Public Policy Evaluation of Free Health Social Security: Social Equity, Governance, and Access in Maluku Province

Authors

DOI:

https://doi.org/10.37251/jske.v7i3.2718

Keywords:

Free Health Insurance, Maluku Province, Policy Evaluation, Public Health Policy, Social Equity

Abstract

Purpose of the study: This study evaluates the implementation of the free public health insurance program managed by the Maluku Provincial Health Office, focusing on policy performance, social equity, governance capacity, and access for low-income and vulnerable communities in an archipelagic setting.

Methodology: This study employed a descriptive qualitative approach with a public policy evaluation design. Data were collected through observation, in-depth semi-structured interviews, and document analysis. Informants were selected purposively from health officials, program administrators, and beneficiary communities. Data were analyzed through data reduction, thematic categorization, data display, conclusion drawing, and source triangulation.

Main Findings: The program reduces financial barriers and improves formal access to health services for disadvantaged groups. Administrative performance is relatively effective, particularly through same-day activation and interagency verification mechanisms. However, fiscal limitations, uneven health infrastructure, data governance problems, weak information dissemination, and geographic fragmentation across islands continue to limit substantive equity.

Novelty/Originality of this study: This study provides a theory-based evaluation of provincial-level health insurance implementation using William N. Dunn's policy evaluation framework. It explicitly links effectiveness, efficiency, adequacy, equity, responsiveness, and accuracy to welfare state theory, social protection, distributive justice, decentralized governance, and spatial access in an archipelagic region.

References

World Health Organization, Constitution of the World Health Organization. Geneva, Switzerland: WHO, 1946.

Republic of Indonesia, The 1945 Constitution of the Republic of Indonesia. Jakarta, Indonesia: Government of Indonesia, 1945.

Republic of Indonesia, Law No. 17 of 2023 Concerning Health. Jakarta, Indonesia: Government of Indonesia, 2023.

Republic of Indonesia, Law No. 40 of 2004 Concerning the National Social Security System. Jakarta, Indonesia: Government of Indonesia, 2004.

Republic of Indonesia, Law No. 24 of 2011 Concerning the Social Security Administering Body. Jakarta, Indonesia: Government of Indonesia, 2011.

Republic of Indonesia, Presidential Regulation No. 82 of 2018 Concerning Health Insurance. Jakarta, Indonesia: Government of Indonesia, 2018.

BPJS Kesehatan, Laporan Pengelolaan Program Tahun 2023 dan Laporan Keuangan Tahun 2023. Jakarta, Indonesia: BPJS Kesehatan, 2024.

World Health Organization and World Bank, Tracking Universal Health Coverage: 2023 Global Monitoring Report. Geneva, Switzerland: WHO, 2023.

World Health Organization, The World Health Report 2010: Health Systems Financing: The Path to Universal Coverage. Geneva, Switzerland: WHO, 2010.

J. Kutzin, “Health financing for universal coverage and health system performance: Concepts and implications for policy,” Bull. World Health Organ., vol. 91, no. 8, pp. 602–611, 2013, doi: 10.2471/BLT.12.113985. DOI: https://doi.org/10.2471/BLT.12.113985

G. Lagomarsino, A. Garabrant, A. Adyas, R. Muga, and N. Otoo, “Moving towards universal health coverage: Health insurance reforms in nine developing countries in Africa and Asia,” Lancet, vol. 380, no. 9845, pp. 933–943, 2012, doi: 10.1016/S0140-6736(12)61147-7. DOI: https://doi.org/10.1016/S0140-6736(12)61147-7

V. Tangcharoensathien et al., “Health-financing reforms in southeast Asia: Challenges in achieving universal coverage,” Lancet, vol. 377, no. 9768, pp. 863–873, 2011, doi: 10.1016/S0140-6736(10)61890-9. DOI: https://doi.org/10.1016/S0140-6736(10)61890-9

A. Acharya et al., “The impact of health insurance schemes for the informal sector in low- and middle-income countries,” World Bank Res. Obs., vol. 28, no. 2, pp. 236–266, 2013, doi: 10.1093/wbro/lks009. DOI: https://doi.org/10.1093/wbro/lks009

