The No-Contact Cohort: Preventable Hospital Admissions Without Prior Primary Care in Indonesia's JKN

Executive summary

This report describes the no-contact cohort: people in Indonesia's National Health Insurance scheme (JKN) who are admitted to hospital for a condition that primary care could have prevented, yet who had no primary care contact in the year before admission. It uses the BPJS Kesehatan Sample Data for 2015 to 2024 and a list of 61 ambulatory care sensitive condition codes agreed by a Delphi panel of Indonesian general practitioners.

A potentially preventable hospitalisation is an inpatient stay whose main diagnosis is one of these 61 conditions, spanning acute, chronic, and vaccine-preventable disease. A no-contact admission is one where the patient had no non-promotive primary care visit in the 365 days before admission. The report measures the size and trend of this gap, who is never engaged, the conditions involved, its cost, its geography, its equity, and the severity of these admissions. All population figures are survey-weighted national projections from the 1 percent household sample; cost figures are verified-paid claim values. Because primary care contacts that are not claimed are not visible in the data, the no-contact share is an upper bound on the true gap.

Questions this report answers

• How large is the primary care engagement gap, and is it shrinking or holding steady over time?
• Who is never engaged by primary care before a preventable admission, and for which conditions?
• How much do no-contact admissions cost the scheme, and how recent is that burden?
• Are these admissions more severe, and is the gap distributed equitably across regions and membership segments?

Key findings

• Across 2015 to 2024, about 34.0 percent of all potentially preventable hospital admissions occurred with no prior primary care contact, making the engagement gap the single largest pathway into preventable admission, ahead of unrelated contact (47.9 percent) and related contact that failed to prevent admission (18.2 percent).
• The gap remains current: in 2024, the most recent year, 31.1 percent of preventable admissions were still no-contact, so this is not a problem confined to the early years of the scheme.
• Total inpatient spending on no-contact admissions reached about Rp 12.3 trillion over 2015 to 2024, including about Rp 2.2 trillion in 2024 alone, at an average of about Rp 4.5 million per admission, so these are not low-cost cases.
• The conditions are led by chronic and vaccine-preventable disease, with pneumonia, heart failure, and type 2 diabetes among the most common, pointing to gaps in routine upstream detection and monitoring rather than a single disease.
• No-contact admissions tend to be more severe, more often arriving through the emergency department and with a slightly higher case fatality, consistent with patients reaching hospital later because there was no primary care entry point.
• The gap is unequal, varying sharply by membership segment (subsidised versus non-subsidised) and by province and island, and a share of patients are repeatedly no-contact, marking them as a priority group for structured outreach.