Chronic Obstructive Pulmonary Disease in Indonesia's National Health Insurance (JKN)

Executive summary

This report describes how people with chronic obstructive pulmonary disease (COPD) use Indonesia's National Health Insurance scheme (JKN), using the BPJS Kesehatan Sample Data for 2015 to 2024. It covers served disease burden, preventable exacerbation admissions, hospital mortality and readmission, cardiometabolic comorbidity, the gap in objective lung-function testing, the cost of care, and equity across regions and membership segments.

The case definition is ICD-10 J44 (COPD) together with J40 to J43 (chronic bronchitis and emphysema); asthma (J45 to J46) is excluded as a separate condition. All population figures are survey-weighted national projections from the sample and describe the population that is served by JKN, not the true community prevalence. COPD is heavily under-diagnosed in Indonesia, so served counts are a lower bound on the real burden. Smoking, the leading risk factor, is not recorded in claims and is triangulated against community survey data. Cost figures are verified-paid claim values.

Questions this report answers

• How many people with COPD are served by JKN, and how has that burden grown?
• How often do preventable COPD exacerbations lead to hospital admission, and how does that trend over time?
• How lethal is a COPD hospital stay, how often do patients return, and which comorbidities travel with the disease?
• How thoroughly is COPD confirmed with objective lung-function testing, and how much does the disease cost the scheme?

Key findings

• In the 1 percent household sample for 2015 to 2024, 55,472 patients had a hospital (FKRTL) claim with a COPD, chronic bronchitis, or emphysema diagnosis, of whom 27,292 carried the J44 code for COPD specifically. The national projection for 2024 reaches about 1,315,927 people served, or 474 per 100,000 JKN members.
• Preventable exacerbation admissions are rising: sample exacerbation claims grew from 1,703 in 2015 to 4,114 in 2024, equivalent to a national projection of about 376,399 admissions in 2024.
• A COPD hospital stay is lethal, with an overall in-hospital case fatality of 4.5 percent that climbs sharply with age to 8.5 percent among those aged 75 and older.
• Patients return often: 30-day readmission after a COPD admission is 5.2 percent, rising to 9.6 percent at 90 days.
• Cardiometabolic comorbidity is common: hypertension accompanies 24.4 percent of patients, and heart failure and ischaemic heart disease each affect more than 12 percent.
• Objective diagnosis is rare: only about 3 percent of patients have a lung-function test claim, pointing to a wide gap in spirometry-confirmed diagnosis.
• Total verified-paid COPD spending reached about Rp 14 trillion over 2015 to 2024.