Regional governments around Indonesia are devising new and ambitious free healthcare for their electorates, but to what end?
Edward Aspinall and Eve Warburton
Over the past decade, Indonesia has witnessed an explosion of local health insurance programs, or Jamkesda (Jaminan Kesehatan Daerah). The nature and scope of these schemes vary greatly from region to region, but most involve a district or provincial government subsidising basic medical services for residents. Sometimes the services are provided free to all residents, more commonly just for the poorest. While accurate data is hard to obtain, the World Bank recently estimated a rise from some 60 district insurance schemes in 2008 to over 300 in 2010. This means that a majority of Indonesia’s districts have such local schemes in operation, and the number keeps growing. What accounts for this sudden spike over such short period?
The surge in local healthcare programs is directly related to democratisation and local electoral politics. Populist campaigns have become a prominent feature of Indonesia’s regional elections, as candidates promise free social services, like healthcare or education, in a bid to appeal to voters. The new political salience of healthcare at the local level (and at the national level too) amounts to a near revolution in the way politicians engage with their electorates.
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