R. Agustina et al., “Universal health coverage in Indonesia: Concept, progress, and challenges,” Lancet, vol. 393, no. 10166, pp. 75–102, 2019, doi: 10.1016/S0140-6736(18)31647-7. DOI: https://doi.org/10.1016/S0140-6736(18)31647-7

E. Pisani, M. Kok, and K. Nugroho, “Indonesia’s road to universal health coverage: A political journey,” Health Policy Plan., vol. 32, no. 2, pp. 267–276, 2017, doi: 10.1093/heapol/czw120. DOI: https://doi.org/10.1093/heapol/czw120

R. Sparrow, A. Suryahadi, and W. Widyanti, “Social health insurance for the poor: Targeting and impact of Indonesia’s Askeskin programme,” Soc. Sci. Med., vol. 96, pp. 264–271, 2013, doi: 10.1016/j.socscimed.2012.09.043. DOI: https://doi.org/10.1016/j.socscimed.2012.09.043

D. Erlangga, S. Ali, and K. Bloor, “The impact of public health insurance on healthcare utilisation in Indonesia: Evidence from panel data,” Int. J. Public Health, vol. 64, no. 4, pp. 603–613, 2019, doi: 10.1007/s00038-019-01215-2. DOI: https://doi.org/10.1007/s00038-019-01215-2

R. Pinto, E. Masaki, and P. Harimurti, Indonesia Health Financing System Assessment. Washington, DC, USA: World Bank, 2016. DOI: https://doi.org/10.1596/26311

W. C. Hsiao and R. P. Shaw, Eds., Social Health Insurance for Developing Nations. Washington, DC, USA: World Bank, 2007. DOI: https://doi.org/10.1596/978-0-8213-6949-4

P. Berman, “Health sector reform: Making health development sustainable,” Health Policy, vol. 32, no. 1–3, pp. 13–28, 1995, doi: 10.1016/0168-8510(95)00726-9. DOI: https://doi.org/10.1016/0168-8510(95)00726-9

W. N. Dunn, Public Policy Analysis: An Integrated Approach, 6th ed. New York, NY, USA: Routledge, 2018. DOI: https://doi.org/10.4324/9781315181226

E. Vedung, Public Policy and Program Evaluation. New Brunswick, NJ, USA: Transaction Publishers, 1997.

M. Q. Patton, Utilization-Focused Evaluation, 4th ed. Thousand Oaks, CA, USA: Sage, 2008.

P. H. Rossi, M. W. Lipsey, and H. E. Freeman, Evaluation: A Systematic Approach, 7th ed. Thousand Oaks, CA, USA: Sage, 2004.

J. L. Pressman and A. Wildavsky, Implementation, 3rd ed. Berkeley, CA, USA: Univ. California Press, 1984.

M. Lipsky, Street-Level Bureaucracy: Dilemmas of the Individual in Public Services, 30th anniversary ed. New York, NY, USA: Russell Sage Foundation, 2010.

G. Esping-Andersen, The Three Worlds of Welfare Capitalism. Princeton, NJ, USA: Princeton Univ. Press, 1990. DOI: https://doi.org/10.1177/095892879100100108

R. M. Titmuss, Social Policy: An Introduction. London, U.K.: Allen & Unwin, 1974.

J. Rawls, A Theory of Justice, rev. ed. Cambridge, MA, USA: Harvard Univ. Press, 1999.

A. Sen, Development as Freedom. New York, NY, USA: Alfred A. Knopf, 1999.

N. Daniels, Just Health: Meeting Health Needs Fairly. Cambridge, U.K.: Cambridge Univ. Press, 2008. DOI: https://doi.org/10.1017/CBO9780511809514

S. Devereux and R. Sabates-Wheeler, “Transformative social protection,” IDS Working Paper 232, Brighton, U.K.: Institute of Development Studies, 2004.

