Behavioral Intention and Trust as Key Drivers of Willingness to Pay for Complementary Health Insurance: Evidence from Indonesia

Healthcare financing sustainability has become a major challenge in countries implementing Universal Health Coverage (UHC). This study develops and empirically validates a behavioral model to explain willingness to pay (WTP) for Complementary Health Insurance (CHI) in Indonesia by integrating perceived service quality, knowledge, perceived benefit, trust, and purchase intention. Using survey data from 445 BPJS Kesehatan participants, the proposed model was estimated using Partial Least Squares Structural Equation Modeling (PLS-SEM). The findings indicate that perceived benefit and knowledge significantly influence trust and purchase intention, while purchase intention is the strongest predictor of WTP. Trust also positively affects WTP, although with a smaller effect. Mediation analysis confirms the roles of trust and purchase intention in translating perceptions into financial commitment. The model demonstrates substantial predictive capability and highlights the importance of behavioral factors in strengthening voluntary participation in CHI, providing practical implications for sustainable healthcare financing under Indonesia’s UHC system.