Analysis of the Direct Medical Cost Burden of Type 2 Diabetes Mellitus Patients with and Without Complications in Indonesia Based on 2023 JKN Claims Data
DOI:
https://doi.org/10.1229/tecempresarialjournal.v21i1.781Keywords:
Type 2 Diabetes Mellitus, Direct Medical Cost, Cost of Illness, Complications, BPJS Kesehatan.Abstract
This study aimed to analyse and compare the direct medical costs of patients with T2DM with and without complications in Indonesia using 2023 BPJS Kesehatan claims data, applying a prevalence-based Cost of Illness (COI) approach from the payer’s perspective. This descriptive study used total sampling of 10,299 patients with T2DM (ICD-10: E11.x) who met the inclusion criteria and had received either outpatient or inpatient care. Complication status was determined using diagnosis codes based on the Diabetes Complications Severity Index and hypoglycaemia codes. Descriptive analysis was conducted to examine patient characteristics, complication profiles, and annual direct medical costs by complication status, sex, province, type of service, and ward class. The results showed that 55.1% of patients had complications, while 44.9% had no complications. The median age was 65 years, and most patients were female (60.3%). The mean annual direct medical cost for all patients was IDR 685 ± 1,808 million. Unexpectedly, the non-complication group had a higher mean cost (IDR 1,016 ± 2,116 million) than the complication group (IDR 415 ± 1,457 million), indicating substantial cost variation and possible differences in claims patterns. Inpatient care was the main cost driver (IDR 951 ± 2,127 million), far exceeding outpatient care (IDR 104 ± 186 million). Among inpatients, class III patients had the highest mean cost (IDR 2,273 ± 3,080 million) despite lower baseline tariffs. These findings highlight the importance of strengthening primary care, chronic disease management, and claims governance, as well as improving diagnostic recording, to enhance efficiency and support the sustainability of JKN financing.
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