Penilaian kerja instalasi rawat inap umum dengan pendekatan balanced scorecard di RSUD dr. H. Moch. Ansari Saleh Banjaemasin

RAFII, Drs. John Suprihanto, MIM. ,Ph.D

2009 | Tesis | S2 Magister Kebijakan Pembiayaan dan Manajemen Asu

Latar 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.

Background: dr. H. Moch. Ansari Saleh Banjarmasin is a public hospital owned by Kalimantan Selatan provincial government. From 2006 to 2008 the hospital could reach the revenue target specified by the local government; however if compared with the cost of routine expenditure that the hospital had to pay, deficit always occured. In 2006 the deficit was Rp 6,363,805,796.00, in 2007 Rp 27,356,547,868.00 and in 2008 Rp 26,342,399,061.00. So far the hospital gets subsidy mostly from the local government through local revenue and expenditure budget (APBD)and national revenue and expenditure budget (APBN) as supporting fund from the central government. According to Trisnantoro (2006) the concept of balanced scorecard as a tool of performance measurement is relevant to be applied in the hospital. Objective: To evaluate the performance of general inpatient installation of dr. H. Moch. Ansari Saleh Banjarmasin using balanced scorecard approach. Method: This was a descriptive quantitative study that used cross sectional survey design and purposive sampling technique. Result: General inpatient installation had its own vision and mission. Viewed from the life cycle the business of hospital was in the state of growth. Viewed from the financial perspective the revenue was growing, value of annual cost reduction decreased (16% in 2007and 10.62% in 2008); income per worker increased (Rp 3,700,212.00 in 2007 and Rp 10,279,183.00 in 2008). Viewed from the perspective of customers the average satisfaction of customers was 79.96%, comprising 78.3% for VIP patients, 82.4% for class I patients, and 79.2% for class II patients. Viewed from the perspective of internal business process there was cooperation among business units that could accelerate the process of service to patients. Viewed from the perspective of growth and learning overall satisfaction of nurses was below 50% (47.4%); dissatisfaction with the job was more than one fifth (22%), income or salary was more than one third (42.7%), promotion was nearly one third (29.3%), peers was one fourth (25.8%) and the lowest dissatisfaction was with the support of the managers, i.e. less than one tenth (8.9%). Conclusion: Overall performance of the four perspectives which was not yet optimum had caused ineffective performance of the organization.

Kata Kunci : Balanced scorecard,Penilaian kinerja, balanced scorecard, performance evaluation