Pneumonia and Lower Respiratory Infection in Indonesia's National Health Insurance (JKN)

Executive summary

This report describes how people with pneumonia and lower respiratory tract infection 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 age pattern of disease, the point of first contact and referral, the hospital setting and cost of care, in-hospital mortality, the quality of diagnostic coding, and what these patterns imply for prevention.

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. Cost figures are verified-paid claim values, not official budget realisation. The analytic cohort combines hospital and primary care records, and most cases are coded as unspecified pneumonia, which limits what claims can say about specific pathogens.

Questions this report answers

• How many people with pneumonia and lower respiratory infection are served by JKN, and which age groups carry the burden?
• How much does pneumonia cost the scheme, and how much of that cost is hospital inpatient care?
• How high is in-hospital mortality, and how does it differ between young children and older people?
• How well is pneumonia coded in claims, and what does that mean for tracking vaccine-preventable disease?
• How much of this burden could be prevented or managed earlier in primary care?

Key findings

• About 83,295 pneumonia and lower respiratory infection patients were served in hospitals in the sample, equivalent to a survey-weighted projection of roughly 1.93 million patients served in 2024.
• The burden follows a bimodal age pattern, concentrated at the two ends of life among children aged 1 to 4 years and older people aged 60 and above, the classic pattern of community-acquired pneumonia.
• Pneumonia is a high-cost inpatient disease: total verified-paid hospital claims reached about Rp 40.3 trillion over 2015 to 2024, including about Rp 8.1 trillion in 2024, with roughly 96 percent of cost coming from inpatient care.
• In-hospital mortality is driven by age: the overall case fatality rate among admissions was about 8.8 percent, rising to about 15.4 percent in older people while remaining about 1.7 percent in children aged 1 to 4 years.
• Coding quality is low: about 96 percent of pneumonia in 2024 was recorded as unspecified (J18), so the vaccine-preventable pneumococcal fraction is not visible in claims, a serious surveillance limitation for vaccine policy.
• Much of this burden is avoidable: childhood pneumonia is largely preventable through pneumococcal and Hib vaccination, while many adult and older-person admissions could be managed earlier in primary care.