Elections, Parties And Policy: The Multilevel Politics Of Free Healthcare In Indonesia

Abstract

This dissertation studies the politics of free healthcare in Indonesia, a country in which national and local governments have recently championed various initiatives to expand access to healthcare among the poor. I document striking spatial variation in the quality of health policy implementation, and develop an original theory of how multi-level governance and partisan politics interact to shape policy outcomes. Using insights from theories of federalism and multilevel governance, I argue that multi-level politics has been crucial in ensuring the delivery of social services at the local level. When districts cooperate with provinces, they receive substantial institutional and financial assistance, which improves the delivery of social services even when local institutions are weak. I also show that politicians, while responding to local electoral incentives, are embedded in political networks that go beyond the local. Political parties, in particular, facilitate cooperation across levels of government despite the lack of differences in their social policy platforms. I argue that this is due to the process of credit claiming for the implementation of popular, pro-poor health policy reforms. These findings have implications for the literatures on democratic consolidation, development, decentralization, and social policy in developing countries. They suggest that local policy outcomes result from a complex interplay between local, regional and national factors, and that political parties may be consequential for democratic consolidation even when they are weakly institutionalized.