Governments around the world have strived to ensure fair access to quality healthcare by reforming health financing and expanding coverage. Despite broad agreement on universal health coverage (UHC), translating it into effective reforms takes time and effort. Complex interactions among stakeholders, influenced by varying power dynamics and economic factors, can hinder reform.

The COVID-19 pandemic prompts a reconsideration of health system directions. Past crises, such as in Argentina, Turkey, Thailand, and South Korea, led to policies expanding coverage and improving population health. Theoretical perspectives underscore the necessity of aligning specific policies with political approaches for reform.

Understanding political and economic dynamics that drove change post-crisis, particularly in Southeast Asia, informs strategies for UHC progress. Indonesia’s health financing transformation, anchored by the 2014 National Health Insurance (JKN) reform, emphasizes rebalancing towards primary health care. Incorporating a political economy perspective aids reform implementation by navigating stakeholder interests.

The success of JKN serves as a valuable source of knowledge, offering insights into stakeholder roles and strategies for securing political support, which can benefit current leaders. Analyzing compromises resulting from political dynamics and their consequences plays a crucial role in shaping the strategy.

In this project, SMERU analyzes stakeholder interactions, power dynamics, and institutional processes drawn from the 2014 JKN reform to gain insight into strategies and compromises to support current reform goal of prioritizing primary care expenditure.