Gastroenteritis and Typhoid Fever in Indonesia's National Health Insurance (JKN)

Executive summary

This report describes how people with gastroenteritis and typhoid fever use Indonesia's National Health Insurance scheme (JKN), using the BPJS Kesehatan Sample Data for 2015 to 2024. It covers the served disease burden, the share of care driven by typhoid, the point of first contact and referral, hospital care and length of stay, case fatality by age, the diagnostic coding of enteric infection, 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. Gastroenteritis and typhoid are largely preventable through clean water, sanitation, and vaccination, yet they continue to absorb a large volume of JKN services and spending. Cost figures are verified-paid claim values, not official budget realisation.

Questions this report answers

• How many people with gastroenteritis and typhoid are served by JKN, and what does that cost the scheme?
• How large is the typhoid burden, and what does it say about water, sanitation, and vaccination?
• How is enteric infection coded in claims, and what does that mean for surveillance?
• Who dies from these infections, and is care delivered close to where people live?

Key findings

• About 129,944 patients with gastroenteritis or typhoid were served in hospital care in the sample, projecting to roughly 5.59 million patients served nationally in 2024, against a combined analytic cohort of 351,904 patients including primary care.
• Care for these infections cost the scheme about Rp 28.2 trillion in verified-paid claims over 2015 to 2024, reaching about Rp 4.6 trillion in 2024, of which roughly 95 percent was inpatient spending.
• Typhoid and paratyphoid fever (code A01) account for about 23 percent of the served burden, far above the pattern expected where water and sanitation are adequate, pointing to continuing water-borne and food-borne transmission and a strong case for typhoid conjugate vaccine.
• Roughly 66 percent of enteric claims carry the unspecified code A09 (diarrhoea and gastroenteritis of presumed infectious origin) with no confirmed pathogen, so the cause is not identified in the claim, a clear limitation for surveillance.
• In-hospital case fatality is about 0.95 percent overall but rises sharply with age, reaching about 3.27 percent among older people compared with about 0.43 percent among children under five.
• Care is delivered close to home: of inpatient referrals with a clear origin, about 95 percent stay within the same district, 4 percent cross districts within a province, and 1 percent cross provinces, and the typical hospital stay is about three days.