The Supply Side of Indonesia's Health System for Chronic Obstructive Pulmonary Disease (COPD)

Executive summary

This report reads Indonesia's capacity to deliver care for chronic obstructive pulmonary disease (COPD) through the World Health Organization's six health-system building blocks: the services available in hospitals, the specialist workforce, health information, essential medicines, financing, and governance. It is the supply-side counterpart to the claims work, asking not who is treated but whether the system has the people, facilities, medicines, and money to deliver COPD care, and how unequally these are spread across districts, islands, and provinces.

Capacity is measured against a population of 284,438,930 across 514 districts and cities (BPS 2025), with an estimated 10,808,679 people living with COPD used as a need denominator. Facility and workforce figures come from the Ministry of Health hospital information system and the DREAMS / SI-SDMK registry for 2025, and financing is computed directly from the BPJS Kesehatan Sample Data for 2015 to 2024 (COPD coded as ICD-10 J40 to J44). Where routine data is absent, the gap is reported plainly rather than treated as the absence of a problem.

Questions this report answers

• How many hospitals provide pulmonary services and intensive respiratory capacity, and how many districts have none at all?
• How large and how concentrated is the pulmonologist workforce relative to the people who need it?
• What does COPD cost the National Health Insurance scheme, and how is that spending split between inpatient exacerbation care and outpatient care?
• Where do the largest gaps in availability, accessibility, and quality of COPD care fall across the country?

Key findings

• Indonesia has only 1,468 pulmonologists nationally, about 5.16 per million people, so a single specialist effectively covers around 193,759 people and roughly 7,363 of the estimated COPD population.
• The specialist workforce is sharply concentrated: 31.5 percent of districts and cities have no pulmonologist at all (Gini 0.71), and the Asthma-COPD subspecialty is almost absent, with about 18 practitioners nationwide.
• Pulmonary services exist in 1,974 of 3,275 hospitals (60.3 percent), yet 27.4 percent of districts remain pulmonary-service deserts, so exacerbations often have to be referred far from home.
• Intensive respiratory capacity (ICU with a ventilator) is present in 2,585 hospitals (78.9 percent) but absent in 17.5 percent of districts.
• JKN spending on COPD (J40 to J44) reached about Rp 1.65 trillion in 2024, with 57.3 percent going to inpatient exacerbation care, and cumulative spending of about Rp 9.1 trillion over 2015 to 2024.
• The pattern is a system that finances downstream exacerbation care while lacking the upstream capacity, early spirometry-based detection, pulmonary rehabilitation, and specialist staff in the regions, that would prevent those exacerbations.