Analisis biaya satuan rawat jalan Puskesmas Salam Kabupaten Magelang
JUNNU, dr. Kristiani, SU
2009 | Tesis | S2 Ilmu Kesehatan MasyarakatLatar Belakang : Pemerintah Kabupaten Magelang berusaha meningkatkan mutu dan menjamin akses pelayanan kesehatan. Kendala utama yang dihadapi pemerintah adalah terbatasnya anggaran, sehingga masing-masing sektor termasuk kesehatan dituntut untuk melakukan perhitungan yang cermat tentang biaya operasional yang dibutuhkan dan sumber-sumber pembiayaan, salah satunya pengaturan tarif. Hal ini menjadi penting karena sumber pembiayaan puskesmas mengandalkan biaya operasional sebesar 85% dari pengembalian setoran sesuai perda tarif nomor 5 tahun 2006. Tujuan : Penelitian ini bertujuan untuk melakukan perhitungan biaya satuan (unit cost) rawat jalan puskesmas dengan menggunakan metode double distribution, menghitung jasa pelayanan, mengukur kemampuan dan kemauan membayar (ATP/WTP) masyarakat dan membandingkan tarif pesaing (dokter dan bidan praktek) dengan tarif Puskesmas Salam. Metode Penelitian : Penelitian ini merupakan penelitian deskriptif dengan rancangan studi kasus, menggunakan metode kuantitatif. Penelitian dilakukan pada unit rawat jalan (BP, BPG, KIA/KB, laboratorium, IGD dan EKG). Variabel yang diteliti meliputi variabel pengaruh (independent variabel) yang terdiri dari biaya satuan (unit cost) rawat jalan, ATP/WTP,Jasa pelayanan dan tarif pesaing, sedangkan variabel terpengaruh (dependent variabel) adalah usulan tarif rawat jalan puskesmas. Instrumen penelitian berupa template (instrumen) biaya dan kuesioner. Analisis data kuantitatif pada perhitungan biaya satuan, analisis ATP/WTP, perhitungan jasa pelayanan dan perbandingan tarif pesaing dengan tarif puskesmas. Hasil Penelitian : Biaya satuan pelayanan rawat jalan puskesmas untuk pemeriksaan umum Rp.6.032,- tumpatan gigi tetap Rp.21.804,- pencabutan gigi permanen Rp. 16.342, pembersihan karang gigi per kwadran Rp.17.016, ANC Rp.9.166, MTBS Rp.13.099, pemasangan IUD Rp.35.803,- pemasangan implant Rp. 42.471, Pemeriksaan hemoglobin Rp. 7.995, gula darah sewaktu Rp.10.170,- kolesterol Rp.12.783,- asam urat Rp.13.836. Besaran jasa pemeriksaan umum sebesar Rp.1.360,- cabut gigi permanen Rp.6.800,- pemasangan IUD Rp.10.625,- pemasangan implant Rp.25.500,- pemeriksaan hemoglobin Rp.2.000,- dan pemeriksaan gula darah sewaktu Rp.2.000,-. Kemampuan membayar masyarakat berdasarkan pengeluaran tersier sebesar Rp.31.206, kemauan membayar didapatkan 21,3% bersedia membayar Rp.7.392,- atau lebih perkali kunjungan dan 78,7% mempunyai kemauan membayar di bawah Rp.7.392,- perkali kunjungan. Besaran tarif dokter praktek lebih tinggi 650% dan tarif bidan praktek lebih tinggi 150% - 400% dari tarif retribusi puskesmas saat ini. Kesimpulan : Berdasarkan pertimbangan besaran unit cost, pemberian jasa pelayanan, kemampuan membayar masyarakat, serta besaran tarif pesaing, maka pemerintah daerah perlu meninjau kembali tarif puskesmas yang berlaku dengan tetap mempertimbangkan besaran subsidi dan alokasi anggaran untuk kesehatan.
Background: District government of Magelang tries to improve quality and ensure access to health services. The major constraint faced by the government is limited budget, so that each sector including health has to make accurate calculation on operational cost needed and sources of funding, one of them is regulating tariff. This becomes important because source of health center funding relies on operational cost as much as 85% from the reimbursement of payment according to local regulation tariff No. 5/2006. Objective: The study aimed to calculate unit cost of outpatient at the health center using double distribution method, service fees, and measure the ability and willingness to pay of the community and compare tariff of competitors (private doctors and midwives) with tariff of Salam Health Center. Method: This was a descriptive study that used a case study design and quantitative method. It was carried out at the outpatient units (medical service, dental service, maternal and child health, emergency installation and electro cardiography). The variables observed were independent variables consisting of outpatient unit cost, ability to pay (ATP), willingness to pay (WTP), services and tariff of competitors; whereas the dependent variable was the proposition of health center outpatient tariff. Research instruments consisted of cost template and questionnaire. Quantitative data analysis used unit cost calculation and ATP/WTP analysis, calculation of service fee and comparison of competitors' tariff and tariff of the health center. Result: Unit cost of health center outpatient for general examination was Rp 6,032; permanent dental filling was Rp 21,804; permanent dental removal was Rp 16,342; dental plague cleaning per quadrant was Rp 17,016; ANC examination was Rp 9,166; MTBS examination was Rp 13,099; IUD fixation was Rp 35,803; implant fixation was Rp 42,471; examination of hemoglobin was Rp 7,995; temporary glucose was Rp 10,170; cholesterol was Rp 12,783; gout arthritis was Rp 13,836. The amount of general examination service was Rp 1,360; permanent dental removal was Rp 6,800; IUD fixation was Rp 10,625; implant fixation was Rp 25,500; hemoglobin examination was Rp 2,000; and temporary blood glucose examination was Rp 2,000. ATP of the community based on tertiary expenditure was Rp 31,206, WTP was Rp 7,392 or more per visit (21,3% of respondents) and 78,7% were willing to pay below Rp 7,392 per visit. The amount of tariff of private doctors was 650% higher and of private midwives was 150% - 400% higher than the tariff of the health center. Conclusion: Based on the amount of unit cost, service fee, ability to pay of the community, and the amount of competitors' tariff, the local government should re-evaluate the present tariff of the health center by considering the amount of subsidy and budget allocation for health.
Kata Kunci : Biaya satuan (Unit cost),Usulan tarif,ATP/WTP, unit cost, tariff proposition, ATP/WTP
