OBJECTIVES: To estimate costs, and identify other consequences of insulin initiation therapy managed by hospitals vs. the primary healthcare amongst insured people covered under the National Health Insurance (NHI, or the JKN) scheme in Indonesia.

METHODS: A budget impact model was used to quantify the costs incurred from the two modalities of insulin initiation. Using payer perspective, the direct medical costs were calculated from the JKN claim data which enable one to estimate the prevalence of diabetes type 2 (T2DM) cases, and their related costs. Based on the model parameters derived from a government report, literature review, and the claim data, costs of the two insulin modality therapies were projected for the year 2024 to 2035. While the model included all the T2DM patients (ICD-10: E11), the insulin initiation was given to the patients who have both an HbA1C level of 7.5% or higher, and received a prescription for one or more blood glucose-lowering drugs.

RESULTS: Shifting the provision of insulin therapy from the current practice at the hospitals into primary health would result in a net benefit of saving of IDR 22 trillion (USD 1.4 billion) for the period 2024-2035, or an average of IDR 1.7 trillion (USD 109 million) per year. This figure represents a 14% reduction in spending on NHI. Other potential consequences of insulin initiation such as: both patients access and their clinical status, economics perspectives, and budget allocations were identified.

CONCLUSIONS: Not only results in cost savings for the scheme, managing the provision of insulin by the primary healthcare would lead to both clinics and economic benefits. Policy implications, Disease Management System (DMS) for chronical disease, are discussed. The proposed DMS include several components: strengthening primary healthcare (e.g., the availability of medical equipment and medication), reforming provider payment (capitation) under the JKN system, and developing monitoring and evaluation system.