Analisis perhitungan unit cost menggunakan time-driven activity-based costing (tdabc) pada tindakan bronkoskopi diagnostik elektif di RSUP Persahabatan

Ewita Gustine, dr. Firdaus Hafidz As Shidieq, M.P.H., A.A.K., Ph.D; dr. Prasenohadi, Ph.D, Sp.P(K), KIC

2026 | Tesis | MAGISTER KEBIJAKAN DAN MANAJEMEN KESEHATAN

Latar Belakang: Bronkoskopi diagnostik elektif memerlukan personel multidisiplin, sarana khusus, pemrosesan ulang alat, obat, dan bahan medis habis pakai. Pembayaran paket belum tentu mencerminkan konsumsi sumber daya setiap jenis tindakan.

Tujuan: Menghitung biaya satuan empat jenis bronkoskopi diagnostik elektif dengan time-driven activity-based costing dan membandingkannya dengan tarif Indonesian Case-Based Groups yang berlaku.

Metode: Studi kasus mixed-methods konkuren dilakukan di RSUP Persahabatan, Jakarta pada Januari-Juni 2026. Data volume layanan, observasi time-motion, dokumen keuangan, dan wawancara 16 informan kunci ditriangulasi. Capacity cost rate personel dan sarana dikalikan durasi aktivitas, kemudian ditambahkan biaya obat, bahan medis habis pakai, dan biaya tidak langsung yang dialokasikan.

Hasil: Dari 1.326 tindakan tahun 2025, bronchoalveolar lavage paling banyak dilakukan (46,4%). Akumulasi waktu aktivitas berkisar 339-372 menit. Biaya satuan observasi adalah Rp10.921.000,- untuk bronchoalveolar lavage, Rp10.938.000,- untuk bronkoskopi toilette, Rp15.301.000,- untuk endobronchial ultrasound-guided transbronchial needle aspiration, dan Rp21.121.000,- untuk transbronchial lung biopsy. Tarif hanya menutup 12%-23% biaya satuan, dengan kesenjangan Rp8.440.908-Rp18.640.900.-. Wawancara menunjukkan bahwa beban kerja, risiko tindakan, dan tugas administratif tambahan belum selalu tercermin dalam remunerasi maupun nilai penggantian.

 

Kesimpulan: Biaya bervariasi menurut jenis tindakan, terutama karena obat dan bahan medis habis pakai, sedangkan alokasi biaya tidak langsung tetap tinggi. TDABC dapat mendukung perbaikan alur, validasi cost pool, telaah koding, penetapan tarif internal, dan dialog tarif berbasis bukti.

 

Kata Kunci: bronkoskopi, analisis biaya, time driven activity-based costing

Background: Elective diagnostic bronchoscopy requires multidisciplinary personnel, specialized facilities, reprocessing, drugs, and medical consumables. Bundled reimbursement may not reflect procedure-specific resource consumption.

Objective: To calculate the unit cost of four elective diagnostic bronchoscopy procedures using time-driven activity-based costing and compare it with the applicable Indonesian Case-Based Groups tariffs.

Methods: A concurrent mixed-methods case study was conducted at RSUP Persahabatan, Jakarta from January to June 2026. Service-volume data, time-motion observations, financial documents, and interviews with 16 key informants were triangulated. Capacity cost rates for personnel and facilities were multiplied by activity time; drugs, consumables, and allocated indirect costs were then added.

Results: Among 1,326 procedures in 2025, bronchoalveolar lavage was most frequent (46.4%). Cumulative activity time ranged from 339 to 372 minutes. Unit costs observed were Rp10.921.000 for bronchoalveolar lavage, Rp10.938.000 for bronchoscopy toilette, Rp15.301.000 for endobronchial ultrasound-guided transbronchial needle aspiration, and Rp21.121.000 for transbronchial lung biopsy. The tariffs covered only 12%-23% of unit costs, leaving gaps of Rp8.440.908-Rp18.640.900. Interviews indicated that workload, procedural risk, and additional administrative tasks were not always reflected in remuneration or reimbursement.

Conclusions: Costs varied substantially by procedure, mainly because of drugs and consumables, while allocated indirect costs remained high. TDABC can support pathway redesign, cost-pool validation, coding review, internal pricing, and evidence-based tariff dialogue.

Keywords: bronchoscopy, cost analysis, time driven activity based costing

Kata Kunci : bronkoskopi, analisis biaya, time driven activity-based costing