Pain Management Services in Indonesia: Workforce Distribution, Service Availability, and Systemic Barriers to Integration
John Frans Sitepu1, Tasrif Hamdi1
1Departement of Anesthesiology and Intensive Care, Adam Malik Hospital, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
National Overview of Pain Management Specialists in Indonesia
The number of Anesthesiology and Intensive Care Specialists (Sp. An-TI) in Indonesia is currently estimated at approximately 3,000 physicians; however, only 243 of them hold qualifications in pain management. Among these, 180 physicians have completed a Fellowship in Interventional Pain (FIP), 40 hold a Subspecialty in Pain Management (Subsp. MN[K]), 11 possess dual qualifications in FIP and Subsp. MN(K), 8 have obtained the Fellow of Interventional Pain Practice (FIPP) credential, and 9 are currently undergoing advanced training in pain medicine. These figures indicate that the proportion of healthcare professionals with specialized expertise in pain management remains disproportionately low relative to the needs of the national population, resulting in an overall insufficient capacity for pain services.
Distribution of Pain Clinic Services
From a service delivery perspective, only 112 anesthesiologists with pain management qualifications have established pain clinics, while 11 have not yet initiated such services. Among those providing care, 107 operate pain clinics within their affiliated hospitals, whereas 21 deliver services through private practice. These numbers illustrate that the availability of pain clinics remains limited and unevenly distributed, particularly when considered alongside Indonesia’s vast geographical area and the high prevalence of patients experiencing chronic and acute pain.
Integration of Pain Clinics with BPJS Kesehatan
This limited service capacity is further exacerbated by suboptimal integration of pain clinics into the national health insurance system. To date, only approximately 21% of hospital-based pain clinics have partnered with BPJS Kesehatan, while about 78% remain uncovered. Reported barriers include the lack of institutional support for pain services within hospitals, failure to submit applications for BPJS collaboration, and rejection of pain service proposals by BPJS. Consequently, most pain management services continue to rely on out-of-pocket payments, posing a significant financial burden for patients and discouraging utilization of professional pain care.
Interdisciplinary Overlap and Public Awareness
Beyond financial constraints, pain management is also a shared competency across at least five medical disciplines. As a result, patients more commonly seek care from other specialties such as internal medicine, neurology, orthopedics, or physical and rehabilitation medicine, while the role of anesthesiologists in pain management remains largely underrecognized by the public. This low level of awareness has prevented anesthesiology-based pain services from becoming a primary referral pathway, despite the frequent need for multidisciplinary and interventional approaches to achieve comprehensive pain control.
National Burden of Pain Conditions
Meanwhile, the burden of pain-related conditions in Indonesia is substantial, encompassing musculoskeletal pain, neuropathic pain, cancer-related pain, and chronic non-cancer pain. Ironically, most patients are unaware of where to seek appropriate care, leading many to undergo repeated treatments without meaningful improvement or to receive only short-term symptomatic therapy. Limited access, inadequate public awareness, and the lack of integration of pain services within the national healthcare system have resulted in a large proportion of pain cases being inadequately managed, ultimately contributing to diminished patient quality of life and increased socioeconomic burden.
Systemic Challenges in Pain Service Development
Overall, these conditions underscore that pain management services in Indonesia continue to face significant challenges, including shortages in specialized human resources, limited facility availability, inadequate financing mechanisms, and low public health literacy. Without strengthened policies, expansion of pain service networks, and improved integration with the national insurance system, the gap between the high demand for pain care and the limited availability of services is likely to persist.
Table 1. Distribution of Anesthesiology and Intensive Care Specialists with Pain Management Qualifications
| Qualification Category | Number of physicians |
| Sp.An-TI with Fellowship Interventional Pain (FIP) | 180 |
| Sp.An-TI with Subspecialty in Pain Management (Subsp. MN[K]) | 40 |
| Sp.An-TI with dual qualifications (FIP + Subsp. MN[K]) | 11 |
| Sp.An-TI with Fellow of Interventional Pain Practice (FIPP) | 8 |
| Sp.An-TI currently in training (FIP/Subsp. MN/FIPP) | 9 |
| TOTAL | 248 |
Figure 1. Distribution of Anesthesiology and Intensive Care Specialists Based on Pain Management Qualifications
Based on the results of a survey involving 123 respondents of Anesthesiology and Intensive Care Specialists (Sp.An-TI) with qualifications in pain management, an overview was obtained regarding physicians’ involvement in the provision of pain clinic services in Indonesia. The data indicate that the majority of respondents (91.1%) have established pain clinics, either within their affiliated hospitals or through private practice. This finding reflects a strong commitment among anesthesiologists to expanding access to pain management services for the community.
Conversely, 8.9% of respondents reported that they had not yet established pain clinics. This situation may be influenced by various factors, including limited institutional support from hospitals, inadequate infrastructure and facilities, the absence of institutional policies governing pain services, as well as administrative and internal regulatory barriers. In addition, some physicians may still be in the process of competency development or service preparation prior to independently establishing pain clinics.
These findings provide important insights into the readiness and implementation of pain services in Indonesia. The high proportion of physicians who have established pain clinics suggests substantial potential for broader expansion of pain management services across different regions. Nevertheless, the presence of physicians who have not yet initiated such services highlights the need for strengthened policy support, facilitation, and regulatory harmonization among hospitals, professional organizations, and relevant stakeholders. Such efforts are expected to optimize equitable access to comprehensive and high-standard pain care.
