Universal Coverage, Unequal Care: Rethinking the Politics of Healthcare Access in Indonesia

Abstract

The expansion of universal health coverage represents a major development in Indonesia’s pursuit of social welfare and equitable healthcare access. Nevertheless, formal entitlement to healthcare does not necessarily guarantee equivalent experiences of service availability, affordability, quality, or continuity. This study proposes to investigate the gap between health insurance coverage and effective access to care, focusing on the institutional and social mechanisms that may sustain inequalities across different populations. A mixed-methods research design would combine analysis of publicly available health-system indicators and policy documents with qualitative interviews involving patients, healthcare professionals, and local health administrators. Comparative case studies would examine differences across selected urban and rural settings, taking account of geographic accessibility, facility capacity, administrative procedures, and socioeconomic position. The theoretical framework draws on health equity, welfare-state analysis, and street-level bureaucracy to understand how national policy is translated into everyday healthcare encounters. Particular attention would be given to the distinction between nominal coverage and the practical ability to obtain timely and appropriate treatment. The study would also consider how institutional constraints influence the experiences of groups facing additional barriers to healthcare access. By connecting healthcare delivery with broader debates on inequality and state capacity, the research aims to contribute an institutionally grounded assessment of universal health coverage in an emerging economy. Its policy relevance lies in identifying opportunities to strengthen service delivery, reduce access barriers, and align insurance expansion with substantive healthcare equity.