LAPORAN PERTANGGUNGJAWABAN
PENGGUNAAN ALAT VENTILATOR NEONATAL
TAHUN 2015-2023
Disusun Oleh :
1. Fajar Ahmad Fauzi
20133010032
2. Muhammad Nasrullah
20133010033
3. Ika Nurcahyani
20133010044
4. Dyan Nova Lesiska N
20133010056
PRODI TEKNIK ELEKTROMEDIK
PROGRAM VOKASI
UNIVERSITAS MUHAMMADIYAH YOGYAKARTA
2016
I. Latar Belakang (Laporan)
Perkembangan teknologi setiap masa dan setiap waktu terus berkembang dengan seiringnya
ditemukan penemuan-penemuan baru di bidang teknologi. Munculnya penemuan transistor telah
merubah kiblat arah perkembangan teknologi dari teknologi konvensional yang berukuran besar
menjadi teknologi modern berukuran kecil (mikro) berupa IC (Intregated Circuit).
Perubahan teknologi dari masa ke masa membuat perubahan di seluruh sektor kehidupan.
Salah satu bidang yang terkena dampak dari kemajuan teknologi ini adalah di bidang kesehatan.
Karena kesehatan saat ini telah menjadi prioritas penting yang diutamakan bagi seluruh umat
manusia sehingga para kreatif teknologi berlomba-lomba untuk membuat alat bantu manusia
dalam bidang kesehatan.
Terlepas dari majunya perkembangan teknologi di bidang kesehatan tersebut, peran
pemerintah dalam memberikan pelayanan publik terkait di bidang kesehatan juga telah membuat
standarisasi alat demi menjamin pelayanan yang baik bagi masyarakat saat ini. Sehingga seluruh
instansi lembaga kesehatan terutama INDONESIA dituntut terus mengembangkan dan
memanfaatkan kemajuan-kemajuan teknologi alat kesehatan di era serba digital.
Salah satu langkah kerja pemerintah tersebut juga dilakukan oleh rumah sakit RSCM Jakarta
dalam penerapan standarisasi alat modern demi memenuhi persyaratan dan kenyamanan pasien
dirumah sakit.
Langkah yang sudah diambil adalah pengadaan alat kesehatan berupa ventilator Bella Vista
yang diterima oleh pihak rumah sakit RSCM Jakarta oleh mitra kerja. Alat ini dibeli pada tahun
2015, untuk mengganti alat ventilator yang sudak tidak layak pakai. Tidak hanya itu, pengadaan
alat ventilator tersebut juga untuk melengkapi syarat-syarat pemenuhan standarisasi alat-alat
rumah sakit di RSCM Jakarta.
Namun, pada pelaksanaannya selama 8 tahun pemakaian alat ventilator ini telah berubah
dalam segi; kinerja mesin, perlengkapan tambahan alat, dan lifetime alat (daya pakai alat)
sehingga perlu dilakukan maintenance dan repair selama pemakaian, tidak hanya itu pemeliharan
alat, service, kalibrasi dan penggantian suku cadang alat juga telah banyak dilakukan.
Maka dengan perubahan-perubahan alat tersebut pihak teknisi rumah sakit RSCM Jakarta
telah merangkum, menyusun, dan menghitung keseluruhan pembiayaan baik pemasukanmaupun
pengeluaran. Di akhir kami membuat laporan rekam jejak alat ventilator secara teknis maupun
pembiayaan alat. Laporan pembukuan ini akan dijadikan sebagai acuan dan dibandingkan dengan
data-data pada proposal pada tahun 2015 untuk diaudit ulang sehingga perubahan-perubahan
struktural bisa dipertanggung jawabkan selama pemakaian alat ventilator dengan merk Bella Vista
yang sudah disetujui oleh pihak rumah sakit dan mitra kerja pada waktu itu.
Dengan segala ulasan yang sudah ditulis dan tersurat maka kami sertakan segala hasil dan
kami informasikan laporan ini dengan judul “LAPORAN PERTANGGUNGJAWABAN
PENGGUNAAN ALAT VENTILATOR NEONATAL TAHUN 2015-2023”. Diharapkan
laporan yang telah dibuat menjadi arsip yang membantu demi terciptanya manajemen peralatan
yang baik dan sesuai standar nasional bahkan internasional yang telah menjadi visi RSCM Jakarta
selama satu dekade ini.
II. Laporan Teknis
Dalam pengajuan proposal ini, kami memiliki dua alternatif alat yang akan diajukan
pengadaannya. Berikut beberapa pembanding yang kami jabarkan sebagai pertimbangan
pemilihan keputusan.
