Realising Free Health Care for the Poor in Indonesia: The Politics of Illegal Fees

This paper examines why illegal fees persist at public health facilities in Indonesia. It suggests that their persistence reflects the political dominance of a coalition of interests consisting of politico-bureaucratic elements in the state apparatus and major business groups and the implications this has had for government spending on the health sector and programmes aimedat providing free health care to the poor in particular among other determinants of the level of illegal fees. Accordingly, the paper concludes that eliminating illegal fees from Indonesia's public health system requires not simply better funding of public health facilities and better change management, as much of the comparative health economics literature suggests – although these are certainly part of the solution – but also efforts to empower the poor and their allies vis-à-vis this coalition of interests.