Analisis biaya per satuan pelayanan di puskesmas Aertembaga Kota Bitung Propinsi Sulawesi Utara
TANGGUNG, Hira, dr. Kristiani, SU
2008 | Tesis | S2 Ilmu Kesehatan MasyarakatLatar Belakang : Sejak Tahun 2003, Pemerintah Daerah (Pemda) Kota Bitung telah menetapkan kebijakan gratis tarif retribusi berobat di seluruh puskesmas dan jaringannya. Konsekuensinya, pembiayaan retribusi menjadi tanggung jawab pemda. Bila biaya (premi) dibebankan kepada pemda maka harus diperhitungkan besaran biaya yang diperlukan agar dapat menghidupi kegiatan Unit Pelaksana Teknis (UPT). Dampak sejak berlakunya kebijakan gratis tarif retribusi itu, puskesmas kehilangan sebagian sumber pendapatan fungsional yang biasa dikelola untuk biaya oprasional dan jasa medis petugas. Keadaan ini menyebabkan terjadinya kesulitan-kesulitan bagi puskesmas untuk menyelenggarakan pelayanan kesehatan yang bermutu guna memenuhi kebutuhan masyarakat sehingga perlu dilakukan perhitungan biaya per satuan pelayanan. Tujuan : Untuk mengetahui berapa besar unit cost dan subsidi operasional pelayanan poli umum, poli gigi dan poli KIA-KB serta persepsi stakeholders terhadap pembiayaan operasional di puskesmas. Metode : Jenis penelitian adalah deskriptif dengan rancangan studi kasus, menggunakan metode kuantitatif dan kualitatif. Instrumen pengumpulan data berupa template dan pedoman wawancara. Pengolahan data mengacu pada perhitungan biaya per satuan dengan metode Activity- Based Costing (ABC) melalui dua langkah yaitu direct tracing dan driver tracing dengan menggunakan matrix EAD dan APD menurut Roztocky (2004). Hasil pengolahan data ini akan dianalisis dan dideskripsikan. Hasil : Biaya per satuan pelayanan poli umum Rp 10.257,- dan Rp 9.510,- poli gigi Rp 30.298,- (untuk biaya pemeriksaan umum), Rp 36.757,- (persistensi), Rp 32.328,- (ganggren pulpa), Rp 28.815,- (scaling) and Rp 38.352,- (plumber) dan poli KIA-KB adalah Rp14.103,- (pelayanan ibu hamil), Rp18.397,- (pemasangan IUD), Rp 11.374 (pemberian imunisai TT) dan Rp15.836 (pelayanan suntik KB), sehingga besaran subsidi masing-masing unit pelayanan poli umum, untuk poli gigi serta poli KIA- KB adalah Rp 183.778.651,- Rp 38.805.680,- dan Rp 23.418.018,-. Selanjutnya Pemda Kota Bitung akan mendukung serta menjamin biaya operasional pelayanan kesehatan di puskesmas karena bidang kesehatan merupakan prioritas pembangunan di Kota Bitung. Kesimpulan : Biaya per satuan pelayanan yang diperoleh dari hasil analisis ini lebih besar dibandingkan dengan tarif dalam Perda No.14 Tahun 2001 dan besaran subsidi yang diperkirakan jauh lebih besar dari subsidi yang diperoleh puskesmas selama ini. Namun Pemda Kota Bitung tetap akan menjamin pembiayaan operasional di puskesmas.
Background: Since 2003, Bitung municipality government has stated a policy to give free health services (i.e. free of charge) in all Community Health Centre (CHC) and its networks in Bitung. This policy delivers a consequence which municipal government should take the responsibility to pay all the cost for delivering health services in CHC. Thus, the government should calculate number of costs to fund the Technical Executor Unit activities. This policy also effects to the CHC management, that is, CHC a loss because they do not receive a part of their functional earnings which was used to fund the operational cost and service fee for the paramedics. Moreover, the health centers faced difficulties in delivering qualified health services in the purpose of fulfilling the society needs. Objectives: To calculate unit cost and operational subsidy for services in policlinic, dentist, mother and child health (MCH)-family planning (FP) Poly, and also to find out the stakeholders’ perceptions to the operational funding at Community Health Centre Methods: In collecting the data, the researcher used a descriptive approach with case study design by using quantitative and qualitative methods. Data were gathered from the existing cost data and interview with the stakeholders. The Activity-Based Costing (ABC) method by using two steps; they were direct tracing and driver tracing with EAD and APD matrix Roztocky (2004) was used to make unit cost analysis. Result: Unit cost for services in polyclinic were Rp 10.257,- and Rp 9.510,-; services in dentist were Rp.30.298,- (for general check up), Rp 36.757,- (persistence), Rp 32.328,- (gangrene pulp), Rp 28.815,- (scaling) and Rp 38.352,- (plumber); services in MCH-FP poly were Rp 14.103,- (antenatal care), Rp 18.397,- (IUD Installation), Rp 11.374 (TT immunization) and Rp 15.826 (FP injection services). From the unit cost calculation, it could be estimated the operational subsidy for each poly in CHC were Rp.183.778.651,- for policlinic, and Rp 38.805.680,- for dentist and Rp 23.418.018 for MCH-FP poly. Furthermore, the government would support and guarantee operational cost for health services considering to health sector. It was one of the development priorities in Bitung. Conclusion: The calculate unit costs were higher than the existed tariff at Regional Regulation No.14/2001 and the estimated subsidy were also much higher than the amount of subsidy received by CHC. Otherwise, Bitung government promised to finance the operational costs at CHC.
Kata Kunci : Biaya persatuan pelayanan,Aktivity,Basedcosting (ABS),puskesmas(PKM),Unit Cost Analysis, Activity-Based Costing (ABC), Community Health Centre (CHC)
