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, who is affected, primary and hospital care, length of stay and mortality, the cost of care, and the water, sanitation, and vaccination roots of a disease burden that is largely preventable.

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. Most mild diarrhoea is managed outside the claims system, so served counts capture the more severe, hospitalised tail of the disease. Case definition uses ICD-10 codes A09 (diarrhoea and gastroenteritis of presumed infectious origin), A01 (typhoid and paratyphoid fever), and A02 to A08 (other specified intestinal infections). 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 how has that burden changed over time?
• How large is typhoid within the served burden, and what does that imply about water and sanitation?
• How much does this largely preventable burden cost the scheme, and who carries the highest risk of death?
• What do the figures suggest about prevention through clean water, sanitation, and vaccination?

Key findings

• About 129,944 people with gastroenteritis or typhoid were served in hospital in the sample (351,904 in the wider cohort including primary care), and the projected served population reached about 5.59 million in 2024.
• This is a large, largely avoidable volume of care: gastroenteritis and typhoid are mostly preventable through clean water, sanitation, and vaccination, yet they absorbed about Rp 28.2 trillion in verified-paid claims from 2015 to 2024, with about Rp 4.6 trillion in 2024 alone, of which roughly 95 percent is inpatient care.
• The typhoid burden is unusually high: about 23 percent of served patients are coded as typhoid or paratyphoid fever, far above the pattern in settings with adequate water and sanitation, pointing to active water-borne and food-borne transmission and a strong case for typhoid conjugate vaccination.
• Mortality is driven by age: the in-hospital case fatality rate is about 0.95 percent overall, rising to about 3.27 percent among older people compared with about 0.43 percent among under-fives.
• Coding is non-specific: about 66 percent of enteric claims use the general A09 "presumed infectious diarrhoea" code without a confirmed pathogen, so the cause of illness is rarely identified in claims, a limitation for surveillance.
• Most of this burden is rooted upstream in unsafe drinking water, poor sanitation, and low vaccine coverage, making it a cross-sector responsibility that extends beyond the health ministry to water and sanitation.