•  
  •  
 

Antropologi Indonesia

Abstract

The issue of healthcare under neoliberalism has been a topic under scrutiny for anthropologists. With the rise of financial capitalism, the state is reconfigured to create a life where the logic of the market triumphs over all other aspects of life. This reconfiguration includes the healthcare sector, where new paradigms of neoliberal governance are incorporated into the fabric of healthcare. In continuing this analysis, I want to address a more specific approach regarding how neoliberal mechanisms work to disrupt caring practices, particularly through the use of bureaucracies. Drawing from various literature and my own ethnographic experiences in Malinau, this article analyses how care and bureaucracy constitute a paradox: where bureaucracy seeks to implement total rationality in a utopian vision of eradicating uncertainty, the foundation of care lies in the practice of facing that reality is always uncertain and contingent. Care involves imagining the receiver as active subjects, while bureaucracy envision subjects through fixed categories determined by the state. Therefore, in its mission to create a more efficient means of healthcare, bureaucracy often falls short and creates barriers that impede acts of care. To demonstrate my argument, I aim to analyse the implementation of Indonesia’s UHC program, JKN, in various healthcare facilities around Malinau, North Kalimantan. In thinking about values, I hope to disentangle the complex knot that constitutes care work and to spark further discussion on what kind of changes that could make healthcare more equitable for people.

Bahasa Abstract

Isu perawatan kesehatan di bawah neoliberalisme telah menjadi topik yang diteliti oleh para antropolog. Dengan munculnya kapitalisme finansial, negara dikonfigurasi ulang untuk menciptakan kehidupan di mana logika pasar mendominasi semua aspek kehidupan. Konfigurasi ulang ini mencakup sektor perawatan kesehatan, di mana paradigma neoliberal dimasukkan ke dalam struktur kesehatan publik. Dalam melanjutkan analisis ini, saya ingin membahas pendekatan yang lebih spesifik mengenai bagaimana mekanisme neoliberal bekerja untuk mempengaruhi praktik perawatan, khususnya melalui birokrasi. Mengacu pada berbagai literatur dan pengalaman etnografi di Malinau, artikel ini menganalisis bagaimana perawatan dan birokrasi membentuk sebuah paradoks: ketika birokrasi berusaha menerapkan rasionalitas total dalam visi utopis untuk menghilangkan ketidakpastian, fondasi perawatan terletak pada praktik dalam menghadapi kenyataan yang tidak pernah stabil. Keperawatan mengimajinasikan penerima sebagai subjek aktif yang memiliki agensinya tersendiri, sementara birokrasi melihat subjek melalui kategori yang sudah ditentukan oleh negara. Oleh karena itu, dalam misinya untuk menciptakan sarana perawatan kesehatan yang lebih efisien, birokrasi seringkali menciptakan hambatan dalam tindakan perawatan. Untuk membuktikan argumen tersebut, saya menganalisis implementasi program Jaminan Kesehatan Nasional di Malinau, Kalimantan Utara. Dengan memikirkan aspek nilai, saya berniat untuk mengurai kompleksitas dari praktik perawatan dan mendorong diskusi mengenai sistem kesehatan yang bisa lebih adil untuk semua.

References

Adams, Vincanne

2016 Metrics: What Counts in Global Health. Durham, NC: Duke University Press.

Applbaum, Kalman, and Michael Oldani

2010 “Special Issue for Anthropology & Medicine: Towards an Era of Bureaucratically Controlled Medical Compliance?” Anthropology & Medicine 17(2):113–127. https://doi.org/10.1080/13648470.2010.493707.

Aspinall, Edward

2014 “Health Care and Democratization in Indonesia.” Democratization 21(5):803–823. https://doi.org/10.1080/13510347.2013.873791.

The Care Collective

2020 The Care Manifesto: The Politics of Interdependence. London: Verso.

Erniaty, and Harun Harun

2020 “Understanding the Impacts of NPM and Proposed Solutions to the Healthcare System Reforms in Indonesia: The Case of BPJS.” Health Policy and Planning 35(3):346–353. https://doi.org/10.1093/heapol/czz165.

Federici, Silvia

1974 Wages Against Housework. London and Bristol, UK: Power of Women Collective and Falling Wall Press.

2019 “Social Reproduction Theory: History, Issues and Present Challenges.” Radical Philosophy 204:55–57.

