Independent Research Project

My study abroad program had a very unique set-up, where an intensive period of traditional academic courses, was followed by a two month independent research project.   This was a big part of why I chose that particular program over others: I was thrilled at the chance to do research on a topic entirely of my choosing, and with a design of my own shaping.  My initial hope was to focus my research on a public maternal and child healthcare program in Yogyakarta, Indonesia, but even the best laid plans go astray.  Shortly before I was supposed to begin my research, Mt. Merapi erupted, leading to dozens of deaths, the destruction of many villages, and mass evacuation from the city.  Instead, I ended up researching a new provincial universal healthcare program in Bali, called Jaminan Kesehatan Bali Mandara (JKBM).

I was interested in looking at different models of healthcare schemes because of my broader interest in public health, but the idea of exploring universal healthcare programs specifically stemmed from the healthcare debates in the US the year before.  I had kept hearing the trope that two components: health services that are sufficiently comprehensive, and health services that are available to the entire community.  Many healthcare analysts I admire bemoaned the fact that the Affordable Care Act fell short of these relatively basic objectives.  I had already looked at alternative systems, including Cuba, where the human and civil right to healthcare is actually written into the constitution.  I was curious about other alternatives – which was also why I had wanted to look at the program in Yogyakarta – particularly in another fiscally conservative representative democracy.

In order to truly understand the successes and problems of JKBM, I based my research directly where care is delivered; in public healthcare centers (or puskesmas) in urban, suburban, and rural areas, including a rural puskesmas on one of Bali’s smaller islands, as well as public hospitals in urban and suburban areas, and interviewed doctors, patients, and administrators.  I also talked with various government workers who either played a role in the original planning and implementation of JKBM, or with its continued oversight, including staff at the Ministry of Health and  members of parliament. Additionally, I conducted interviews with experts in the field of health care policy in Bali, including NGO staff and faculty members at Bali’s major public university.  I ended up titling my paper “Bali Mandara Health Insurance: Universal Coverage or a Political Ploy?” which I think sums up my findings.  The program was implemented by the sitting governor, to follow a campaign promise, and had many markings of being a pure political maneuver.  At the same time, the program did, on the whole, provide effective coverage – and was certainly much more comprehensive than current healthcare access for  people in the US.

One parliament member I spoke to emphasized the importance of the program by explaining that “when people in Bali get sick, they get poor.”  Obviously, this is also true in the US, and is one (of many) reasons why I think healthcare access must be thought of in the realm of human rights.  I criticized JKBM a lot in my final 60-page research paper, but I also think that despite the program’s shortcomings it can act as an important model.