Social Policy Development Revisited: The Interplay between Push and Pull Factors in the Indonesian Healthcare Expansion

Abstract

Established theories of social policy development, such as industrialisation and power resources, have been extensively used to explain the expansion of social policy, predominantly in developed economies. We argue that they may not always be applicable in the Global South. Our article examines multiple factors at play in Indonesia’s healthcare policy expansion using qualitative content analysis of historical sources, literature, and nine interviews with key policy architects. Using the pull-and-push factor model, we examined the interactions between policy entrepreneurs and centre-right political parties in creating national healthcare policy architecture and expansion. Our findings confirm that the window of opportunity for expansion was augmented when the political party of the ruling government experienced a decline in public trust, while clientelistic motives among elites facilitated the reform process. Drawing the lesson from Indonesia, we contend push prevails over the pull factors (labour movement and cross-class alliances) in social policy development.

Beyond path dependency: Analysing Indonesia's social policy responses to two crises

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“…Jamkesmas and other stopgap schemes were discontinued and integrated under BPJS Kesehatan. The reform could be attributed to the extensive role played by policy entrepreneurs (academics‐turned‐top bureaucrats), which found their significance as the ruling party lost public trust between 2011 and 2014 due to mega corruption among its members (see also Yuda & Asfhina, 2023). This corruption case presented a disadvantage to the ruling government's position in the 2014 election agenda.…”

Bringing Indonesia into the global welfare regime debate: A literature review and future research agenda

“…The former illustrates the limited effectiveness of the civil society movement (Komite Aksi Jaminan Sosial, KAJS) in pressing the government to implement social security reform in 2010–2014 since it was newly formed, and their sole agenda was not on social policy reform. However, a recent empirical study (Yuda & Rahmaddina, n.d., forthcoming ) found that KAJS utilized the heated discussion on social security reform to pressure president Susilo Bambang Yudhoyono's (SBY) administration during its second term. Furthermore, they found that KAJS' agenda for social protection reform was at odds with that of most civic organizations, which mobilized their resources to urge the government to reduce fuel prices rather than reform social protection.…”

Risk Rationalities in Welfare State Policy and Practice in Indonesia: A Phenomenological Study of National Health Insurance in a Rural Community

“…As a country just starting its late industrialisation, there is considerable variation in the degree of formalisation of the economic system, which is generally concentrated in a small number of regions (Yuda & Ashfina, 2023). Consequently, modern and traditional societies have developed in parallel, making efforts to install welfare state institutions side by side with informal social security (Nurhadi et al, 2023).…”

“…The institutionalisation of the welfare state in Indonesia has experienced a similar trend. The economic crisis, parallel to the collapse of authoritarian regimes, stimulated decentralisation politics, resulting in a new pattern whereby welfare systems, especially healthcare, were expanded to cover those outside the formal sector (Aspinall, 2014; Fossati, 2017; Murphy, 2019; Yuda & Ashfina, 2023). Nevertheless, the sustainability of health insurance is faced with obstacles, especially in the informal sector, which is represented by the category of Non-Wage Recipient Participants ( Peserta Bukan Penerima Upah , PBPU).…”