Universal health coverage, or “UHC”, is much talked about these days. There’s a lot of technical analysis about how best to achieve it — should it funded out of the national tax base or out of pooled premia? How much should people pay out of their own pockets? Does task-shifting between differently trained health workers increase reach or affect outcomes? Many such questions are asked, but there’s less work examining in detail the political processes that affect the desirability or feasibility of each of these options.

Working with colleagues at Migunani Research Institute in Yogyakarta and Erasmus University in Rotterdam, we’ve tried to look at the political economy of health insurance in Indonesia, and its evolution over the last seven decades.

We’ve also published a detailed anlaysis of health insurance, service availability and service use in Indonesia, which shows that richer families are the single largest consumers of free healthcare in the country. This is in part because of the uneven distribution of health services. Although people in the poorest parts of the country are most likely to report having health insurance (because the government picks up the tab for people too poor to pay their own premiums), the insurance system also pays out less in those areas, because there are simply not many health services where your shiny government-issued health insurance card can be used.

We’ve also been investigating the way under-resourced scale-up of public health provision can create perverse incentives for organisations that provide medicines and health services. One potential consequence is an increase in fake and poor quality medicines on national markets.