A. Spesifikasi (brochure) dan Gambar Alat
i. Terlampir
B. Anggaran Biaya dan Analisis Perhitungan
ii. Terlampir
C. Jaringan Proyek
iii. Terlampir
D. Cash Flow
iv. Terlampir
III.
Daftar Referensi
1. (E-katalog lkpp 2016), Katalog alat-alat kesehatan, 2016 [online] tersedia :
<e-katalog.lkpp.go.id >. [8 januari 2016 14.47 WIB].
2. (Imtmedical 2016), Bellavista® 1000, imtmedical, 2016 [online] tersedia :
<http://www.imtmedical.com/enus/products/bellavista/Documents/bellavista_Basis_Brochure_EN.pdf>.
[8
januari
2016].
3. (Jaringan Dokumentasi dan Informasi Hukum Kementerian Keuangan RI 2016), Tarif
biaya penggunaan fasilitas rumah sakit anak dan bunda harapan jakarta, 2016 [online]
tersedia
:
<http://www.jdih.kemenkeu.go.id/fullText/2013/149~PMK.05~2013Perlamp.pdf>.
[6
Januari 2016].
4. (Lembaga Bank Indonesia 2016) BI Rate, bank indonesia, 2016 [online] tersedia :
< http://www.bi.go.id/id/moneter/bi-rate/data/Default.aspx >. [8 januari 2016].
5. (PT PLN (Persero) Distribusi Jakarta Raya dan Tangerang 2016) Penyesuaian tarif tenaga
listrik,
PLN,
2015
[online]
tersedia
:
<http://www.pln.co.id/disjaya/?p=3645>. [7 januari 2016].
6. (APBD DKI Jakarta 2015) Informasi Belanja Langsung, Informasi APBD, 2015 [online]
tersedia : <http://www.jakarta.go.id/v2/apbd/browse/2015#browse>. [13 Januari 2016].
7. (Teknisi RSI Klaten Bpk.Susilo Ari Wibowo, S.T 2016) [online] tersedia :
a. penggantian Oxygen Cell 2.750.000
b. maintenance kit tiap 5000 jam (+-) 3.000.000
c. jumlah pasien rata2 per hari 6,75 (dibulatkan menjadi 6 pasien/hari).
8. ( Teknisi RSUP. Sardjito Yogyakarta Bp. Kuat Supriyadi, S.T 2016 ) [online] tersedia :
a. kenaikan biaya perawatan antara 10%-50%
LAMPIRAN I
Spesifikasi (brochure) Alternatif Alat 2
Design and performance
Good things can be improved. With this in mind, we have
developed a revolutionary new generation of ventilators.
bellavista ensures a step into the future for all of our clients.
Not only the attractive, elegant outward appearance and
outstanding technology, but also the new, groundbreaking
operating system, developed closely with leading physicians,
set bellavista apart from the competition. bellavista
refreshingly redefines ventilation technology with an attractive yet conspicuously discreet design, which stands
out from the typical clinical instrumentation and integrates
functionality, Swiss quality and high performance with
user-friendliness and innovative design.
Intelligent aesthetics
bellavista offers a new type of operating experience by
allowing individual adaptation of the applications to suit the
needs and habits of the user. Whether a patient, nurse,
or doctor, the relevant information is immediately visible and
available.
Revolutionary operation
Smart touch operation
UserView ™
Building user confidence
bellavista’s new touch screen simplifies
the set-up process and adjustment
of ventilator and monitoring values and
curves.
The screen displays only relevant information for the selected user. A status
indicator simplifies the screen by hiding
complicated graphs and figures that
could otherwise confuse the patient.
The physician, however, sees all values,
curves and loops, which enables
him/her to rapidly familiarise himself/
herself with the patient’s condition.
bellavista supports daily use of the
ventilator with multimedia capabilities.
Wizards and instructional videos displayed directly on the device support the
bellavista set-up and operating process.
These instruments assist in reducing user
anxiety while operating the device.
By using the direct menu, the user can
see the actions available in the selected
field, thereby guaranteeing intuitive
operation of the device. Various respiratory parameter setting methods
are additionally available to the user.
The user interface can be individually
customised directly on the screen according to the user’s wishes and requirements by positioning each operating
component where expected.
Videos and pictures detailing health
conditions and treatments can be loaded
and displayed directly on the ventilator.
These informational spots support
the patient as well as physician with video
and audio functions and ensure comfortable assistance for example during mask
fitting. These capabilities enable ventilator acceptance by the patient and increase the chances of successful therapy.
