This study aims to analyze the influence of knowledge level (literacy), perceptions of service quality and benefits, and economic factors (income) on the decision of the public to become participants in the BPJS Kesehatan program in Medan from an Islamic economics perspective. The study employs a quantitative approach with an explanatory design. The sample consisted of 100 respondents, determined using the Slovin formula. Primary data were collected via a questionnaire using a five-point Likert scale and analyzed using SPSS through validity and reliability tests, classical assumptions, multiple linear regression, t-tests, F-tests, and the coefficient of determination (R²). The results indicate that the level of knowledge, perceptions of service quality and benefits, and economic factors have a positive and significant influence on the public’s decision to enroll in BPJS Health, both partially and simultaneously. Economic factors are the variables with the relatively greatest influence. An R² value of 0.838 indicates that 83.8% of the variation in the public’s decision can be explained by these three variables. From an Islamic economics perspective, the decision to become a BPJS Kesehatan participant can be linked to the principles of public interest, protection of wealth, justice, and mutual aid in facing health risks.
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