The Concentration of Preventable Hospital Spending in Indonesia's National Health Insurance (JKN)

Executive summary

This report measures how spending on potentially preventable hospital admissions concentrates in Indonesia's National Health Insurance scheme (JKN), using the BPJS Kesehatan Sample Data for 2015 to 2024. A preventable admission is an inpatient stay for a condition that good primary care should have prevented or managed, drawn from a curated list of 326 ambulatory care sensitive conditions. The report covers the scale and trend of this spending, how concentrated it is across episodes, which conditions drive it, whether it is acute or chronic in origin, and how it varies across membership segments, age, and geography.

All figures are survey-weighted national projections from the sample and describe care that is served by JKN, not the true burden in the whole population. Spending uses verified, paid claim values rather than official budget realisation. The aim is to show where a marginal rupiah of prevention would avert the most catastrophic hospital cost.

Questions this report answers

• How concentrated is spending on preventable hospital admissions in JKN, and is it becoming more concentrated over time?
• What share of the budget is absorbed by the most expensive episodes, the top 10 percent, top 5 percent, and top 1 percent?
• Which conditions dominate preventable spending, and which carry catastrophic per-admission costs even at low volume?
• Is the concentration driven by chronic conditions, the primary care prevention pathway, or by acute conditions, and how does it vary across membership, age, and region?

Key findings

• Preventable hospital admissions cost JKN about Rp 157.1 trillion over 2015 to 2024, across roughly 31.7 million weighted inpatient episodes.
• In 2024 these preventable admissions accounted for about 37.5 percent of all JKN inpatient spending, a substantial and avoidable share of the hospital budget.
• Spending is highly concentrated: the costliest 10 percent of episodes absorb about 37.0 percent of the preventable budget, and the top 1 percent absorb about 12.6 percent, with a per-episode Gini coefficient of 0.43.
• The concentration is driven by chronic conditions, which account for about 65.4 percent of preventable spending, led by coronary heart disease at about 23.2 percent of the total on its own.
• Java carries about 60.8 percent of preventable spending, and the largest single cost groups are cardiovascular procedures, pointing to high-cost cardiometabolic care as the dominant driver.
• Because this spending stems from unmanaged chronic disease upstream, the most effective marginal prevention rupiah is directed at high-cost cardiometabolic entry points in primary care.