VentilationAssist™
VentilationAssist supports the medical
specialist in parameter adjustment
when a patient is initially connected to
bellavista ventilator. After entering
the relevant patient information (includ
patient history, age, lung volume, etc)
VentilationAssist suggests a suitable ve
lation configuration. This suggestion
can then be evaluated and adjusted by
medical specialist.
Innovative features
MaskFit™
WeanVent™
ChameleonLook™
Experts agree that initial ventilator contact is critical in determining future
therapy success. If the patient accepts the
ventilator and mask during this first
phase, it is very likely that non-invasive ventilation can be used throughout the
therapy. If non-invasive therapy is not
an option, the consequence is often intubation causing long-term therapy with
increased complications.
During ventilator weaning, bellavista
supports the patient with WeanVent.
During this phase, the patient is prepared
with targeted measures and training
programs that are individually customised
by the medical specialist. The entire
weaning process is supported by multimedia functions. Real-time patient
information and measuring results are
continuously available for review and
diagnosis during therapy.
The multitude of ventilators with varying
user-interfaces presents significant
challenges for medical specialists.
The consequences encountered by this
variety are increased costs for device
familiarisation and training.
MaskFit assists the patient and medical
specialist during initial contact with the
device and mask. With assisted guidance
and multimedia support, the patient
easily adjusts to ventilation step by step.
bellavista’s ChameleonLook offers
revolutionary support for anyone working
with a broad range of ventilators. At the
click of a button, the ChameleonLook
adapts bellavista’s operating surface to
an interface that the operator is more
familiar with.
ModeAssist™
While the ventilation is running, a new
mode or form of therapy can be selecte
and pre-configured using ModeAssist.
Selections of varying ventilation pattern
based upon empirical values are available. Changes are only applied when t
configuration is complete and the user
initiates the new settings.
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Innovative features
FlexiView™
ActiveHelp™
ConnectionAssist™
The bellavista user interface can be
individually customised using FlexiView.
This feature allows users to continuously adjust the user interface to their
needs and wishes. While the device is
in operation, monitoring values and curves
can be adjusted and loops can easily
be configured.
ActiveHelp is easily accessible directly
on bellavista’s user interface. In every
phase of operation, assistance pertaining
to the current topic is available by the
push of a button. The bellavista ventilator
details responses with informative text
including pictures, instructional videos or
relevant sections from the electronic
user manual.
Correctly connecting and operating
bellavista is detailed step-by-step with
ConnectionAssist. All interfaces have
a ConnectionAssist button next to them.
When this button is pushed, information appears on the screen describing the
function of the selected connection.
An adequate pneumological examination requires a substantial diagnosis. During this process, parameters from
various machines must be correlatively analysed. bellavista
is the world’s first ventilator where all the sensors
necessary for a reliable pneumological diagnosis are either
integrated in the device or attachable.
All relevant parameters are displayed and recorded polygraphically and simultaneously. This allows the specialist to
make a reliable diagnosis quickly and simply and evaluate
critical changes in the patient’s condition.
With a complete record of all patient parameters, a detailed
post-analysis can be determined. The ArtefactFinder
supports the physician in evaluating the data displayed and
reliably highlights irregularities.
Cardio Pleth
SpO2
CO2
FiO2
Lung mechanics
Flow & volume
Pressure
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World premier in diagnostics and monitoring
Standard parameters
Lung mechanics
Blood gas monitoring
The flow, volume and pressure parameters give insight into respiratory tract
obstructions, compliance dysfunctions
and leakages. Alarm parameters can
be comfortably adjusted directly on the
touch screen.
The quantitative analysis of the respiratory
system must be accompanied by an
understanding of the complex reciprocal
effect between patient and ventilator.
This analysis delivers important clinical
information about lung function and
the course of a disease and allows the
medical specialist to customise ventilator
settings for the individual patient.
Pulse oximetry, the transcutaneous measurement of SpO2, is crucial in recognizing
the quality of ventilation. Blood gas
monitoring simplifies long-term monitoring
and avoids invasive arterial blood gas
analysis.
Capnography
The integrated capnograph enables simple
monitoring of the tubus and indicates
potential pulmonary embolism.
Ventilators providing high-performance for every type of
therapy are rare. For years the devices used at home
were dramatically different from those used in hospitals.
bellavista combines the advantages of the proven,
classic proportional valve technology of ICU ventilators,
with the high-performance blower technology primarily used in non-invasive ventilation. Thus, bellavista offers
a ventilation platform for all applications; for noninvasive and invasive ventilation, for children and adults,
at home and in the hospital.
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Top ventilation performance
Ventilation and synchronisation
Various types of therapy
Oxygen
The proportional valve technology
patented for bellavista enables optimal
synchronisation between the ventilator and patient and regulates an exact
air dosage for each breathing phase.
bellavista’s superior exhalation
performance also increases patient
comfort.
