Biofinancing Citizenship: Gotong Royong and the Political Construction of National Health Insurance Ideology in Indonesia

Abstract

This paper examines the fund-collecting model of Indonesia's national health insurance system, Jaminan Kesehatan Nasional (JKN), performed by its organizing body, Badan Penyelenggara Jaminan Sosial (BPJS). The system is based on the home-grown idea of gotong royong, often vaguely defined as ‘mutual assistance.’ As gotong royong has been prominent in Indonesia's nation building projects since before independence, scholars have argued that the term has carried numerous interpretations shared by political elites and the larger public they sought to mobilize. Analyzing recent public debates regarding the JKN, we argue that these debates are rooted in the unstable nature of the gotong royong principle. We begin with a brief history of Indonesia's national health insurance system and the evolution of the gotong royong notion, before presenting the various interpretations of gotong royong in the national health insurance system. We also examine the concept of biofinancing citizenship that has emerged as a consequence of the current implementation of the gotong royong principle as the central ideology of Indonesia's national health insurance system. This paper aims to enrich the literature in welfare politics by providing insights from one of the world’s largest and most ambitious national health insurance programs.