Usulan penetapan tarif rawat jalan Puskesmas unit swadana berbasis biaya satuan dan kemampuan membayar masyarakat di Puskesmas Tanjung AMpalu Kabupaten Sawah Lunto/Sijunjung

AKBAR, Ali, Prof.dr. Ali Ghufron Mukti, MSc.,PhD

2008 | Tesis | S2 Ilmu Kesehatan Masyarakat (Kebj. Pembiayaan dan

Latar Belakang Desentralisasi mengakibatkan perubahan disemua bidang, konsekwensi diterapkan otonomi daerah perubahan sisitem administrasi yang berlaku. Rendahnya alokasi pembiayaan kesehatan, perlu dicari alternatif sumber pembiayaan masyarakat salah satunya adalah puskesmas swadana. Puskesmas swadana adalah puskesmas yang diberi wewenang untuk mengolah sendiri pendapatan fungsionalnya yang bertujuan meningkatkan mutu pelayanan kepada masyarakat. Tarif puskesmas yang berlaku saat ini berdasarkan peraturan daerah yang perhitungannya belum berdasarkan biaya satuan. Maka perlu dilaksanakan penelitian tentang analisis biaya satuan dengan mempertimbangkan kemampuan membayar masyarakat dan harga pesaing. Tujuan Penelitian Memperoleh besaran usulan tarif rawat jalan Puskesmas Tanjung Ampalu dan mengetahui kemampuan membayar masyarakat. Metode Penelitian Penelitian ini merupakan penelitian studi kasus dengan rancangan deskriptif yang berkaitan dengan biaya total dan biaya satuan dengan menggunakan metode double distribution. Subjek penelitian ini adalah dokumentasi Puskesmas Tanjung Ampalu untuk mendapatkan data biaya unit penunjang dan biaya unit utama dan data Susenas dari Biro Pusat Statistik. Pengumpulan data dilakukan melalui penelusuran dokumentasi puskesmas tentang data kepegawaian, unit kerja, pemakaian obat, biaya umum, biaya ATK, biaya pemeliharaan, data inventaris alat medis dan non medis, inventaris gedung dan output layanan serta melakukan observasi lapangan dan wawancara dalam rangka mengidentifikasi biaya, serta menelusuri data Susenas. Analisis biaya dilakukan dengan metode double distribution dengan menggunakan program spreat-sheet. Hasil dan Pembahasan Biaya satuan pelayanan di Puskesmas Tanjung Ampalu pada tahun 2006 dengan insentif tanpa investasi dan gaji untuk rawat jalan poliklinik umum sebesar Rp 5.469,- , poliklinik gigi rata-rata Rp 20.027,- dan poliklinik KIA-KB rata-rata Rp 10.316,-, laboratorium Rp 6.327,-. Kemampuan membayar masyarakat Rp 16.690,- perkapita perbulan dan tarif pesaing lebih dari Rp 15.000,-. Usulan tarif rawat jalan Puskesmas Tanjung Ampalu hasil perhitungan unit cost ditambah dengan margin 5% agar pendapatan puskesmas dapat menutupi biayanya Rp 5.743,-. Usulan tarif ini masih dibawah kemampuan membayar masyarakat dan tarif pesaing dan bila ditetapkan masih bisa dijangkau oleh masyarakat Kesimpulan Tarif puskesmas bila diusulkan sesuai dengan perhitungan unit cost dengan insentif tanpa gaji dan investasi masih bisa dijangkau oleh masyarakat karena masih dibawah kemampuan membayar masyarakat dan tarif pesaing.

Background : Decentralization caused some changes in all fields and the impact is expected could be applied in regional autonomy of existing administration system. The low allocation of health financing caused the need to find source alternative for public financing which is self funding primary health care. Self funding primary health care is primary health care that is given authority to manage its own functional income that is aimed to improve service quality to tha community. The primary health care tariff until this time is based on regional rule which its calculation was not yet based on unit cost. Therefore, a research regarding unit cost analysis by considering ability to pay of community and competitor price is necessary to be conducted. Objective : This research was aimed to obtain the amount of tariff proposal of outpatient treatment in the Primary Health Care Tanjung Ampalu and find out the ability to pay of community. Method : This was a case study that used descriptive design that has relationship with total funding and unit cost by using double distribution method. The research subject was document of Primary Health Care of Tanjung Ampalu in order to obtain data of supporting unit cost and main unit cost as well as Susenas data from Statistic Center Bureau. Data was collected by using examination of Primary Health Care document regarding employment data, working unit, drugs utilization, general cost, stationary cost, maintenance cost, medical and non medical equipment inventory data, building inventory and service output as well as having field observation and interview in terms of cost identification, as well as Susenas data examination. The cost analysis was conducted by using double distribution method by using spread sheet program. Result and Discussion : unit cost of service in Primary Health Care of Tanjung Ampalu in the year of 2006 was done with incentive without investment and salary for outpatient treatment with Rp 5.469,-, dental policlinic average was Rp 20.027 and KIA-KB policlinic average was Rp 10.316,- laboratory Rp 6.327,-. Ability to pay of community Rp16.690,-, per capita per month and competitor tariff was more than Rp 15.000,-. The proposal of outpatient tariff in the Primary Health Care of Tanjung Ampalu is that the calculation result of unit cost was added with margin of 5% in order that the Primary Health Care’s income could cover the cost. Tariff proposal is still under ability to pay of community and competitor tariff, and it still and it still can be covered by the community. Conclusion : The primary health care tariff when it is proposed it suitable with unit cost measurement with insentive without salary and investment still can be reached by community as it till under ability to pay of community and competitor tariff.

Kata Kunci : Pembiayaan Kesehatan,Tarif Puskesmas,Kemampuan Masyarakat, Tariff proposal, unit cost, ability to pay of communit