Analisis perhitungan biaya satuan rawat inap dalam rangka usulan penetapan tarif

HARDADI, Riduan, drg. Julita Hendrartini, M.Kes

2007 | Tesis | S2 Ilmu Kesehatan Masyarakat (Manaj. Rumah Sakit)-

Latar Belakang : Saat ini tarif pelayanan RSUD Tarakan yang ditetapkan melalui Peraturan Daerah Nomor 11/ 2005, tidak dihitung berdasarkan analisis biaya satuan, melainkan dengan indeks biaya makan. Selama 2 tahun berturut-turut terdapat defisit anggaran, tahun 2004 (20,90%) dan tahun 2005 (39,05%). Kondisi ini menyebabkan rumahsakit kesulitan untuk menutup biaya operasional, terutama biaya operasional yang berasal dari anggaran Swadana. Penelitian ini bertujuan untuk menghitung biaya satuan, melihat besaran subsidi di instalasi rawat inap, kontribusi tarif dan biaya satuan terhadap cost recovery rumahsakit, serta penerapan kebijakan subsidi silang. Metode Penelitian : Penelitian ini merupakan penelitian deskriptif, dengan rancangan studi kasus. Analisis data menggunakan pendekatan analisis deskriptif kuantitatif. Subyek penelitian adalah petugas rumahsakit, terdiri dari ; petugas keuangan, bagian kepegawaian, instalasi rekam medik, instalasi farmasi, instalasi pemeliharaan sarana, instalasi logistik, instalasi gizi, instalasi laundry, instalasi rawat inap, instalasi rawat jalan, instalasi penunjang medik serta direktur rumahsakit, dengan unit analisis instalasi rawat inap. Variabel penelitian terdiri dari biaya satuan, subsidi biaya dan tingkat pemulihan biaya. Data penelitian berupa data sekunder yang dikumpulkan dari beberapa sumber, diantaranya ; devisi keuangan, devisi kepegawaian, instalasi logistik, instalasi rekam medik, dan unit perawatan. Hasil pengolahan data dalam bentuk angka dan persentase. Proses analisis biaya satuan menggunakan metode double distribution, hasil penelitian disajikan dalam bentuk narasi dan tabel. Hasil Penelitian : Biaya satuan yang dihitung dengan metode double distibution jauh lebih tinggi dari tarif yang berlaku. Rerata kemampuan tarif terhadap biaya satuan dengan investasi antara (11 % - 40%), rerata tarif tanpa investasi antara (29% - 99%). Subsidi biaya per-kelas perawatan, Paviliun, kelas Utama, I menyerap (52,3%), kelas II (20,4%), kelas III (27,3%). Rerata tingkat pemulihan biaya dengan investasi antara (12% - 33%), dan tanpa investasi antara (32% - 99%%). Kontribusi revenue tarif pada pendapatan rumahsakit (9,7%), revenue biaya satuan dengan investasi (35,5%), dan revenue biaya satuan tanpa investasi (13%). Kebijakan subsidi silang tidak bisa diterapkan, karena seluruh tarif di bawah biaya satuannya. Hasil analisis titik impas ruang Paviliun menyatakan bahwa untuk mencapai break even tingkat hunian minimal 73,5%. Kesimpulan : Tarif rawat inap yang berlaku lebih rendah dari biaya satuan. Seluruh kelas rawat inap menerima subsidi biaya, Paviliun, Kls Utama, Kls I, Kls II, menerima subsidi (72,7%), dan Kelas III (27,3%). Revenue tarif berkontribusi (9,7%), biaya satuan dengan investasi (35,5%) dan tanpa investasi (13%) terhadap total pendapatan rumahsakit tahun 2006. Pada pola tarif saat ini tidak terjadi subsidi silang. Hasil perhitungan analisis titik impas pada ruang Paviliun menyatakan belum mencapai break event point.

Background: Service tariff in Tarakan district hospital is determined using local government rule no: 11/2005 but this rule does not cover the calculation based on unit cost analysis but only food cost index. For 2 years there was budget deficit that was in 2004 (20.90%) and in 2005 (39.05%). Those conditions difficult hospital in covering operational cost, especially for operational cost based on self-fund budget. Objectives: The study aimed to count unit cost based on subsidy number in inpatient installation, tariff contribution and unit cost toward hospital cost recovery and implementation policy of cross subsidy. Methods: This was descriptive study using case study design. Data were analyzed using quantitative descriptive. Subjects were hospital staffs of finance department, administration department, medical record installation, pharmacy installation, tool maintenance, logistic installation, nutrition installation, laundry installation, inpatient and outpatient installation, medical support installation, and hospital director. Unit analysis of the study was inpatient installation. Variable of the study consists of unit cost, cost subsidy, and cost recovery level. Secondary data were collected from finance and administration division, logistic and medical record installation, and care unit. Processing data were on the form of number and percentage. Unit cost was analyzed u sing d ouble distribution method and the result was p resented in the form of narrative and table. Results: The result of unit cost that analyzed using double distribution method shows higher than tariff that implemented. The average capability of tariff using unit cost and investment are 11% - 33%, while the average tariff without investment is 32% - 94%. Costs ubsidy per class of care, p avilion, primary class, and first class are 52.3%, second class is 20.4%, and third class is 27.3%. The average level of cost recovery with investment is 19% 28% but 32% - 99% without investment. Tariff revenue contribution on hospital income is 9.7% and unit cost revenue with subsidy is 35.5%, while unit cost revenue without investment is 13%. Subsidy policy can not be implemented because all of tariffs are under unit cost. Equal point analysis of Pavilion room shows that in order to get break even point, minimum occupation level is 73.5%. Conclusions: Inpatient tariff that implemented by Tarakan district hospital is lower that the unit cost. All classes of care get subsidy but Pavilion, VIP, first class, and second class get bigger Subsidy (72.7%) than third class (27.3%). Contribution tariff toward hospital total income in 2006 was 9.7% for tariff revenue, 35.5% unit cost with investment, and 13% unit cost without investment. Now, tariff system does not implement cross subsidy. The result of equal point shows that Pavilion room does not get break even point yet.

Kata Kunci : Kebijakan Rumah Sakit,Biaya Satuan Rawat Inap