From Periphery to Centre: Local Government and the Emergence of Universal Healthcare in Indonesia

From Periphery to Centre: Local Government and the Emergence of Universal Healthcare in Indonesia Abstract: While the debate on universal healthcare coverage (UHC) often focuses on policy prescription and technical issues, the expansion of access to healthcare in developing countries is an eminently political process. This article analyzes the historical background of the adoption of UHC in Indonesia to articulate two intertwined arguments. First, in decentralized young democracies such as Indonesia, local government can play an important role in health policy by experimenting with innovative health insurance schemes. Although such activism may widen subnational inequalities, it can also contribute to the adoption of UHC by increasing the salience of health reform and by allowing policy learning. Second, institutional developments such as decentralization and the introduction of local direct elections can have a substantial impact on incentives for political elites to provide broad-based social services. This article discusses the relevance of these findings for the comparative literature on UHC and social policy in low and middle-income countries. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Contemporary Southeast Asia: A Journal of International and Strategic Affairs Institute of Southeast Asian Studies

From Periphery to Centre: Local Government and the Emergence of Universal Healthcare in Indonesia

From Periphery to Centre: Local Government and the Emergence of Universal Healthcare in Indonesia


Contemporary Southeast Asia Vol. 39, No. 1 (2017), pp. 178–203 DOI: 10.1355/cs39-1f © 2017 ISEAS – Yusof Ishak Institute ISSN 0129-797X print / ISSN 1793-284X electronic From Periphery to Centre: Local Government and the Emergence of Universal Healthcare in Indonesia DIEGO FOSSATI While the debate on universal healthcare coverage (UHC) often focuses on policy prescription and technical issues, the expansion of access to healthcare in developing countries is an eminently political process. This article analyzes the historical background of the adoption of UHC in Indonesia to articulate two intertwined arguments. First, in decentralized young democracies such as Indonesia, local government can play an important role in health policy by experimenting with innovative health insurance schemes. Although such activism may widen subnational inequalities, it can also contribute to the adoption of UHC by increasing the salience of health reform and by allowing policy learning. Second, institutional developments such as decentralization and the introduction of local direct elections can have a substantial impact on incentives for political elites to provide broad-based social services. This article discusses the relevance of these findings for the comparative literature on UHC and social policy in low and middle-income countries. Keywords: Indonesia, healthcare, democratization, decentralization, policy diffusion. Diego Fossati is a Research Fellow at the Griffith Asia Institute, Griffith University. Postal address: Griffith Asia Institute, 170 Kessels Road, N16 Room 1.75, Nathan QLD 4111, Australia; email: d.fossati@griffith. edu.au. 06 Diego-3P.indd 178 30/3/17 2:17 pm Local Government and Universal Healthcare in Indonesia Access to healthcare has long been a topical issue in developing countries, in which healthcare services are often underprovided, of low quality and too costly for a large proportion of the population. In recent years,...
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Institute of Southeast Asian Studies
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Copyright © The Institute of Southeast Asian Studies.
ISSN
1793-284X
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Abstract

Abstract: While the debate on universal healthcare coverage (UHC) often focuses on policy prescription and technical issues, the expansion of access to healthcare in developing countries is an eminently political process. This article analyzes the historical background of the adoption of UHC in Indonesia to articulate two intertwined arguments. First, in decentralized young democracies such as Indonesia, local government can play an important role in health policy by experimenting with innovative health insurance schemes. Although such activism may widen subnational inequalities, it can also contribute to the adoption of UHC by increasing the salience of health reform and by allowing policy learning. Second, institutional developments such as decentralization and the introduction of local direct elections can have a substantial impact on incentives for political elites to provide broad-based social services. This article discusses the relevance of these findings for the comparative literature on UHC and social policy in low and middle-income countries.

Journal

Contemporary Southeast Asia: A Journal of International and Strategic AffairsInstitute of Southeast Asian Studies

Published: May 5, 2017

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