Chronic Kidney Disease and Dialysis in Indonesia's National Health Insurance (JKN)

Executive summary

This report describes how people with chronic kidney disease (CKD) and people on dialysis use Indonesia's National Health Insurance scheme (JKN), using the BPJS Kesehatan Sample Data for 2015 to 2024. It covers served disease burden, CKD stage, the dialysis population and its sessions, the point of first contact and referral, hospital setting and length of stay, mortality, 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 prevalence in the whole population. Early-stage CKD is largely undiagnosed, so served counts are a lower bound on the real burden. A community comparison using the 2018 Riskesdas and 2023 Indonesia Health Survey is provided as context, and cost figures are verified-paid claim values, not official budget realisation.

Questions this report answers

• How many people with CKD and on dialysis are served by JKN, and how has the dialysis population grown?
• How late is CKD detected, and how quickly do patients move from diagnosis to dialysis?
• How much does CKD and dialysis cost the scheme, and how concentrated is that spending?
• What is the mortality of the dialysis cohort, and is access equitable across regions and membership segments?

Key findings

• In 2024 about 143,143 people on dialysis were served by JKN, with roughly 64,912 starting dialysis that year, and the dialysis population has grown steadily over the period.
• Dialysis is the centre of the CKD burden in JKN: it is delivered overwhelmingly as haemodialysis (about 79 percent), peritoneal dialysis is minimal, and kidney transplantation is almost absent, so lifelong kidney-replacement therapy is largely unavoidable.
• CKD is detected late: end-stage disease dominates the coded stages and the median time from a CKD diagnosis to starting dialysis is only about 13 days, meaning the disease is often first recorded only once it is already terminal.
• Dialysis sessions reached about 7.33 million in 2024, and dialysis is the dominant cost driver, accounting for roughly 69 percent of CKD spending, with total dialysis spending of about Rp 44.4 trillion over 2015 to 2024.
• Spending is highly concentrated among a small share of patients, and CKD spending in 2024 was about Rp 10.9 trillion.
• Mortality in the dialysis cohort is high, about 44.8 percent (a lower bound, since deaths are undercaptured), and access to dialysis varies sharply across provinces and membership segments in a pattern consistent with an inverse-care gradient.