Indonesian national health policy: Legal analysis of the elimination of mandatory health spending

Abstract

Pusphose: The elimination of mandatory spending in Law No. 17 of 2023 on Health has sparked controversy, particularly because it contradicts the World Health Organization's recommendation that allocates 5-6% of GDP to health budgeting to facilitate better access to healthcare services. This removal also potentially violates the Indonesian Constitution, which through Article 28E, Article 28H paragraph (2), Article 28D paragraph (3), and Article 34 paragraph (3) guarantees the fulfillment of health rights for vulnerable groups.

Method: This study employs a legal dogmatic research method to analyze the constitutionality of eliminating mandatory spending in Law Number 17 of 2023 on Health, as it pertains to the 1945 Constitution of the Republic of Indonesia, using John Rawls' theory of justice as a tool for legal analysis.

Result: Law No. 17 of 2023 on Health has eliminated the mandatory spending provision, which previously stipulated a minimum health budget allocation of 5% from the national budget (called APBN) and 10% from the regional budgets (called APBD), as per Law No. 36 of 2009. The new law introduces performance-based budgeting, but it remains unclear how it will be implemented, especially at the regional level. The main criticism is that this potential elimination could reduce health guarantees for vulnerable groups, contradicting the principles of social justice mandated in the Indonesian Constitution.

Conclusion: Although the Constitutional Court has rejected a formal review of this law, opportunities still remain for a substantive examination of the real impact of this elimination on the health access of vulnerable groups.