Urinary Stone Disease (Urolithiasis) in Indonesia's National Health Insurance (JKN)

Executive summary

This report describes how people with urinary stone disease (urolithiasis) use Indonesia's National Health Insurance scheme (JKN), using the BPJS Kesehatan Sample Data for 2015 to 2024. It covers the served burden and how it has grown, who is affected by age, sex and geography, where stones occur, the surgical interventions used (shockwave lithotripsy, ureteroscopy, and upper-tract surgery), recurrence, obstruction, hospital length of stay, mortality, comorbidity, the cost of care, and equity of access across regions and membership segments.

All population figures are survey-weighted national projections from the household sample and describe the population that is served by JKN, not the true prevalence in the whole population. Many people with stones never reach a facility, so served counts are a lower bound on the real burden. Cost figures are verified-paid claim values, not provider charges or official budget realisation.

Questions this report answers

• How many people with urinary stones are served by JKN, who are they, and how has the served burden grown?
• What share of patients actually receive a stone procedure, and which interventions are used?
• How common is recurrence, and how concentrated and large is the cost of stone care?
• How fatal is the disease in hospital, and is access equitable across regions, sex, and membership segments?

Key findings

• In 2024 about 804,173 people with urinary stones were served by JKN, a served prevalence of about 289 per 100,000 members, and the served burden rose steadily from 2015 to 2024 with a dip during 2020 and 2021 as elective stone procedures were deferred.
• Most served patients are managed without surgery: only about 19.8 percent ever received an intervention procedure (shockwave lithotripsy, ureteroscopy, or upper-tract surgery), so the majority are managed conservatively or with medication.
• Kidney and ureter stones (ICD-10 N20) dominate, accounting for about 50.2 percent of patients, and men are served at about 1.4 times the rate of women, concentrated in the 40 to 59 age group.
• Repeat contact is common: about 22.4 percent of patients had stone claims in two or more separate years, a lower bound on true recurrence given that stones recurring within the same year are not counted.
• Stone care cost the scheme about Rp 20.0 trillion in verified-paid claims over 2015 to 2024, a burden large enough to make urinary stones a significant surgical condition for JKN.
• In-hospital death is rare, with an inpatient case fatality rate of about 1.12 percent, consistent with a largely benign condition, while obstructive uropathy (N13) affected about 9.8 percent of stone patients; access to procedures varies across provinces, sex, and membership segments.