Healthcare expansion in Indonesia and Thailand: a causal mechanism and its implications for welfare regimes

Tauchid Komara YUDA, Aungsumalee PHOLPARK*

*Corresponding author for this work

Research output: Journal PublicationsJournal Article (refereed)peer-review

8 Citations (Scopus)


This article provides an overview of the scholarship on healthcare reform in democratic middle-income countries through comparative cases from Indonesia and Thailand. This study identifies the reasons why Thailand has achieved universal healthcare faster than Indonesia and analyses the policy outputs towards universalism resulting from unfolding reforms. Taking a closer look at the causal mechanisms underpinning healthcare developments (clientelistic-based mechanism and limited vertical alliance-based mechanism), we discuss how changes in political economy have enhanced the state’s intervention in the healthcare sector while reproducing the fragmented and stratified nature of the system. Based on coverage, generosity and financial risk protection, Thailand has a higher degree of universalism in comparison with Indonesia. The article suggests that the welfare regime now governing healthcare can be conceptualised as a developmental-universalist state, while noting a less-effective model for Indonesia and a more effective model for Thailand.
Original languageEnglish
Pages (from-to)111-129
Number of pages19
JournalJournal of International and Comparative Social Policy
Issue number2
Early online date14 Jul 2022
Publication statusPublished - Jul 2022

Bibliographical note

Funding Information:
Nonetheless, the UCS implementation cannot be achieved without the support from the bureaucracy and professional movement. Dr. Mongkol Na Songkhla, Permanent Secretary of MOPH, the highest-ranking civil service official, who had close links with the network rural doctors, committed to the rapid implementation of the UCS policy and expected to enact this program before his retirement due to the uncertainty of political commitment and stability (Harris, ). With the strong leadership of Permanent Secretary and progressive executives of the MOPH, starting in April 2001, the UCS policy has been rapidly implemented through a pilot project that expanded nationally within 1 year even before the legislation of the National Security Act in November 2002 (Harris, ; Harris & Selway, ).

Publisher Copyright:
© The Author(s), 2022. Published by Cambridge University Press in association with Social Policy Association.


  • Democratic middle-income countries
  • healthcare reform
  • Welfare analysis
  • Southeast Asia
  • Indonesia
  • Thailand


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