Urinary Tract Infection and Pyelonephritis in Indonesia's National Health Insurance (JKN)

Executive summary

This report describes how people with urinary tract infection (UTI) and pyelonephritis use Indonesia's National Health Insurance scheme (JKN), using the BPJS Kesehatan Sample Data for 2015 to 2024. It treats UTI as an ambulatory care sensitive condition, where good primary care should prevent most hospital admissions, and follows the served burden, the sex and age gradient, the escalation to inpatient care, the cost of care, case fatality, and equity across regions and membership segments.

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 community. Mild UTI treated outside the scheme is not captured, so served counts are a lower bound on the real burden. The non-specific code N39 dominates the coding and is framed as served volume rather than a precise diagnosis, and cost figures are verified-paid claim values, not official budget realisation.

Questions this report answers

• How many people with UTI are served by JKN, and how has the served burden changed over time?
• How often does UTI escalate to a hospital admission that better primary care could have prevented?
• Who carries the burden across sex and age, and how much does UTI care cost the scheme?
• How fatal is escalated UTI, and is access to care equitable across regions and membership segments?

Key findings

• In 2024 the served burden of UTI in JKN reached 526 per 100,000 members, the highest point across 2015 to 2024, with about 522,064 UTI-coded inpatient admissions as a national projection, indicating a burden that continues to rise.
• UTI is a largely preventable cause of hospital care: 92.7 percent of patients admitted for UTI had no prior primary care (FKTP) contact coded for UTI, a direct opportunity to strengthen early detection and treatment before the disease escalates.
• Pyelonephritis and upper UTI (codes N10 to N13) account for 15.1 percent of patients but carry the highest inpatient cost per case, concentrating the most expensive care in the escalated minority.
• UTI care falls more heavily on women: the served rate in women, 28.9 per 1,000, is about 1.5 times the rate in men, 19.4 per 1,000, consistent with the epidemiology of the condition.
• Escalated UTI can be fatal: the inpatient case fatality rate is 2.36 percent, with a sharp age gradient that leaves older patients most at risk.
• Inpatient UTI spending over 2015 to 2024 reached about Rp 17.2 trillion, the largest share of the total Rp 20.1 trillion in UTI claims, with the most expensive care concentrated in escalated pyelonephritis.