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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.
Acknowledgement
My thanks for comments on earlier versions of this article by participants at the workshop on “Challenging Inequalities: Contestation and Regime Change in East and Southeast Asia”, Murdoch University, especially Aurel Croissant, Meredith Weiss, Eva Hansson, and Kevin Hewison, as well as for comments by Dinna Wisnu and anonymous reviewers for this journal. I also benefited from input by Robert Sparrow, and am very thankful to Eve Warburton for expert research assistance and to the Australian Research Council for funding part of the research on which the article is based.
Notes on contributor
Edward Aspinall is a specialist on the politics of Indonesia. He is the author of two books, Opposing Suharto: Compromise, Resistance and Regime Change in Indonesia (2005) and Islam and Nation: Separatist Rebellion in Aceh, Indonesia (2009) as well as many scholarly articles, chapters, and papers on aspects of Indonesian politics.
Notes
1. “Rethinking the Welfare State: Asia's Next Revolution,” The Economist, 8 September 2012.
2. See especially, Robison and Hadiz, Reorganising Power; Hadiz, Localising Power; and Winters, Oligarchy.
3. Mietzner, “Fighting the Hellhounds.”
4. For a further elaboration of these arguments see Aspinall, “Popular Agency”; and other articles in issue 96 of Indonesia, where the oligarchy perspective is debated by its proponents and critics.
5. Haggard, “Political Economy of the Asian Welfare State,” 148, 169.
6. Wong, Healthy Democracies, 10.
7. Holliday, “East Asian Social Policy,” 145, cited in Hwang, “New Global Challenges,” 2.
8. Hewison, “Crafting Thailand's New Social Contract,” 513. Note, however, that the dynamics in Thailand were distinctive from those in Indonesia described in this article. Thaksin was a populist leader who appealed over the heads of political elites and organizations directly to the people; policymaking was more exclusionary than in the Indonesian case described here. My thanks to one of the reviewers for making this point.
9. Thabrany, “Social Security for All,” 1.
10. ILO, Social Security in Indonesia, 21. This number was equivalent to only about 47% of the formal labour force of 36 million persons.
11. Kristiansen and Santoso, “Surviving Decentralisation?,” 248.
12. Ibid., 248–9.
13. Ibid., 249.
14. Sumarto, Suryahadi. and Bazzi, “Indonesia's Social Protection,” 121.
15. Sumarto, Suryahadi, and Widyanti, “Design and Implementation,” 117.
16. Sumarto, Suryahadi, and Bazzi “Indonesia's Social Protection,” 123.
17. Ibid., 123.
18. Sparrow, Suryahadi, and Widyanti, Social Health Insurance for the Poor, i.
19. See for example, Pedoman Pelaksanaan Jaminan Kesehatan Masyarakat (Jamkesmas) 2008, 15–18.
20. Sparrow, “Targeting the Poor,” 197; see also Suharyo et al., Social Protection Programs, 52–7.
21. Elly Burhaini Faizal, “Jamkesmas in 2013 Expanded with 10 Million More Entitled,” The Jakarta Post, 21 January 2013.
22. Rosser, Wilson, and Sulistiyanto, “Leaders, Elites and Coalitions,” 22.
23. Hasegawa, “Decentralization,” 13.
24. Ibid., 17.
25. SMERU, District Health Care Financing Study: Descriptive Statistics and Initial Results (PowerPoint Presentation, 2012).
26. Profil Data Kesehatan Indonesia Tahun 2011, 198.
27. Wisnu, Governing Social Security, 169.
28. Ibid., 169–70; see also GTZ, Social Security System Reform, 12–13.
29. Ibid., 155.
30. Ibid., 179, 183.
31. Ibid., 196.
32. Haggard and Kaufman, Development, Democracy and Welfare States, 12.
33. World Bank, Indonesia Economic Quarterly, 24.
34. Wisnu, Politik Sistem Jaminan Sosial, 163. Early reports showed that the integration of the BPJS and the local and state employee health schemes was far from smooth. See for example, “Criticism Grows Over Lack of Awareness of Health Scheme.”
35. “Premi Rendah, “BPJS Kekurangan Dana,” Kompas, 18 March 2013.
36. Wong, “Healthy Democracies,” 15.
37. Ibid., 16.
38. Slater, “Indonesia's Accountability Trap”; see also Aspinall, “Irony of Success.”
39. Barrientos and Hulme, “Social Protection,” 445; see also Sumarto, Suryahadi, and Bazzi, “Indonesia's Social Protection.”
40. Croissant, “Changing Welfare Regimes,” 520.
41. Barrientos and Hulme, “Social Protection.”
42. Mietzner, “Indonesia's 2009 Elections,” 4.
43. Wisnu, “Governing Social Security”; Wisnu, Politik Sistem Jaminan Sosial.
44. Wisnu, Politik Sistem Jaminan Sosial, 125.
45. See Cole, “Coalescing for Change”; and Cole, “A New Tactical Toolkit”, for useful summaries of the KAJS campaigns.
46. “Buruh dan Politik,” 26.
47. See for example, “KAJS Fields 100,000 to Stage Rallies on May Day”; “Minta RUU BPJS Disahkan, 50 Ribu Orang Demo di Depan DPR.”
48. See for example: “Ribuan Buruh Tolak BPJS dan SJSN di Depan Istana.”
49. Cole, “A New Tactical Toolkit.”
50. Rosser, Wilson, and Sulistiyanto, “Leaders, Elites and Coalitions,” 3.
51. Aspinall, “Popular Agency and Interests.”
52. “Decentralization Poses Threats to Public Healthcare.”
53. “Free Healthcare, Education not Essential”; see also Damanik, “Wajar, Sektor Kesehatan Jadi Komoditas Politik.”
54. Haggard and Kaufman, Development, Democracy and Welfare States, 2.
55. “Jamkesmas has Deficiencies, BPK says,” The Jakarta Post, 3 April 2013.
56. Harimurti et al., “Nuts and Bolts,” 19.
57. Ibid., 20.
58. Pisani, “Medicine for a Sick System.”
59. According to the World Health Organization's National Health Accounts, government expenditure accounted for 35.7% of total health expenditure in 1995, a figure that had fallen somewhat to 34.1% in 2011.
60. Harimurti et al., “Nuts and Bolts,” 21.
61. Rosser, “Realising Free Health Care for the Poor,” 259.
62. Ibid., 267.
63. Aspinall and van Klinken, The State and Illegality.
64. Dick and Mulholland, “The State as Marketplace.”
65. “Rp 8 Trilyun Dana JPS Salah Alamat,” Kompas, 23 April 1999.
66. See for example, “Golkar dan PDRD Bantah Salah Gunakan JPS,” Kompas, 28 May 1999.
67. Wisnu, “Governing Social Security,” 203–7.
68. Ibid., 200.
69. Wisnu, Politik Sistem Jaminan Sosial, 160.
70. Wisnu, “Governing Social Security,” 185–93.
71. Haggard and Kaufman, Development, Democracy and Welfare States, 360.