Creating Equity? A Process Evaluation of Jamkesus Disabilitas, A Disability-Focused Health Financing Scheme in Yogyakarta, Indonesia

Background This study aims to explore the initiation and implementation of Jamkesus Disabilitas, a health financing scheme for people with disabilities in Yogyakarta Province, using the UK Medical Research Council (MRC) Process Evaluation for Complex Intervention. Methods We interviewed 19 people with disabilities with different types of impairment as beneficiaries, 3 people from Organisations for People with Disabilities (OPDs), 4 government officials, and 4 health providers, either in person, online, or by phone. Interviews were conducted by LA, and took place in Yogyakarta Province in July-September 2024. Data were analysed using a thematic analysis approach using NVivo 15 software. Findings Jamkesus Disabilitas has improved access to assistive technology (AT) and demonstrated inclusive care through its one-stop service. It also highlights the importance of consistent leadership in disability-inclusive health systems. However, challenges persist, including uneven AT quality, low coverage, limited availability, and inadequate data for evaluation and planning persisted. Moreover, the absence of inclusive features in the regular service means the scheme has not fully closed the equity gap in healthcare access for people with disabilities. Conclusion Jamkesus Disabilitas has expanded access to AT overlooked by the national health insurance (JKN). However, implementation should prioritise AT quality standards, financial and operational sustainability, and stronger data systems. Broader systemic reforms are also needed to embed disability inclusive practices in regular healthcare service delivery. Keywords Health equity, inclusive health system, social protection, health insurance, health financing