From Curative to Preventive: Operationalising Hospital Without Walls for More Efficient Indonesia’s Public Health Service Transformation in 2045
DOI:
https://doi.org/10.63953/vjkm.v3i2.52Keywords:
Hospital Without Walls, Remote Patient Monitoring, Smart Ambulance, Telemedicine, Health System Transformation, Indonesia 2045Abstract
Background: Indonesia is transitioning from a curative to a preventive–promotive health paradigm as part of its national health system transformation toward Indonesia Emas 2045. Yet, an aging population, rising chronic disease burden, and geographic inequities threaten to overwhelm hospital capacity and the single-payer JKN system. The Hospital Without Walls (HWW) model—hospital-grade care extended into homes and communities through digital monitoring, telemedicine, and national interoperability—offers a systems-level redesign rather than a technology experiment. Methods: A narrative review was conducted using structured PubMed/MEDLINE searches (2014–2025) targeting core HWW components: hospital-at-home (HaH) with remote patient monitoring (RPM), ward-based continuous monitoring, pre-hospital telemedicine (smart ambulance), home/smart-home sensing, AI-assisted triage, and economic evaluations. Eligible PubMed-indexed RCTs, systematic reviews, and cohort studies were thematically synthesised around safety, efficiency, costs, and implementation relevance to Indonesia. Results: Nine high-quality studies indicate that HaH with RPM achieves non-inferior—and often superior—clinical outcomes and cost efficiency compared with conventional inpatient care. Pre-hospital telemedicine accelerates decision-making for time-critical conditions such as stroke and STEMI, while continuous monitoring and AI triage demand strong alert governance and local validation. Persistent risks of alarm fatigue, data gaps, and digital inequity emphasise the need for structured workflows and equitable design. Conclusion: Implementing HWW in Indonesia requires aligning JKN incentives (HaH iDRG tariffs, shared-savings mechanisms, risk-adjusted capitation), strengthening SATUSEHAT as the national utility layer, and ensuring workforce and connectivity readiness across regions. With these enablers, Indonesia can transform its health system from reactive to proactive—from curative to preventive—achieving safe, equitable, and sustainable distributed care by 2045.
References
Levine DM, Ouchi K, Blanchfield B, Saenz A, Burke K, Paz M, et al. Hospital-Level Care at Home for Acutely Ill Adults: A Randomized Controlled Trial. Ann Intern Med [Internet]. 2020 Jan 21 [cited 2025 Nov 8];172(2):77–85. Available from: https://www.acpjournals.org/doi/10.7326/M19-0600
Whitehead D, Conley J. The Next Frontier of Remote Patient Monitoring: Hospital at Home. J Med Internet Res [Internet]. 2023 Mar 16 [cited 2025 Nov 8];25:e42335. Available from: https://www.jmir.org/2023/1/e42335
Bowles T, Trentino KM, Lloyd A, Trentino L, Jones G, Murray K, et al. Outcomes in patients receiving continuous monitoring of vital signs on general wards: A systematic review and meta-analysis of randomised controlled trials. Digit Health [Internet]. 2024 Jan [cited 2025 Nov 8];10:20552076241288826. Available from: https://journals.sagepub.com/doi/10.1177/20552076241288826
Morita PP, Sahu KS, Oetomo A. Health Monitoring Using Smart Home Technologies: Scoping Review. JMIR MHealth UHealth [Internet]. 2023 Apr 13 [cited 2025 Nov 8];11:e37347. Available from: https://mhealth.jmir.org/2023/1/e37347
Sarpourian F, Ahmadi Marzaleh M, Fatemi Aghda SA, Zare Z. Application of Telemedicine in the Ambulance for Stroke Patients: A Systematic Review. Prehospital Disaster Med [Internet]. 2023 Dec [cited 2025 Nov 8];38(6):774–9. Available from: https://www.cambridge.org/core/product/identifier/S1049023X23006519/type/journal_article
Saeed SA, Masters RM. Disparities in Health Care and the Digital Divide. Curr Psychiatry Rep [Internet]. 2021 Sept [cited 2025 Nov 8];23(9):61. Available from: https://link.springer.com/10.1007/s11920-021-01274-4
