Health care and democratization in Indonesia

Abstract

Analyses of Indonesian democracy often emphasize elite capture of democratic institutions, continuity in oligarchic power relations, and exclusion of popular interests. Defying such analyses, over the last decade, Indonesia has experienced a proliferation of social welfare programmes, some with a redistributive element. This article analyses the expansion of social welfare protection by focusing on health care. At the national level, Indonesia has introduced programmes providing free health care to the poor and approved a plan for universal social insurance. At the subnational level, in the context of far-reaching decentralization reforms, politicians have competed with each other to introduce generous local health care schemes. Taking its cue from analyses of social welfare expansion in other East Asian states, the article finds the origins of policy shift in the incentives that democracy creates for elites to design policies that appeal to broad social constituencies, and in the widening scope for engagement in policymaking that democracy allows. The article ends with a cautionary note, pointing to ways in which oligarchic power relations and the corruption they spawn still undermine health care quality, despite expansion of coverage.