Analisis satuan pelayanan rawat inap di Puskesmas Perawatan Teluk Dalam sebagai dasar usulan tarif di Kabupaten Nias Selatan
NAPITUPULU, Wilser Juliadi, dr. Kristiani, SU
2008 | Tesis | S2 Ilmu Kesehatan MasyarakatLatar Belakang : Saat ini belum ada Peraturan Daerah Kabupaten Nias Selatan yang mengatur tentang besaran tarif pelayanan kesehatan di Puskesmas khususnya di unit rawat inap, saat ini pola tarif yang diberlakukan berdasarkan kesepakatan di masing-masing puskesmas. Proses pencairan biaya operasional untuk Puskesmas perawatan Telukdalam Kabupaten Nias Selatan masih sering mengalami keterlambatan, sehingga berdampak buruk terhadap kinerja pelayanan di puskesmas. Tujuan : penelitian ini bertujuan untuk melakukan perhitungan biaya satuan dengan metode Activity Based Costing (ABC) di unit rawat inap Puskesmas perawatan Telukdalam dan mengidentifikasi kemauan masyarakat (Ability to pay/ATP) dan kemampuan masyarakat (Willingness to pay/WTP) serta melihat pendapat stakeholder tentang usulan besaran tarif pelayanan kesehatan. Metode Penelitian : penelitian ini merupakan penelitian deskriptif dengan rancangan studi kasus, menggunakan metode kuantitatif dan kualitatif. Pengolahan data untuk biaya satuan menggunakan metode Activity Based Costing (ABC) dengan menentukan direct tracing dan driver tracing dengan menggunakan matriks Expense-Activity-Dependence (EAD) dan Activity-Product-Dependence (APD). Melakukan identifikasi ATP/WTP masyarakat serta persepsi stakeholder. Hasil Penelitian : Biaya satuan(unit cost) pelayanan kesehatan di unit rawat inap Puskesmas perawatan Telukdalam dengan metode ABC sebagai berikut : layanan sewa ruang Rp.37.791, pemasangan infus Rp.25.652 dan pemasangan kateter Rp.22.548. Besaran usulan tarif untuk layanan sewa ruang Rp.50.000, pemasangan infus Rp.33.752, dan layanan pemasangan kateter Rp.29.668. ATP masyarakat untuk pelayanan kesehatan sebesar Rp.27.017.-. dan WTP masyarakat untuk layanan di unit rawat inap Rp.25.350 . Stakeholder mendukung usulan tarif berdasarkan perhitungan unit cost untuk jenis layanan di unit rawat inap karena dianggap masih terjangkau oleh masyarakat Kesimpulan : Stakeholder setuju dengan usulan tarif rawat inap berdasarkan perhitungan unit cost, akan tetapi usulan tarif tersebut masih lebih besar dari ATP masyarakat sehingga diharapkan perlu adanya subsidi dari Pemerintah Daerah.
Background: Presently there is no local regulation of Nias Selatan District that deals with the amount of health service tariff at the health center particularly at inpatient unit. The tariff pattern currently imposed is based on agreement in each health center. The process of claim of operational cost of Telukdalam Health center at District of Nias Selatan often encounters delay resulting in bad impact to service performance at the health center. Objective: The study aimed to calculate unit cost using activity-based costing (ABC) method at inpatient unit of Telukdalam Health Center, identify willingness to pay of the community and get stakeholders' opinion about the amount of health service tariff. Method: This was a descriptive study with case study design and quantitative and qualitative methods. Data processing used ABC method to determine unit cost through direct tracing and driver tracing with Expense- Activity-Dependence (EAD) and Activity-Product-Dependence (APD) methods. The study identified ability to pay and willingness to pay of the community and perception of stakeholders. Result: Unit cost of health service at inpatient unit of Telukdalam Health Center using ABC method were as followed; rent of room Rp 37.791 intravenous instrument installation Rp 25,652 and catheter installation Rp 22,548. The amount of proposed tariff for rent of room was Rp 50,000,00 intravenous instrument installation was Rp 33,752 and catheter installation was Rp 29,668. Ability to pay of the community for health service was Rp 27.017 and willingness to pay of the community was Rp. 25.350. Stakeholders agreed with tariff proposition based on unit cost calculation for inpatient services because they were affordable. Conclusion: Stakeholders agreed with tariff proposition for inpatient service fund an unit cost calculation; however the proposed tariff was still greater than the ability to pay of the community so that there should be subsidy from the local government.
Kata Kunci : Biaya satuan (Unit cost),Activity Based Costing (ABC), unit cost, Activity-Based Costing, tariff, ability to pay, willingness to pay, stakeholders
