Heart Disease Financing Reaches Rp17.35 Trillion, Burdening JKN Budget

BPJS Kesehatan is officially driving the transformation of cardiac services within the National Health Insurance (JKN) Programme through a Value-Based Health Care (VBHC) approach. This strategy places health outcomes and total costs throughout the care cycle as the primary foundation for creating value for participants.

The President Director of BPJS Kesehatan, Prihati Pujowaskito, explained that this transformation is a crucial step in addressing the challenges of rising healthcare service costs. He noted that the sustainability of the JKN Programme depends heavily on the system’s ability to produce real health impacts for the community, rather than simply financing medical treatments.

“The challenge of increasing healthcare costs is evident in the high level of hospital financing. According to BP_JS Kesehatan data, the total healthcare service cost for the JKN Programme in 2025 has reached Rp191.3 trillion, with approximately 87.1 per cent of realised financing originating from hospital services,” Pujo stated in a briefing on Thursday.

Heart disease has become a top priority in this transformation due to high service utilisation rates and significant cost burdens. Pujo emphasised the importance of early anticipation at the Primary Health Care (FKTP) level. Strengthening the upstream level is being conducted through promotive and preventive efforts to control risk factors before they develop into chronic conditions.

At the primary care level, the main focus includes managing risk factors such as hypertension and diabetes. Meanwhile, at the hospital level, BPJS Kesehatan is encouraging more quality-oriented services. Technical approaches being developed include the formation of ‘Heart Teams’ for integrated decision-making, the implementation of clinical management according to guidelines, Fractional Flow Reserve (FFR) examinations, and staged revascularisation.

This transformation also targets changes in monitoring indicators. BPJS Kesehatan is shifting its focus from process indicators to outcome indicators. This includes monitoring critical response times, post-procedure safety, intervention accuracy, recovery quality, and the efficiency of the referral system.

“We want to change the paradigm from paying for services to purchasing better outcomes, from treating events to preventing events, and from measuring utilisation to measuring outcomes,” Pujo concluded.