The IMPACT OF HEALTHCARE ACCESSIBILITY ON THE REFERRAL SERVICE SELECTION DECISIONS OF JKN PBI BENEFICIARIES IN MEDAN, NORTH SUMATRA

Abstract

Decision-making among National Health Insurance–Contribution Assistance (JKN-PBI) beneficiaries in selecting referral health services remains substantially influenced by accessibility constraints. Accessibility continues to be a major barrier, particularly for JKN-PBI beneficiaries living in areas with high poverty levels and unequal distribution of healthcare facilities. Although the referral system has been updated to enhance service accessibility, many JKN-PBI beneficiaries still face obstacles such as long distances to referral facilities, limited availability of public transportation, and unaffordable travel costs, all of which affect their decisions when choosing referral services. This study aims to analyze the influence of accessibility on the decision-making of JKN-PBI beneficiaries in selecting referral health services in Medan City. A quantitative cross-sectional design was employed and conducted from August to September 2025. The study population consisted of 7,464 JKN-PBI beneficiaries from six districts selected through cluster sampling. A total sample of 90 respondents was determined using the Slovin formula and selected through simple random sampling. Data were collected using a structured questionnaire that had undergone validity and reliability testing. Data analysis utilized chi-square tests and multivariate logistic regression. The findings indicate that three accessibility variables had significant effects on referral service decision-making: distance (p-value=0.002; ExpB=0.183), ease and availability of public transportation (p-value=0.001; ExpB=0.143), and affordability of transportation costs (p-value=0.002; ExpB=0.186), while time required to healthcare services showed no significant effect (p-value=0.132). It is recommended that the government expand transportation access, provide subsidies or financial support for health-related travel costs, and strengthen the referral system based on geographic proximity to improve equitable access to healthcare services.