Cardiometabolic Multimorbidity in Indonesia's National Health Insurance (JKN)

Executive summary

This report describes how cardiometabolic conditions cluster, sequence, and drive cost within a single person across Indonesia's National Health Insurance scheme (JKN), using the BPJS Kesehatan Sample Data for 2015 to 2024. It covers six conditions, diabetes, hypertension, coronary heart disease, heart failure, stroke, and chronic kidney disease, and follows their served prevalence, co-occurrence, the order in which they appear, the preventable hospital admissions they generate, the concentration of spending, geography, and equity.

All population figures are survey-weighted national projections from the sample and describe the population served by JKN, not the true prevalence in the whole population. Cost figures are verified-paid hospital claim values, not official budget realisation. A community comparison using the 2018 Riskesdas and the 2023 Indonesia Health Survey is provided as context to indicate the treatment gap.

Questions this report answers

• How common is cardiometabolic multimorbidity among people served by JKN, and how is it changing over time?
• Which conditions most often occur together, and what are the dominant disease combinations?
• In what order do conditions appear, and which is the most common entry point into the cardiometabolic continuum?
• Which entry point generates the most preventable hospital admissions and downstream burden?
• How large is the cost of care, how concentrated is it, and how does access vary across regions and membership segments?

Key findings

• Across 2015 to 2024 about 17.99 million people with cardiometabolic conditions were served by JKN, and nearly half were multimorbid: 47.7 percent carried two or more cardiometabolic conditions, with an average of 1.77 conditions per patient.
• The conditions that most often occur together are diabetes with hypertension, present in 18.5 percent of all cardiometabolic patients, followed by hypertension with stroke and coronary heart disease with heart failure, confirming an interlinked cardiometabolic continuum.
• The entry point sets the downstream burden. Patients who enter through diabetes accumulate the most preventable admissions, about 1.46 per patient, with 69.6 percent ever hospitalised for a preventable cause, and the highest progression to multimorbidity at 56.9 percent, making uncontrolled diabetes and hypertension the highest-leverage targets for prevention.
• Spending is highly concentrated: the most expensive 1 percent of patients absorb 24.6 percent of total spending and the top 10 percent absorb 62.0 percent.
• Total verified hospital spending on cardiometabolic care reached about Rp 218.6 trillion over the period, of which about Rp 132.2 trillion was for admissions that could have been prevented with effective primary care.
• In the most recent year, 2024, JKN served about 5.84 million cardiometabolic patients, 44.9 percent of them multimorbid, with about 3.31 million preventable admissions costing about Rp 24.4 trillion out of total cardiometabolic spending of about Rp 40.2 trillion.