Pressure and volume controlled ventilation
modes give the user the greatest flexibility in selecting the appropriate therapy.
For anxiety-free and assisted mask
adjustment, bellavista offers the MaskFit
mode which provides multimedia assistance to doctors and patients.
Depending on the clinical diagnosis
and therapy, the air provided can be mixed
with a precise dose of oxygen. bellavista
supports all O2 supply systems available
in the market.
The DayNight mode enables patients to
switch independently between two
different types of prescribed therapies.
This accommodates the physiological differences of the lung functions and
optimises the patient’s comfort.
The DayNight mode also takes into account
differing therapies at the relevant time
of day and adjusts the ventilation
appropriately.
Medication therapy support
An integrated medication nebuliser
permits exact dosages of medication in
accordance with the chosen therapy.
The intelligent control system can adapt
the dosage patterns. Customised modes
such as pressure and volume controlled sighs or targeted administration
of manual breath can further promote
patient weaning off the ventilator.
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The appropriate device for every application. The bellavista
model 1000 is available in two separate basic versions
in order to accommodate varying ventilator applications –
bellavista 1000 and bellavista 1000e. Each version
distinguishes itself through unique attributes and advantages. Several features are available separately or
after an initial purchase.
1000
Area of application
Intensive care unit (ICU)
Subacute / Intermediate care unit (IMC)
Emergency Room (ER)
Intrahospital transfers
Ventilation
Non-invasive (High Performance NIV)
Invasive
Neonatal
Pediatric
Adult
Single limb breathing circuit
Dual limb breathing circuit
Ventilation modes
Pressure controlled
CPAP, PCV, P-A/C, PC-SIMV, PSV, beLevel, APRV
CPAP, S, S/T, T, P-A/C
Volume controlled
VCV, V-A/C, VC-SIMV
PLV (Pressure Limited Ventilation)
on all volume controlled modes
Oxygen
Basic Oxygen Therapy
Advanced Oxygen Therapy
Oxygen flush
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available, included in the ClinicSuite
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TM package
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1000
ExpertVentilation TM package
Single & multiple sighs
Manual breath
Inspiratory hold
Expiratory hold
AutoPEEP
NIF (Negative Inspiratory Force)
Vtrapped (trapped volume)
P0.1 (occlusion pressure)
ATC (fully configurable)
bellavistaModes (beModes)
SingleVent™
Backup Ventilation
TargetVent™
DualVent™
DayNight™
MaskFit™
WeanVent™
Special features
UserView™
FlexiView™
UserAssist™
VentilationAssist™
Various monitoring and trending views
ConnectionAssist™
ActiveHelp™
ChameleonClassic™
ChameleonGreen™
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16
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Overview
1000
Monitoring
Standard parameters
Pressure
Ppeak, Pplateau, Pmean, PEEP
Volume
Vti, MVi (MinVol), Vti/kg, MVi/kg,
Vte, MVe (MinVol), Vte/kg, MVe/kg
Timing
Rate, Ti, Te, I:E, Ti/Tot
Oxygen
FiO2
Curves
Pressure, Flow, Volume
incl. Ptrach curve if ATC is enabled
Up to three curves
Up to eight curves & loops
Curve freeze
Curve cursor
Leak
Leak flow, Auto-Leak TM
Pulse oximetry Pulse rate, SpO2 saturation,
Cardio pleth curve
Capnography inCO2, etCO2, CO2-curve
SBE
% Spont
ExpertMonitoring TM
Volume
MVi spont
MVe spont
Timing
Rate spont, Ti support,
SBE
%Spont 1h, %Spont 8h
WOBimp
Work of Breathing imposed
PTP
Pressure Time Product
P0.1
breath-by-breath occlusion pressure
Tobin Index
RSBI (Rapid Shallow Breathing Index)
Leak
% Leak
Curves
Up to eight real time curves
1000 e
1000
Patient info
Patient info sheet
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Diagnostics
Correlated diagnostic data
Oxygen fraction FiO2
Diagnostic Package Pulse Oximetry
Diagnostic Packages Capnography
Diagnostic lung mechanics
Curves
Proximal flow & volume
Loops
P/V (pressure/volume)
P/F (pressure/flow)
F/V (flow/volume)
Loop freeze
Loop cursor (inflection points, ...)
