#PETA MEGAPOLITAN 2017 DRIVERS#

In most cases, the impetus for more inclusive health coverage has been domestic, and implementation has been nationally driven. This push for what has become known as ‘universal health coverage’ is being promoted by development agencies such as the World Health Organisation (WHO) and the World Bank ( Rodin and de Ferranti 2012). Over the last decade, >30 middle-income countries and a handful of low income countries have launched ambitious plans to ensure that all of their citizens can get the health care they need without undue financial pain. While technical considerations took a back seat to political priorities in developing the structures for health coverage nationally, they will have to be addressed going forward to achieve sustainable UHC in Indonesia. In the Indonesian example, UHC became possible when the interests of politically and economically influential groups were either satisfied or neutralised.

#PETA MEGAPOLITAN 2017 DRIVERS#

Specific drivers of success and failure should be taken into account when scaling UHC to the national level. The Indonesian experience underlines the value of policy experimentation, and of a close understanding of the contextual and political factors that drive successful UHC models at the local level. It also became contested, with national policy-makers appropriating health insurance programmes that were first developed locally, and taking credit for them. UHC became an electoral asset, moving up the political agenda. When direct elections for local leaders were introduced in 2005, popular health schemes led to success at the polls. The end of this programme coincided with decentralisation, leading to experimentation with several different models of health provision at the local level. To stave off social unrest, the government provided health coverage for the poor for the first time, creating a path dependency that influenced later policy choices. We find that Indonesia's path has been determined largely by domestic political concerns – different groups obtained access to healthcare as their socio-political importance grew.Ī major inflection point occurred following the Asian financial crisis of 1997.

This paper explores Indonesia's journey towards universal health coverage (UHC) from independence to the launch of a comprehensive health insurance scheme in January 2014. This crystallised an ambition first enshrined in law over five decades earlier, but never previously realised. In 2013 Indonesia, the world's fourth most populous country, declared that it would provide affordable health care for all its citizens within seven years.

Peta megapolitan 2017