Heart Failure in Indonesia's National Health Insurance (JKN)

Executive summary

This report describes how people with heart failure use Indonesia's National Health Insurance scheme (JKN), using the BPJS Kesehatan Sample Data for 2015 to 2024. It covers served disease burden, demography and geography, the role of primary care, severity and length of hospital stay, referral, in-hospital fatality, thirty-day readmission, comorbidity, the cost of care, and equity across regions and membership segments.

Heart failure is the endpoint of a chain that runs from hypertension through ischaemic heart disease to heart failure. 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. Many earlier-stage cases are not yet diagnosed or are managed in primary care, so served counts are a lower bound on the real burden. Fatality and readmission figures are also lower bounds, because deaths and readmissions outside the scheme or after discharge are not captured, and cost figures are verified-paid claim values.

Questions this report answers

• How many people with heart failure are served by JKN, and how fast is that burden growing?
• How much do heart-failure hospital admissions cost the scheme, and how concentrated is that spending?
• What share of admitted patients die in hospital, and how often are patients readmitted within thirty days?
• Is access to heart-failure care equitable across membership segments and regions?

Key findings

• In 2024 about 1,148,907 people with heart failure were served by JKN, and the served burden has grown steadily over the period as the population ages and cardiovascular risk accumulates.
• Heart-failure care is concentrated in hospitals: spending on these admissions reached about Rp 4.37 trillion in 2024, with a cumulative total of roughly Rp 24.8 trillion over 2017 to 2024.
• Spending is highly concentrated, with the top 5 percent of patients accounting for about 44 percent of costs, reflecting patients with repeated decompensation and recurrent admissions.
• Outcomes after admission are poor: in-hospital fatality was about 6.5 percent in 2024 and rises to roughly 10 percent in patients aged 75 and over, while about 6.6 percent of admitted patients were readmitted within thirty days.
• Inpatient care carries by far the highest unit cost, averaging about Rp 9.0 million per claim against about Rp 225,000 for outpatient care, so each prevented admission frees substantial resources.
• Access is uneven across membership segments, with served rates ranging from about 877 per 100,000 in the subsidised PBI group to about 5,365 per 100,000 in the non-subsidised non-worker segment, a pattern consistent with an inverse-care gradient.