Reference loop
Loop overlay
Parameters
Rinsp, Rexp, Cstat, Cdyn,
C20/Cdyn, CDyn/kg, CStat/kg
Trending
Standard trending (all monitoring parameters)
Real time trending (all curves)
Alarms
Alarm log
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Ventilation alarms
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System alarms
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Auto self-test
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1000
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1000
Data transfer / Central Monitoring (PDMS)
USB-stick
Screenshot (on USB-stick)
bellavista ConfigurationSuite™
Philips VueLink™ and IntelliBridge
Operation and signals
Giant screen (13,3")
Touch screen operation
360° multicolor signals
Stereo loudspeakers
Ergonomics
Compact design
Innovative bellavista operating concept
Ergonomic colour design
Integrated carrying handle
Integrated mounting possibilities
Low noise design
Technology
Multiprocessor architecture
Redundant safety components
Low power design
Proportional valve technology
High performance turbine
Oxygen
External medication nebulizer
1000 e
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1000
1000 e
Extension modules
beBay™
Humidifier
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Software upgrades
Software upgrade via USB interface
iVista software download
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Maintenance
Minimal maintenance
Easy air filter exchange
ServiceAssist™
Easy to clean surface
Support
Test and diagnostic tools
Training
Integrated multimedia applications
Tutorial videos
Integrated electronic user manual
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Overview
1000
Technical data
Ventilation settings
Pinsp (IPAP)
0 .. 60 mbar
0 .. 80 mbar
Psupport
0 .. 60 mbar
0 .. 80 mbar
PEEP (EPAP)
0 .. 40 mbar
CPAP
4 .. 30 mbar
Rise time
0 .. 2000 ms
Ramp
Off, 5 .. 45 min
Tidal volume
40 .. 2500 mL
10 .. 2500 mL
2 .. 2500 mL
Body Weight
6 .. 250 kg
1.5 .. 250 kg
0.4 .. 250 kg
Peak flow
260 L/min
Flow pattern
Square, Dec., Dec. 50 %
Breathing frequency
1 .. 100 bpm
1 .. 150bpm
Inspiration time
0.1 .. 10 s
I:E ratio
1:599 .. 49:1
Inspiration trigger (flow)
0.1 .. 20 L/min
Inspiration trigger (pressure) 0.1 .. 15 mbar
Expiration trigger
5 .. 90 % of insp. peak flow
Auto-Synch TM
Apnea backup
off, 2 .. 100 s
Oxygen
5 levels
Advanced Oxygen Therapy
21 .. 100 % FiO2
1000 e
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1000
Technical data
Technical specifications
Weight
Dimensions (w x h x d)
Ambient temperature
Ambient humidity
Ambient pressure
Energy supply
Wide range power input
Low voltage input
Battery operation
Intelligent battery
management
Green power mode
Oxygen connector
Wide range oxygen inlet
9.1 kg
35 x 22 x 33 cm
5 .. 40 °C
10 ..90 % r.H.
600 .. 1100 hPa
100- 240 VAC / 50-60 Hz / 80 W
24 VDC / 3.5 A (Typ.)
4-6 h (internal)
0 .. 7 bar/0 .. 100 psi
Interfaces
Coded plug connections
100 MBit ethernet
beBus™
USB 2.0 interfaces
Serial ports
Nurse call
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 included
indelivery
 optionally 
available
optionally 
available, included in the ClinicSuite
TM package
1000
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2 0 0 8 Good Design Award of The Chicago Athenaeum, USA
Design Award of the Federal Republic of Germany 2010
imtmedical ag Gewerbestrasse 8 9470 Buchs Switzerland
T +41 81 750 66 99 www.bellavista-ventilator.com
MADE IN
SWITZERLAND
LAMPIRAN II
PEMBIAYAAN
Tabel 1. Pembiayaan Penggunaan Ventilator
Pembelian alat
Per unit
Biaya pengiriman
Rp
666,270,000.00
Rp
2,730,650.00
Tarif Dokter NICU (dari ventilator)
Per tindakan
Rp
57,715.19
Ganti Oxygen Cell
Per tahun
Rp
2,750,000.00
Maintenance kit
Per tahun
Rp
12,000,000.00
Tarif listrik
Rp/kWH
Rp
Daya alat
Watt
80
Kebutuhan
Jam/hari
15
Penggunaan listrik
kWH/hari
1.2
Bayar listrik
Per hari
Rp
1,811.26
Perkiraan tarif ventilator
Per tindakan
Rp
254,625.85
1,509.38
ANALISIS PERHITUNGAN
Asumsi
1. 1 bulan=30 hari
2. Suku bunga (i) yang digunakan 7.5% (dari link BI suku bunga tanggal 17 Desember 2015).
3. Inflasi per tahun yang digunakan adalah rata-rata inflasi tahun 2015 yaitu 6.38%.
4. Kenaikan tarif dokter, tarif ventilator (mulai 2018) sesuai perhitungan menggunakan
inflasi.
