Since decentralization in 2001, Indonesian local governments have acquired a key role in poverty alleviation and social service delivery. The extent to which they have been able to meet this challenge is subject to debate, however, and systematic analysis of policy outcomes remains scarce. This paper contributes to the literature with a study of the district-level implementation of Jamkesmas, Indonesia's free healthcare program for the poor. Using original data on policy implementation, I show that local government is to some extent responsive to the needs of the most vulnerable. In years when local elections (pilkada) are implemented, low-income households are targeted more accurately, suggesting that electoral incentives for local elites may increase access to social services among the poor. However, I also show that the positive effect of local direct elections is limited to districts with electorally competitive politics.

中文翻译：

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印尼地方政府对穷人负责吗？来自卫生政策实施的证据

自 2001 年权力下放以来，印度尼西亚地方政府在扶贫和提供社会服务方面发挥了关键作用。然而，他们能够在多大程度上应对这一挑战仍有待商榷，对政策结果的系统分析仍然很少。本文通过研究印度尼西亚为穷人提供的免费医疗保健计划 Jamkesmas 的地区级实施为文献做出了贡献。我使用有关政策实施的原始数据表明，地方政府在一定程度上响应了最弱势群体的需求。在地方选举（皮尔卡达) 实施后，低收入家庭的目标更加准确，这表明对地方精英的选举激励措施可能会增加穷人获得社会服务的机会。然而，我也表明，地方直选的积极影响仅限于具有选举竞争政治的地区。