Appendicitis and Appendix Perforation in Indonesia's National Health Insurance (JKN)

Executive summary

This report describes how appendicitis and ruptured appendix (appendix perforation) are treated under Indonesia's National Health Insurance scheme (JKN), using the BPJS Kesehatan Sample Data for 2015 to 2024. Appendicitis is a curable acute surgical condition when the appendix is removed in time, so a ruptured appendix signals a patient who reached the operating table too late. The report reads the inpatient perforation ratio as a clinically meaningful indicator of timely surgical access and referral quality, alongside served burden, hospital setting, length of stay, comorbidity, the cost of care, and equity across regions and membership segments.

All population figures are survey-weighted national projections from the sample and describe the population that is served by JKN, not the true incidence in the whole community. The headline access indicator is the perforation ratio limited to inpatient care, where a ruptured appendix is actually managed. A claim-level ratio that also counts outpatient claims is far higher but inflated by coding artefact, so it is reported only as context. Cost figures are verified-paid claim values.

Questions this report answers

• How many people with appendicitis are served by JKN each year, and how has that burden grown?
• How often does appendicitis reach the operating table only after it has ruptured, and how does that vary across provinces?
• How much more does a perforated case cost, and how much does the scheme spend on appendicitis overall?
• Is timely surgical access equitable across regions and membership segments?

Key findings

• In 2024 about 287,958 people with appendicitis were served by JKN, roughly 103.6 per 100,000 members, and the served burden has risen over the period (cumulative national projection about 1.81 million patients across 2015 to 2024).
• The main access indicator, the perforation ratio among inpatient appendicitis admissions, was 0.81 percent in 2024 (0.93 percent cumulative), having peaked at 1.81 percent in 2021 in a pattern consistent with delayed care-seeking during the COVID-19 period.
• Where appendicitis ruptures varies sharply across the country: the inpatient-equivalent perforation ratio is highest in the Maluku-Papua region (about 11.9 percent) and lowest in Sulawesi (about 5.5 percent), with Papua the single highest province, a signal of uneven access to emergency surgery.
• A ruptured appendix is markedly more expensive to treat: an average perforated inpatient claim cost about Rp 11.2 million against about Rp 4.8 million for an uncomplicated case (roughly 2.3 times more), and perforated cases stay longer in hospital (about 5.7 days against 3.9 days).
• Appendicitis claims spending reached about Rp 1,210 billion in 2024, with cumulative verified-paid spending of about Rp 6,801 billion across 2015 to 2024.
• Timely surgical access is unequal across membership segments: the perforation ratio is higher among locally subsidised (PBI APBD, about 10.9 percent) and self-paying (PBPU, about 10.1 percent) members than among salaried workers (PPU, about 8.0 percent) and centrally subsidised members (PBI APBN, about 7.5 percent).