5. Kenaikan biaya perawatan dan biaya tiap tahun sesuai perhitungan menggunakan inflasi.
6. Jumlah pasien setiap tahun diasumsikan pada tabel 2.
7. Pada akhir tahun ke-8 alat rusak kemudian digudangkan.
Formula:
1. Menghitung listrik tahun 2016
Jumlah tarif listrik tahun 2016 = tarif listrik/hari x 30 (hari dalam 1 bulan) x 12 (bulan)
2. Menghitung jumlah tarif listrik setiap tahun
Jumlah tarif tahun depan = jumlah tarif tahun sekarang x (1 + 6.38%)1
n yang digunakan hanya satu (1) karena perhitungan dari satu tahun sebelumnya.
Contoh:
Jumlah tarif listrik tahun 2001 = jumlah tarif listrik tahun 2000 x (1 + 6.38%)1
Jumlah tarif listrik tahun 2002 = jumlah tarif listrik tahun 2001 x (1 + 6.38%)1
Dst.
3. Menghitung jumlah tarif dokter dan jumlah tarif ventilator setiap tahun
Jumlah tarif setiap tahun = tarif per tindakan (di Th 2016) x (1 + 6.38%)1 x jumlah pasien
setiap tahun[Tabel 2]
4. Menghitung Future Worth (saldo) setiap tahun
FW = P x (1 + i )1
FW: Future Worth (saldo masa depan (setiap tahun))
P: uang/saldo tahun sekarang
i: suku bunga (7.5%)
n yang digunakan hanya satu (1) karena perhitungan dari satu tahun sebelumnya.
Contoh:
FW (saldo) tahun 2001 = FW (saldo) tahun 2000 x (1 + 7.5%)1
FW (saldo) tahun 2002 = FW (saldo) tahun 2001 x (1 + 7.5%)1
Dst.
5. Menghitung saldo (rumus pembukuan)
a. Sisa saldo – kredit
b. Sisa saldo + debet
Tabel 2. Jumlah pasien setiap tahun
No.
Tahun
Jumlah Pasien
1.
2016
2160
2.
2017
3.
4.
No.
Tahun
Jumlah Pasien
5.
2020
1806
2160
6.
2021
1967
2018
2301
7.
2022
2203
2019
2045
8.
2023
2184
Tabel 3. Laporan Keuangan Penggunaan Ventilator Tahun 2015-2023
Tahun
KETERANGAN
Pembelian alat
TAHUN 2015
Biaya pengiriman
PENGELUARAN
PEMASUKAN
SALDO
FUTURE WORTH
Rp
Rp
Rp
Rp
666.270.000,00
(666.270.000,00)
2.730.650,00
(669.000.650,00)
Sisa saldo tahun lalu
Biaya listrik
TAHUN 2016
Mengganti Oxygen Cell
Maintenance Kit
Biaya dokter
(719.175.698,75)
(719.827.750,91)
2.750.000,00
(722.577.750,91)
12.000.000,00
(734.577.750,91)
124.664.810,40
(859.242.561,31)
Sisa saldo tahun lalu
TAHUN 2017
Biaya listrik
Mengganti Oxygen Cell
(719.175.698,75)
652.052,16
Pendapatan ventilator
(719.175.698,75)
549.991.836,00
(309.250.725,31)
(332.444.529,71)
(332.444.529,71)
652.052,16
(333.096.581,87)
2.925.450,00
(336.022.031,87)
(332.444.529,71)
Maintenance Kit
Biaya dokter
124.664.810,40
(473.452.442,27)
549.991.836,00
76.539.393,73
Sisa saldo tahun lalu
82.279.848,26
82.279.848,26
Mengganti Oxygen Cell
Maintenance Kit
Biaya dokter
652.052,16
81.627.796,10
3.112.093,71
78.515.702,39
13.580.045,28
64.935.657,11
141.275.461,40
(76.339.804,29)
Pendapatan ventilator
623.274.123,21
546.934.318,92
Sisa saldo tahun lalu
587.954.392,84
587.954.392,84
Biaya listrik
Mengganti Oxygen Cell
TAHUN 2019
(348.787.631,87)
Pendapatan ventilator
Biaya listrik
TAHUN 2018
12.765.600,00
Maintenance Kit
Biaya dokter
652.052,16
587.302.340,68
3.310.645,29
583.991.695,39
14.446.452,17
569.545.243,22
133.568.304,77
435.976.938,45
Pendapatan ventilator
Sisa saldo tahun lalu
Biaya listrik
TAHUN 2020
589.271.960,06
1.025.248.898,50