Fraser, Nancy

2016 “Contradictions of Capital and Care.” New Left Review 100:99–117.

Graeber, David

2001 Toward an Anthropological Theory of Value: The False Coin of Our Own Dreams. New York: Palgrave.

2013 “It Is Value That Brings Universes into Being.” HAU: Journal of Ethnographic Theory 3(2):219–243. https://doi.org/10.14318/hau3.2.012.

2015 The Utopia of Rules: On Technology, Stupidity, and the Secret Joys of Bureaucracy. Brooklyn, NY: Melville House.

Gruening, Gernod

2001 “Origin and Theoretical Basis of New Public Management.” International Public Management Journal 4(1):1–25. https://doi.org/10.1016/S1096-7494(01)00041-1.

Julianda, Zirma, and Ecep Mochammad

2023 “Supply Infrastructure Financing & Kualitas Mutu Layanan dalam Meningkatkan Kepuasan Peserta JKN.” Jurnal Jaminan Kesehatan Nasional 3(1). https://doi.org/10.53756/jjkn.v3i1.146.

Kementerian Kesehatan

2025 “Penugasan Khusus Tenaga Kesehatan.” Sistem Informasi Penugasan Khusus, February 7. https://tugsusnakes.kemkes.go.id/.

Lea, Tess

2021 “Desiring Bureaucracy.” Annual Review of Anthropology 50(1):59–74. https://doi.org/10.1146/annurev-anthro-101819-110147.

Mol, Annemarie

2008 The Logic of Care: Health and the Problem of Patient Choice. London: Routledge.

Muharram, Farizal Rizky, Hanif Ardiansyah Sulistya, Julian Benedict Swannjo, Fikri Febrian Firmansyah, Muhammad Masrur Rizal, Alifina Izza, Muhammad Atoillah Isfandiari, Ninuk Dwi Ariningtyas, and Achmad Chusnu Romdhoni

2024 “The Indonesia Health Workforce Quantity and Distribution.” medRxiv, April 1. https://doi.org/10.1101/2024.03.31.24305126.

Mulligan, Jessica

2016 “Insurance Accounts: The Cultural Logics of Health Care Financing.” Medical Anthropology Quarterly 30(1):37–61. https://doi.org/10.1111/maq.12157.

Munandar, Aris

2020 “Nation-State Formation at the Indonesia–Malaysia Border in West Kalimantan.” International Journal of Interdisciplinary Civic and Political Studies 15(2):16–27. https://doi.org/10.18848/2327-0071/CGP/v15i02/16-27.

Pisani, Elizabeth, Maarten Olivier Kok, and Kharisma Nugroho

2016 “Indonesia’s Road to Universal Health Coverage: A Political Journey.” Health Policy and Planning. https://doi.org/10.1093/heapol/czw120.

Sciortino, Rosalia, and Roy Tjong

2015 “Human Resources for Health: A Critical yet Challenging Pathway to Universal Health Coverage in Indonesia.” World Health & Population 16(1):51–61. https://doi.org/10.12927/whp.2015.24315.

Tronto, Joan Claire

1998 “An Ethic of Care.” Journal of the American Society on Aging 22(3):15–20.

Wacquant, Loïc

2010 “Crafting the Neoliberal State: Workfare, Prisonfare, and Social Insecurity.” Sociological Forum 25(2):197–220. https://doi.org/10.1111/j.1573-7861.2010.01173.x.

2012 “Three Steps to a Historical Anthropology of Actually Existing Neoliberalism.” Social Anthropology 20(1):66–79. https://doi.org/10.1111/j.1469-8676.2011.00189.x.

Weber, Max

1946 From Max Weber: Essays in Sociology. Edited by Hans H. Gerth and C. Wright Mills. New York: Oxford University Press.

Wollenberg, Eva, Moira Moeliono, Godwin Limberg, Ramses Iwan, Steve Rhee, and Made Sudana

2006 “Between State and Society: Local Governance of Forests in Malinau, Indonesia.” Forest Policy and Economics 8(4):421–433. https://doi.org/10.1016/j.forpol.2005.08.012.

Download

Included in

Anthropology Commons

Share

COinS