Cancer in Indonesia's National Health Insurance (JKN)

Executive summary

This report describes how people with cancer (malignant neoplasms, ICD-10 C00 to C97) use Indonesia's National Health Insurance scheme (JKN), using the BPJS Kesehatan Sample Data for 2015 to 2024. It covers the served burden and dominant cancer sites, treatment mix across chemotherapy, radiotherapy and surgery, the point of first contact and referral, hospital setting and length of stay, childhood cancer, mortality, comorbidity, the cost of care and its concentration, 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. Cancer stage at diagnosis is not recorded in the claims, which is the single most important determinant of cost and outcome and a critical data gap. A community comparison using the 2018 Riskesdas is provided as context, and cost figures are verified-paid claim values, not official budget realisation.

Questions this report answers

• How many people with cancer are served by JKN, which cancer sites dominate, and how has this changed from 2015 to 2024?
• What is the mix of cancer treatment received, across chemotherapy, radiotherapy and surgery, and can disease stage be assessed from claims?
• How much does cancer cost the scheme, and how concentrated is that spending?
• What does childhood cancer look like in JKN, and is access equitable across regions and membership segments?

Key findings

• About 2.9 million members were served for cancer over 2015 to 2024 (cumulative, weighted), and the served prevalence reached about 231.8 per 100,000 members in 2024.
• The burden is concentrated in cancers that can be detected early: breast cancer (C50) is the most common at about 22.4 percent of patients, followed by colorectal (6.5 percent) and cervical (6.2 percent) cancer, both of which have national screening programmes.
• Treatment mix shows about 47.2 percent of patients had surgery, 18.4 percent received chemotherapy, and 7.4 percent received radiotherapy, while disease stage at diagnosis is not captured in the claims at all.
• Cancer is a catastrophic cost driver: it accounts for about 4.79 percent of all hospital (FKRTL) spending in JKN, with cumulative cancer hospital spending of about Rp 34.8 trillion over 2015 to 2024.
• Spending is highly concentrated, with the most expensive 10 percent of patients accounting for about 57.1 percent of cancer spending.
• Childhood cancer (under 18 years) made up about 3,109 patients, roughly 8.5 percent of the cohort, and access is unequal: self-paying members (PBPU) were served at about four times the rate of the poorest, subsidised members (PBI), a pattern consistent with an inverse-care gradient.