1.102.142.565,89
1.102.142.565,89
652.052,16
1.101.490.513,73
3.521.864,46
1.097.968.649,27
Maintenance Kit
15.368.135,82
1.082.600.513,46
Biaya dokter
25.483.849,63
957.116.663,83
Mengganti Oxygen Cell
Pendapatan ventilator
553.605.244,53
1.510.721.908,36
82.279.848,26
587.954.392,84
1.102.142.565,89
1.624.026.051,48
Sisa saldo tahun lalu
Biaya listrik
Mengganti Oxygen Cell
TAHUN 2021
Maintenance Kit
Biaya dokter
1.624.026.051,48
652.052,16
1.623.373.999,32
3.746.559,41
1.619.627.439,91
16.348.622,88
1.603.278.817,03
145.389.965,52
1.457.888.851,51
Pendapatan ventilator
Sisa saldo tahun lalu
Biaya listrik
Mengganti Oxygen Cell
TAHUN 2022
Maintenance Kit
Biaya dokter
Mengganti Oxygen Cell
Maintenance Kit
Biaya dokter
2.099.315.199,63
2.256.763.839,60
2.256.763.839,60
2.256.111.787,44
3.985.589,90
2.252.126.197,54
17.391.665,02
2.234.734.532,52
173.222.601,55
2.061.511.930,97
Sisa saldo tahun lalu
TAHUN 2023
641.426.348,12
652.052,16
Pendapatan ventilator
Biaya listrik
1.624.026.051,48
764.217.395,09
2.825.729.326,05
3.037.659.025,51
3.037.659.025,51
652.052,16
3.037.006.973,35
4.239.870,54
3.032.767.102,81
18.501.253,25
3.014.265.849,56
182.684.911,71
2.831.580.937,85
Pendapatan ventilator
805.962.883,04
3.637.543.820,88
AKHIR
TAHUN 2023
Alat rusak (digudangkan)
Saldo akhir
3.637.543.820,88
2.256.763.839,60
3.037.659.025,51
Tabel 4. Pembiayaan alat
Harga pembelian
Biaya Operasional
Pendapatan
1
2
3
4
5
6
7
8
1
2
3
4
5
6
7
8
Useful life
Salvage value (Asumsi:
digudangkan)
Ventilator Neonatal Bellavista 1000
Rp
669.000.650,00
Rp
140.066.862,56
Rp
141.007.912,56
Rp
158.619.652,55
Rp
151.977.454,39
Rp
145.025.902,06
Rp
166.137.199,98
Rp
195.251.908,63
Rp
206.078.087,66
Rp
549.991.836,00
Rp
549.991.836,00
Rp
623.274.123,21
Rp
589.271.960,06
Rp
553.605.244,53
Rp
641.426.348,12
Rp
764.217.395,09
Rp
805.962.883,04
8 tahun
Rp
KEUNTUNGAN
Formula:
1. PW = PW Benefit – PW Cost – P
P Benefit = F Benefit / (1 + i)n
P Cost = F Cost / (1 + i)n
PW Benefit = ∑ P Benefit
PW Cost = ∑ P Cost
2. FW = PW x (1 + i)n
Diketahui:
Periode analisis= 8 tahun
Suku bunga= 7.5%
-
Tabel 5. Keuntungan
Merk Alat
Periode (n)
Bellavista 1000
Total
(1 + 0.075)n
Costs
Benefits
1 1.075
Rp 130,294,755.87
Rp 511,620,312.56
2 1.155625
Rp 122,018,745.32
Rp 475,925,872.15
3 1.242296875
Rp 127,682,565.85
Rp 501,711,093.18
4 1.335469141
Rp 113,800,798.36
Rp 441,247,155.87
5 1.435629326
Rp 101,019,044.00
Rp 385,618,511.99
6 1.543301526
Rp 107,650,512.37
Rp 415,619,590.51
7 1.65904914
Rp 117,689,044.84
Rp 460,635,780.24
8 1.783477826
Rp 115,548,444.01
Rp 451,905,188.55
Rp 936,563,817.53
Rp 3,644,283,505.05
P
Rp 669,000,650.00
PW
Rp 2,039,578,944.44
FW
Rp 3,637,543,820.88
PAYBACK PERIOD
Tabel 6. Payback Period
Nama Alat
Bellavista 1000
Formula
Tahun 1
– P + (Benefit – Cost) th 1
Rp
(259,075,676.56)
Tahun 2
Saldo balik modal 1 + (Benefit – Cost) th 2
Rp
149,908,246.88
Payback Period
DEPRESIASI
Formula
1. Straight Line (SL)
dt 
Saldo balik modal
BS
N
2. Sum of Years Digits
1 - (saldo balik modal 1/ (benefit-cost) tahun 2) = 1.63 Tahun
3. Unit of Production
