Sepsis as the Severity Endpoint of Infection in Indonesia's National Health Insurance (JKN)

Executive summary

This report treats sepsis as the most severe endpoint of infection and examines how it presents in Indonesia's National Health Insurance scheme (JKN), using the BPJS Kesehatan Sample Data for 2015 to 2024. It covers the served burden by age, sex, and geography, the point of first contact and referral, the hospital setting, length of stay and intensive care, hospital case fatality, the host comorbidity and organ dysfunction recorded alongside sepsis, the cost of care, and equity across regions and membership segments.

Cases are identified by ICD-10 codes A41, A40, and R65 in hospital (FKRTL) claims. 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 claim values, not provider charges or budget realisation. Hospital case fatality counts only deaths recorded during the admission, so it is a lower bound on true sepsis mortality.

Questions this report answers

• How heavy and how fatal is the sepsis burden served by JKN, and who carries it across age and geography?
• What infections precede sepsis, and how often is a milder contact visible in claims before the patient escalates?
• How much does a sepsis admission cost, and how does it compare with other infectious diseases?
• Is access and outcome equitable across regions, hospital classes, and membership segments?

Key findings

• Sepsis is the most fatal endpoint in the infection cluster: across 2015 to 2024 the sample held 13,374 sepsis patients, almost all claims were inpatient, and about 39.1 percent of sepsis admissions ended in death in hospital (4,712 deaths across 12,062 admissions), far higher than other infectious diseases.
• Sepsis carries the highest cost per case among the infectious diseases compared, several times the cost of pneumonia, typhoid fever, or diarrhoea per admission, at about Rp 12.8 million in verified cost for an average inpatient admission.
• Total verified sepsis spending in 2024 reached about Rp 2,144 billion as a national projection, concentrated in inpatient and intensive care.
• Only about 8.0 percent of sepsis patients had a milder recorded infection contact (respiratory, urinary, or skin and soft tissue) in the 90 days beforehand, and 5.4 percent within 30 days; this is a detection-limited lower bound, since only contacts captured in hospital claims are visible.
• The remaining roughly 92 percent appear as a sudden escalation in the claims record, so early detection and treatment of low-grade infection remains the policy lever even though its trace is rarely seen in claims.
• Burden and death concentrate in infants and older people, and access and outcome vary across provinces, hospital classes, and membership segments, pointing to early management of low-grade infection rather than downstream intensive care alone.