Previous crises have opened a window of opportunity for countries to enact reforms and policies that dramatically expand health coverage and improve the health of their populations. Indonesia has gone through a multitude of crises, especially in the economic sector. This study aims to understand the influence of these crises on the political economy dynamics that facilitated changes in the health system and the various strategies pursued to move forward reforms. The study used retrospective assessments using a Political Economy Analysis framework. Data collection was carried out through literature reviews (including media tracking) and in-depth interviews with eight selected key informants from September to October 2023. This study found that the watershed moment in Indonesia’s health financing history was the Asian Financial Crisis (AFC) of 1997/1998. The crisis not only caused an expansion of financial protection for the poor but also instigated the establishment of a legal framework for social security, including the National Health Insurance (JKN), that extended to the entire population. The launch of JKN involves various stages of law and policymaking processes. The deliberative process of the laws consisted of contested ideas and interests, including strategic actions and collaboration by key actors involved. One of the key successes of this reform was the presence of a change team comprising diverse stakeholders, including civil society organizations, academics, external organizations, parliamentary members, and the mass media. These stakeholders recognized the urgency of implementing health and security protection schemes for the general populace, the impoverished, and vulnerable groups, as a preemptive measure against potential future crises. Furthermore, throughout the reform process, the presence of technical assistance from international organizations also played a pivotal role.

Suggested citation:

Saputri, Nurmala Selly, Arif Budi Darmawan, Nina Toyamah, and Rizki Fillaili (2024) ‘Political Economy Analysis of Health Financing Reforms in Times of Crisis: Identifying Windows of Opportunity for Countries in the SEA Region. Indonesia Case Study Report.’ Research Report No. 3. Jakarta: The SMERU Research Institute <URL> [access date].