Figure 2. Proportion of Anesthesiology and Intensive Care Specialists Establishing Pain Clinics
Among respondents who reported having established pain clinics, further information was obtained regarding the location or setting of service delivery. Of the 119 respondents who answered this question, the vast majority, 107 physicians (89.9%) operated pain clinics within the hospitals where they were employed. This finding indicates that hospitals remain the primary facilities for providing pain management services, both in terms of infrastructure availability, institutional support, and the high demand for pain-related care among patients.
In addition, 21 respondents (17.6%) reported providing pain clinic services through independent or private practice. Although this proportion is smaller compared with hospital-based services, it demonstrates that some physicians have developed pain management services independently, adapting to local needs or service opportunities within their practice areas.
A small number of respondents also reported more diverse and specific service settings, including dedicated pain clinics, clinics within private hospitals, and pain services delivered in facilities that have not yet formally established pain clinics. Each of these categories accounted for only 0.8% of respondents, reflecting limited but relevant variations in the national landscape of pain service provision.
Overall, these findings indicate that hospitals serve as the primary centers for pain clinic services, while independent practice represents a meaningful alternative mode of care delivery. The variation in service locations reflects the flexibility of clinical practice and the adaptability of physicians in providing pain management services tailored to the needs of local communities.
Figure 3. Distribution of Pain Clinic Practice Settings
Based on the survey of Anesthesiology and Intensive Care Specialists who had not yet established pain clinics, a total of 82 responses were collected regarding the reasons for not providing such services. Among all reported factors, the most frequently cited reason was the lack of hospital facilitation for opening pain clinics, reported by 14 respondents (17.1%). This finding indicates that institutional barriers and insufficient hospital management support remain major obstacles to the availability of pain services in many regions.
In addition, several respondents reported inadequate administrative and regulatory support from their hospitals, as well as internal systems or policies that do not yet allow the establishment of pain clinics. Each of these reasons was cited by 12 respondents (14.6%). These administrative challenges highlight the need for improved coordination among physicians, related departments, and hospital leadership.
Some respondents also stated that they lacked sufficient time to manage an additional clinic (4 respondents; 4.9%) or that pain services had not yet been opened at their hospitals, preventing them from initiating such services (5 respondents; 6.1%). Furthermore, a range of other reasons was reported in smaller numbers (1–2 respondents each), including awaiting hospital policy decisions, constraints related to the insurance (BPJS Kesehatan), lack of supporting personnel, or having only limited pain services without a formally established clinic.
Overall, these findings suggest that barriers to establishing pain clinics are predominantly driven by institutional factors rather than individual physician-related issues. This underscores the importance of hospital policy support, availability of facilities, and harmonization with financing regulations, including national health insurance mechanisms, to expand access to pain management services on a national scale.
Figure 4. Factors Contributing to Anesthesiology and Intensive Care Specialists Not Establishing Pain Clinics
Based on the survey of 123 respondents, insights were obtained regarding collaboration between hospital-based pain clinics and insurance or BPJS Kesehatan. Among all respondents, only 21.1% reported that pain clinics at their facilities had established partnerships with insurance or BPJS Kesehatan. Meanwhile, the majority (78.9%) indicated that pain clinics in their hospitals had not yet collaborated with insurance or BPJS Kesehatan.
These findings demonstrate that although pain services have begun to develop and are being initiated by many anesthesiologists, integration of these services into the national health financing system remains highly limited. The lack of collaboration with insurance or BPJS Kesehatan may negatively affect service accessibility, considering that most of the population relies on this national health insurance scheme. This situation is also consistent with barriers identified in previous survey results, including insufficient institutional support and the absence of internal hospital regulations to facilitate comprehensive pain service provision.
Therefore, collaborative efforts among hospitals, professional organizations, and insurance or BPJS Kesehatan are needed to expand the coverage and sustainability of pain clinic services, thereby enabling broader patient access across diverse regions.
Figure 5. Involvement of Insurance or BPJS Kesehatan in Pain Clinic Services
Among the 111 respondents who provided reasons why pain clinics at their workplaces had not yet established collaboration with BPJS Kesehatan, several key findings emerged, reflecting administrative, regulatory, and facility-related barriers.
The most frequently reported reason was rejection of the hospital’s application for pain service collaboration by BPJS Kesehatan, as stated by 37 respondents (33.3%). This rejection suggests discrepancies in perceptions or unmet requirements between hospitals and BPJS, including issues related to facility credentialing, hospital classification, and the recognition of pain services within approved reimbursement packages.
The second most common reason was that hospitals had not yet submitted applications for pain services to BPJS Kesehatan, reported by 36 respondents (32.4%). This finding indicates that some institutions have not initiated the administrative process for collaboration, possibly due to insufficient facility readiness, lack of internal policies, or failure to meet established standards for pain service provision.
In addition, 11 respondents (9.9%) reported that their hospitals did not facilitate the application process, such as by providing inadequate managerial support, failing to establish pain clinics as formal service units, or not prioritizing pain services within institutional development plans.
Various other reasons were reported in smaller proportions (each ranging from 0.9% to 1.8%), including credentialing constraints, perceptions that pain services are not cost-effective, hospitals being in the process of application, BPJS accepting only specific case types, shortages of supporting personnel, and rejections based on hospital classification (e.g., type C or D hospitals).
Overall, these data indicate that the primary barriers to collaboration between pain clinics and BPJS Kesehatan stem from misalignment in administrative processes at both hospital and insurer levels. Internal hospital factors, BPJS regulatory requirements, facility preparedness, and differences in the classification of pain services emerge as critical determinants influencing the establishment of sustainable partnerships.
Figure 6. Factors Preventing Integration of Pain Services with BPJS Kesehatan
