Diabetes Increasingly Burdens Public Health

It is estimated that the burden of the BPJS Kesehatan in treating diabetes will continue to swell until 2045. The costs could end up between Rp 10.22 trillion and Rp 23.59 trillion if no new policy approaches are taken.

RUNIK SRI ASTUTI

A number of residents queued for access to services at the Sidoarjo Branch of the Health BPJS office, Tuesday (28/3/2023).

JAKARTA, KOMPAS – The Kompas data journalism team estimates that the burden of treating diabetes will continue to increase. It also projects that the number of National Health Insurance (JKN) participants will increase by 3.2 million people, from 6.9 million participants in 2022 to 10.2 million participants in 2045.

The average handling fee per participant over the past five years (2018-2022) is Rp 912,538, which will increase to Rp 2,309,599 based on the average inflation rate of 4.12 percent per year in the last decade. This means that the total fee for 10.2 million people in 2045 could reach Rp 23.59 trillion, a drastic increase compared to the current total of Rp 6.3 trillion.

The projection that 3.2 million additional people will be diagnosed with diabetes in 2022-2045 is based on Kompas’ estimate of the number of Indonesians with diabetes, which totals 19.6 million today. This figure was based on data from the 2022 Health Care and Social Security Agency (BPJS Kesehatan) on the 11.8 million people who had been diagnosed with diabetes, plus an estimated 7.8 million people with undiagnosed diabetes based on an analysis by Kompas.

Also read:

> BPJS, Life Support for People with Diabetes

As many as 7.8 million people have a high risk of developing diabetes but have not been diagnosed. This estimate was calculated by analyzing data in the 2021 National Socioeconomic Survey (Susenas) from Statistics Indonesia (BPS), by combining the number of people with sugar consumption exceeding the World Health Organization (WHO) threshold of 10 percent of daily calorie consumption, with physical inactivity (73.86%) and the prevalence of obesity-driven diabetes (22.4%).

Kompas’ estimate that 19.6 million people have diabetes, both diagnosed and undiagnosed, indicates a difference of less than 1 percent compared to the International Diabetes Federation’s estimate of 19.46 million Indonesians with diabetes.

Increasing

KOMPAS/SATRIO PANGARSO WISANGGENI

Endocrinologist, Faculty of Medicine, University of Indonesia RSCM Dr. Em Yunir SpPD-KEMD when interviewed online on Monday (10/4/2023) from Jakarta.

Dr. Em Yunir, a staff member of the metabolic endocrine division at Cipto Mangunkusumo hospital (RSCM), said that incidences of diabetes had been on the rise for the last 20 years.

Diabetes was first thought to be a disease of the elderly, but it is now detected in adults aged 40 years and below.

Yunir expressed concern that the number of Indonesians with diabetes today actually exceeded the recorded figure. He concurred with Kompas’ analysis that the total number of people with diabetes could reach nearly 20 million.

What is dangerous is that people in the group of undiagnosed diabetes will not control their blood sugar level until it has a serious impact on their health.

Also read:

> One in six Indonesians Prone to Obesity and Diabetes

“Indeed, we currently estimate that there are 11 to 12 million people [with diabetes]. But in reality, it could be almost 20 million. This means that [these people] will continue to have high blood sugar levels. In hospitals, the most common internal diseases are diabetes and cancer,” Yunir said in Jakarta on Monday (10/4/2023).

BPJS Kesehatan principle director Dr. Ali Ghufron Mukti said the burden on the state health insurer continued to grow in proportion to the number of participants who were diagnosed with diabetes. The last five years (2018-2022) had seen an increasing trend in the total claims made by BPJS Kesehatan participants with diabetes. In 2018, the total cost was Rp 4.9 trillion. In 2022, this had increased to Rp 6.4 trillion.

Even without the increasing costs, Ghufron said, diabetes was already a relatively heavy burden on BPJS Kesehatan. “Yes, [the burden of diabetes] is quite heavy, [it is] among the top 10 BPJS claims,” he said.

Yes, [the burden of diabetes] is quite heavy.

Indonesian Endocrinology Association (Perkeni) chairman Dr. Ketut Suastika also agreed that diabetes was costly to treat. This was even more so if diabetes had led to other complications that required medical action, such as ring or stent placement and dialysis.

“The [treatment] costs can increase many times over and it is very costly for BPJS. Indonesia may not be the highest in terms of prevalence, but our population is very large, which means it is a heavy burden on the state and a heavy burden on the people,” said Ketut.

KOMPAS/SATRIO PANGARSO WISANGGENI

Chairperson of the Indonesian Association of Endocrinology Prof. Dr. dr. Ketut Suastika SpPD-KEMD when interviewed online from Jakarta, on Friday (24/3/2023).

According to him, members of the public must increase their awareness of the impacts of lifestyle and diet on blood sugar levels. Doctors also needed to educate the public and spend more time with patients at risk of developing diabetes.

“This costly disease can be prevented. If there was early detection of prediabetes, exercise and reducing food intake can restore normal [health],” said Ketut.

Diabetes due to unhealthy eating habits has already been detected in young children. Dr. Aman Bhakti Pulungan, project leader of the Changing Diabetes in Children (CDIC) program, said type 2 diabetes in children had been increasing recently. “It is mostly because of indolence and lifestyle,” said Aman, who is also executive director of the International Pediatric Association.

Education

Health Minister Budi Gunadi Sadikin said diabetes was the mother of all diseases. The complications that diabetes could trigger, such as heart disease, stroke and kidney disease, were costly.

“Heart disease kills 250,000 people a year and BPJS claims reach Rp 12 trillion. Stroke, which kills 300,000 a year, total Rp 3.2 trillion in [insurance] claims. These are very large figures. If we can educate people to reduce their sugar consumption, they will be much healthier and more productive. It will also reduce the [risk] of heart attack and stroke,” said Budi.

The government is now prioritizing promotional and preventive measures. One measure implemented this year is the provision of free glucose screening tests at Puskesmas (community health centers). It is hoped that people can start managing their blood sugar before it is too late.

Also read:

> Sweet Beginning That Ends in Suffering

> Diabetes in Children on the Rise

“We waived the [cost of] blood sugar tests. Those with high blood sugar levels will be given medicine before it is too late,” said Budi.

To enhance the effort to reduce excess sugar consumption, Budi said he had sent a letter to the Finance Ministry to consider imposing a sugar excise.

“This is so that we can reduce the amount of sugar in our food and drink. However, what is most important is that parents teach their children not to consume a lot of sugar,” said Budi.