Depreciati on per unit 
BS
Total number of unit
Tabel 7. Depresiasi Alat
Nama Alat
Bellavista 1000
Tahun (N)
SL
SOYD
UP
0
Rp 666,270,000.00
Rp 666,270,000.00
Rp 666,270,000.00
1
Rp 599,643,000.00
Rp 545,130,000.00
Rp 580,739,083.56
2
Rp 533,016,000.00
Rp 436,104,000.00
Rp 495,208,167.12
3
Rp 466,389,000.00
Rp 339,192,000.00
Rp 404,093,982.53
4
Rp 399,762,000.00
Rp 254,394,000.00
Rp 323,116,795.44
5
Rp 333,135,000.00
Rp 181,710,000.00
Rp 251,603,445.86
6
Rp 266,508,000.00
Rp 121,140,000.00
Rp 173,714,875.19
7
Rp 199,881,000.00
Rp 72,684,000.00
Rp 86,481,259.95
8
Rp 133,254,000.00
Rp 36,342,000.00
Rp
-
9
Rp 66,627,000.00
Rp 12,114,000.00
Rp
-
10
Rp
Rp
Rp
-
-
-
Rp700,000,000.00
Rp600,000,000.00
Rp500,000,000.00
Rp400,000,000.00
SL
SOYD
Rp300,000,000.00
UP
Rp200,000,000.00
Rp100,000,000.00
Rp0
1
Grafik 1. Laju Depresiasi Alat
2
3
4
5
6
7
8
9
10
LAMPIRAN III
JARINGAN PROYEK
Tabel 8. Jaringan Proyek Alternatif Terpilih
No.
Kegiatan
Jalur
Waktu
Analisis:
1. Menghubungi penyedia barang dan membuat janji
-
2 hari
Perbedaan jaringan proyek pada proposal
2. Menemui penyedia barang dan order
1
1 jam
dengan laporan yaitu, jenis kegiatan yang lebih
3. Menjalin kerja sama di atas materai
2
20 menit
sedikit dan waktu yang lebih singkat. Karena
4. Pembayaran
2
5 menit
analisis periode yang digunakan hanya 8 tahun
5. Menunggu barang
3, 4
3 minggu
(alat rusak).
6. Barang diterima
5
1 hari
Note:
7. Disimpan di gudang
6
1 hari
Seluruh kegiatan dan perkiraan waktu hanya
8. Instalasi ventilator
7
2 jam
asumsi berdasar materi kuliah dari mata kuliah
9. Laporan barang telah diterima
6
1 hari
lain yang mendukung.
10. Membuat SOP dan jadwal pemeliharaan
6
4 hari
11. Terima faktur dari penyedia alat
6
10 menit
12. Alat dioperasikan
8, 9, 10, 11
8 tahun
Gambar 1. Jaringan Proyek Alternatif Terpilih
Gambar 2. Jalur Kritis Alternatif Terpilih
LAMPIRAN IV
805.962.883,04
764.217.395,09
641.426.348,12
Analisis hasil:
Pada proposal tarif dokter memasang tarif seharga Rp.40.000,00
553.605.244,53
589.271.960,06
623.274.123,2
549.991.836,00
549.991.836,00
CASH FLOW
Namun,
pada
perhitungan
kenyataannya
berubah
menjadi
Rp.57,715.19. Perubahan ini mengakibatkan jumlah pendapatan
menjadi berkurang. Kemudian biaya perawatan berupa (ganti
oxygen cell, maintenance kit) mengalami penurunanan tarif
pembiyayaan, sehingga dampaknya pendapatan semakin bertambah.
2
4
5
6
7
8
Pendapatan dari hasil penggunaan tarif ventilator juga mengalami
145.025.902,06
kenaikan
harga,
sehingga
perubahan
ini
akan
mengakibatkan kenaikan pendapatan yang signifikan. Jumlah pasien
menurut proposal mengalami penurunan jumlah pasien, sehingga
pendapatan mengalami penurunan. Kemudian diakhir tahun ke-8
ventilator mengalami kerusakan, sehingga keuntungan tidak sesuai
dengan
Gambar 3. Cash flow Ventilator Neonatal Bellavista 1000
diproposal.
perhitungan,
206.078.087,66
195.251.908,63
166.137.199,98
151.977.454,39
158.619.652,5
669.000.650,00
3
perubahan
141.007.912,5
1
140.066.862,5
0
Pada
kesimpulannya
mendapatkan
Rp.3,644,283,505.05
dari
keuntungan
hasil
akhir
sebesar