R. Holzmann and S. Jorgensen, “Social risk management: A new conceptual framework for social protection,” Int. Tax Public Finance, vol. 8, pp. 529–556, 2001, doi: 10.1023/A:1011247814590. DOI: https://doi.org/10.1023/A:1011247814590

R. Penchansky and J. W. Thomas, “The concept of access: Definition and relationship to consumer satisfaction,” Med. Care, vol. 19, no. 2, pp. 127–140, 1981. DOI: https://doi.org/10.1097/00005650-198102000-00001

M. F. Guagliardo, “Spatial accessibility of primary care: Concepts, methods and challenges,” Int. J. Health Geogr., vol. 3, no. 1, p. 3, 2004, doi: 10.1186/1476-072X-3-3. DOI: https://doi.org/10.1186/1476-072X-3-3

D. H. Peters, A. Garg, G. Bloom, D. G. Walker, W. R. Brieger, and M. H. Rahman, “Poverty and access to health care in developing countries,” Ann. N. Y. Acad. Sci., vol. 1136, pp. 161–171, 2008, doi: 10.1196/annals.1425.011. DOI: https://doi.org/10.1196/annals.1425.011

D. McIntyre, M. Thiede, and S. Birch, “Access as a policy-relevant concept in low- and middle-income countries,” Health Econ. Policy Law, vol. 4, no. 2, pp. 179–193, 2009, doi: 10.1017/S1744133109004836. DOI: https://doi.org/10.1017/S1744133109004836

T. J. Bossert, “Analyzing the decentralization of health systems in developing countries: Decision space, innovation and performance,” Soc. Sci. Med., vol. 47, no. 10, pp. 1513–1527, 1998, doi: 10.1016/S0277-9536(98)00234-2. DOI: https://doi.org/10.1016/S0277-9536(98)00234-2

P. Heywood and Y. Choi, “Health system performance at the district level in Indonesia after decentralization,” BMC Int. Health Hum. Rights, vol. 10, no. 1, p. 3, 2010, doi: 10.1186/1472-698X-10-3. DOI: https://doi.org/10.1186/1472-698X-10-3

J.-P. Faguet, “Decentralization and governance,” World Dev., vol. 53, pp. 2–13, 2014, doi: 10.1016/j.worlddev.2013.01.002. DOI: https://doi.org/10.1016/j.worlddev.2013.01.002

R. B. Saltman, V. Bankauskaite, and K. Vrangbaek, Eds., Decentralization in Health Care: Strategies and Outcomes. Maidenhead, U.K.: Open Univ. Press, 2007.

J. W. Creswell and C. N. Poth, Qualitative Inquiry and Research Design: Choosing Among Five Approaches, 4th ed. Thousand Oaks, CA, USA: Sage, 2018.

M. B. Miles, A. M. Huberman, and J. Saldana, Qualitative Data Analysis: A Methods Sourcebook, 3rd ed. Thousand Oaks, CA, USA: Sage, 2014.

M. Q. Patton, Qualitative Research and Evaluation Methods, 4th ed. Thousand Oaks, CA, USA: Sage, 2015.

R. K. Yin, Case Study Research and Applications: Design and Methods, 6th ed. Thousand Oaks, CA, USA: Sage, 2018.

Y. S. Lincoln and E. G. Guba, Naturalistic Inquiry. Beverly Hills, CA, USA: Sage, 1985. DOI: https://doi.org/10.1016/0147-1767(85)90062-8

V. Braun and V. Clarke, “Using thematic analysis in psychology,” Qual. Res. Psychol., vol. 3, no. 2, pp. 77–101, 2006, doi: 10.1191/1478088706qp063oa. DOI: https://doi.org/10.1191/1478088706qp063oa

A. Tong, P. Sainsbury, and J. Craig, “Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups,” Int. J. Qual. Health Care, vol. 19, no. 6, pp. 349–357, 2007, doi: 10.1093/intqhc/mzm042. DOI: https://doi.org/10.1093/intqhc/mzm042

S. J. Tracy, “Qualitative quality: Eight ‘big-tent’ criteria for excellent qualitative research,” Qual. Inquiry, vol. 16, no. 10, pp. 837–851, 2010, doi: 10.1177/1077800410383121. DOI: https://doi.org/10.1177/1077800410383121

Ministry of Health of the Republic of Indonesia, Profil Kesehatan Indonesia 2023. Jakarta, Indonesia: Ministry of Health, 2024.

Downloads

Published

2026-05-21

Issue

Section

Articles

How to Cite

[1]
F. Pelu, M. A. Rahawarin, and H. V. R. Pattimukay, “Public Policy Evaluation of Free Health Social Security: Social Equity, Governance, and Access in Maluku Province”, Jo. Soc. Know. Ed, vol. 7, no. 3, pp. 228–235, May 2026, doi: 10.37251/jske.v7i3.2718.

Most read articles by the same author(s)