehatan Nasional ( JKN ) Terhadap Akses dan Kualitas Pelayanan Kesehatan,” J. Kolaboratif Sains, vol. 7, no. 7, pp. 2616–2626, 2024, doi: 10.56338/jks.v7i7.5573.
[22] A. Minarni, D. Arimbi, and A. Retnowati, “Dilema Etik Tenaga Medis dalam Pelayanan Kesehatan Sakit Kritis di Era Jaminan Kesehatan Nasional,” JIIP - J. Ilm. Ilmu Pendidik., vol. 8, no. 10, pp. 11571–11576, Oct. 2025, doi: 10.54371/jiip.v8i10.9335.
[23] A. Utarini, Penelitian kualitatif dalam pelayanan kesehatan. Yogyakarta: Gadjah Mada University Press, 2020.
[24] A. N. R. Hasibuan, S. A. Putri, S. R. Hasibuan, and F. P. Gurning, “Analisis Kesesuaian Anggota BPJS Penerima Bantuan Iuran (PBI) dengan Indikator Kemiskinan di Kota Medan,” J. Kolaboratif Sains, vol. 7, no. 5, pp. 1556–1561, 2024, doi: 10.56338/jks.v7i5.5075.
[25] C. Jamani, E. Budiati, and S. E. Irianto, “Implementasi Kebijakan Penerima Bantuan Iuran Badan Penyelenggara Jaminan Sosial Kesehatan di Kabupaten Lampung Tengah,” Arus J. Sos. dan Hum., vol. 2, no. 2, pp. 111–116, Aug. 2022, doi: 10.57250/ajsh.v2i2.84.
[26] R. F. Syahadah, E. Hariyani, N. Fadila, and F. P. Gurning, “Implementasi Program Penerima Bantuan Iuran (PBI) Jaminan Kesehatan di Puskesmas Kutalimbaru,” Indones. J. Heal. Sci., vol. 4, no. 4, pp. 256–266, 2024.
[27] E. N. W. Rosalina, “Status Kepesertaan JKN Nonaktif Sebagai Dasar Penolakan Pasien : Analisis Yuridis terhadap Undang-Undang No 17 Tahun 2023 tentang Kesehatan,” J. Contemp. Law Stud. Vol., vol. 3, no. 2, pp. 259–276, 2026, doi: https://doi.org/10.47134/lawstudies.v3i2.5542.
[28] K. I. P. Putri, H. Irianto, and S. Ratnawati, “Aksesibilitas layanan kesehatan berbasis BPJS pada FKTP Puskesmas Sidoarjo,” Triwikrama J. Multidisiplin Ilmu Sos., vol. 11, no. 10, pp. 1–7, 2026.
[29] A. S. Susanti and N. A. S. Billa, “Analisis Dampak Perubahan Status BPJS Non-Aktif Menjadi Program Universal Health Coverage (UHC) Guna Meningkatkan Mutu Pelayanan di Rumah Sakit,” J. Kesehat. Indones., vol. 15, no. 3, pp. 113–117, 2025.
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