Levine DM, Ouchi K, Blanchfield B, Diamond K, Licurse A, Pu CT, et al. Hospital-Level Care at Home for Acutely Ill Adults: a Pilot Randomized Controlled Trial. J Gen Intern Med [Internet]. 2018 May [cited 2025 Nov 9];33(5):729–36. Available from: http://link.springer.com/10.1007/s11606-018-4307-z
TRANSFORMASI KESEHATAN INDONESIA [Internet]. [cited 2025 Nov 9]. Available from: https://kemkes.go.id/id/layanan/transformasi-kesehatan-indonesia?utm_source=chatgpt.com
Downey CL, Chapman S, Randell R, Brown JM, Jayne DG. The impact of continuous versus intermittent vital signs monitoring in hospitals: A systematic review and narrative synthesis. Int J Nurs Stud [Internet]. 2018 Aug [cited 2025 Nov 8];84:19–27. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0020748918300981
Moxham RN, d’Entremont MA, Mir H, Schwalm J, Natarajan MK, Jolly SS. Effect of Prehospital Digital Electrocardiogram Transmission on Revascularization Delays and Mortality in ST-Elevation Myocardial Infarction Patients: Systematic Review and Meta-Analysis. CJC Open [Internet]. 2024 Oct [cited 2025 Nov 9];6(10):1199–206. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2589790X24002804
Bøtker MT, Jacobsen L, Rudolph SS, Knudsen L. The role of point of care ultrasound in prehospital critical care: a systematic review. Scand J Trauma Resusc Emerg Med [Internet]. 2018 Dec [cited 2025 Nov 9];26(1):51. Available from: https://sjtrem.biomedcentral.com/articles/10.1186/s13049-018-0518-x
Steinhubl SR, Waalen J, Edwards AM, Ariniello LM, Mehta RR, Ebner GS, et al. Effect of a Home-Based Wearable Continuous ECG Monitoring Patch on Detection of Undiagnosed Atrial Fibrillation: The mSToPS Randomized Clinical Trial. JAMA [Internet]. 2018 July 10 [cited 2025 Nov 9];320(2):146. Available from: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2018.8102
Zhang Y, Peña MT, Fletcher LM, Lal L, Swint JM, Reneker JC. Economic evaluation and costs of remote patient monitoring for cardiovascular disease in the United States: a systematic review. Int J Technol Assess Health Care [Internet]. 2023 [cited 2025 Nov 8];39(1):e25. Available from: https://www.cambridge.org/core/product/identifier/S0266462323000156/type/journal_article
Ahmed Abdalhalim AZ, Nureldaim Ahmed SN, Dawoud Ezzelarab AM, Mustafa M, Ali Albasheer MG, Abdelgadir Ahmed RE, et al. Clinical Impact of Artificial Intelligence-Based Triage Systems in Emergency Departments: A Systematic Review. Cureus [Internet]. 2025 June 9 [cited 2025 Nov 8]; Available from: https://www.cureus.com/articles/375105-clinical-impact-of-artificial-intelligence-based-triage-systems-in-emergency-departments-a-systematic-review
Whitehead AK, Li Z, LaPenna KB, Abbes N, Sharp TE, Lefer DJ, et al. Cardiovascular dysfunction induced by combined exposure to nicotine inhalation and high-fat diet. Am J Physiol Heart Circ Physiol. 2024 Jan 1;326(1):H278–90.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Qorry Amanda, Muhammad Fikri Akmal, Fabella Ade Kusumawati, Kamila Izza Utomo, Novia Ariyana Ramadhani Putri, Yudhistira Syihab Azzuhri
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Karya ini dilisensikan di bawah Lisensi Internasional Creative Commons Atribusi-BerbagiSerupa 4.0.
Anda bebas untuk:
- Bagikan — salin dan distribusikan ulang materi dalam media atau format apa pun untuk tujuan apa pun, bahkan tujuan komersial.
- Adaptasi — mencampur, mengubah, dan mengembangkan bahan untuk tujuan apa pun, bahkan tujuan komersial.
Dengan ketentuan sebagai berikut:
- Atribusi — Anda harus memberikan penghargaan yang sesuai, menyediakan tautan ke lisensi, dan menunjukkan jika ada perubahan yang dilakukan. Anda dapat melakukannya dengan cara yang wajar, tetapi tidak dengan cara yang menunjukkan bahwa pemberi lisensi mendukung Anda atau penggunaan Anda.
- ShareAlike — Jika Anda me-remix, mengubah, atau membuat sesuatu berdasarkan materi asli, Anda harus mendistribusikan kontribusi Anda di bawah lisensi yang sama dengan materi asli.
- Tidak ada batasan tambahan — Anda tidak boleh menerapkan ketentuan hukum atau tindakan teknologi yang secara hukum membatasi orang lain untuk melakukan apa pun yang diizinkan oleh lisensi.
