ABSTRACT
Calculation Analysis of Unit Cost On Tonsillectomy Service
with Activity Based Costing Method
(Case Study at PKU Muhammadiyah Hospital of Yogyakarta)
Elga Ria Vinensa1, Ietje Nazarudin2, Triyani Maryati 3
Fakultas Kedokteran dan Ilmu Kesehatan
Universitas Muhammadiyah Yogyakarta
Background : Private hospitals should strive to have the technical capability to
manage and calculate costs based on the condition that both hospitals and
facilities that can use the Indonesian Case Based Group (INA CBG) appropriately.
RS PKU Muhammadiyah Yogyakarta as one of the private hospitals that
participate and support the government's program of the Sistem Jaminan Sosial
Nasional. Calculating the unit cost of a tonsillectomy was done as a study of the
correspondence between the cost of services and a health claim
Methods :The study was a descriptive qualitative case study design.
Tonsillectomy unit cost calculation using activity based costing (ABC) with the
goal difference obtained unit costs plus a margin to claim CBG INA in 2012.
Result : Based on the calculation, the unit cost of services tonsillectomy with
activity-based costing method is Rp. 2.265.732. ABC unit cost calculations result
in a greater cost than the claims of INA CBG so get the difference in cost of Rp.
785.034.
Conclusions : There is a negative difference between the calculation of service bi
tonsillectomy ABC method with INA CBG claim. So that needs to be done by the
hospital cost efficiency.
Key Word : Tonsillectomy, INA CBG, Activity Based Costing.
1
INTRODUCTION
Health care costs will increase continuously. Hospital as a health care
provider has the burden to be able to provide quality health services and for the
community fair. This encourages all elements of both the hospital and
stakeholders (providers or government ) to calculate exactly how much it costs
needed services .
There are two major forces in determining the cost of health care: 1.
related groups based on similarity of case ( cased -based groups ) and related
capitation and 2. opening of competitive pressures within the industry has
increased
the
major
structural
changes
become
manage
care1.
The Birth of Law of Undang Undang Sistem Jaminan Sosial Nasional (UU SJSN)
Nomor 40 Tahun 2004 sourced fromUndang Undang Dasar (UUD) 1945 showed
that
the government's plan to establish the national health insurance for all
indonesian citizens . The security system will come into force in 2014 . As per
Law Undang Undang Nomor 24 Tahun 2011 the program will be held by Badan
Penyelenggara Jaminan Sosial ( BPJS ) which represents the union of some of the
Badan Umum Milik Negara (BUMN)were appointed, namely:PT. Jamsostek, PT.
Askes, PT. Taspen, dan PT. Asabri2.
Health insurance refers to the quality control and cost control by applying
the principles of managed care is to enable the efficient financing with guaranteed
quality remains appropriate medical indication.Control financing is one of the
effective and efficient by using a pattern that is capitation and prospective
payment Indonesian Case Based Groups (INA CBG)3.
Analysis of the cost per unit ( unit cost) can be used to measure hospital
performance as the basis for preparing the budget, subsidies, and financing
negotiation tools to stakeholders. Calculation of unit cost by activity based costing
( ABC ) can accurately measure the cost out of each activity. This is because the
number of cost drivers used in imposition of overhead costs in order to improve
the accuracy and precision of the cost breakdown charging more accurate4.
2
Tonsillectomy is not free of morbidity and mortality that is necessary to
realize that the action is the same as the other surgery and should be done
optimally 5. In the United States classified tonsillectomy surgery because of fears
of major complications, whereas in Indonesia tonsillectomy surgery is classified
as being due to the short duration and not difficult enough 5,6.
Tonsillectomy is the case for most surgical services in the field of Telinga
Hidung dan Tenggoro (ENT) are handled by the hospital. Tonsillectomy is a
servant of action which ranks 15th on the amount of service equal to 67 actions in
2012 at the Hospital of the PKU Muhammadiyah Yogyakarta. PKU
Muhammadiyah Hospital is a private hospital in Yogyakarta that support the
Social Security program in the field of health. PKU Muhammadiyah Hospital
located at Jln. KHA Ahmad Dahlan Yogyakarta with 12 service areas of type B.
CBG INA package rates are applicable also regulate the rates of
tonsillectomy action. Rates INA act of CBG for tonsillectomy is Rp. 1.699.571
while the cost of real rates of tonsillectomy action at PKU Muhammadiyah
Hospital of Yogyakarta is Rp. 3.275.100, the difference that occurs between CBG
and real cost is Rp. 1.575.529 or by 93 % .
The issue of cost efficiency and important role in the health care process
and actions tonsillectomy procedure above lead researcher sees the need of
research on the calculation of unit cost analysis of the ABC method in
tonsillectomy at PKU Muhammadiyah Hospital of Yogyakarta. From the
background described above, it can be formulated:
1. How much the unit cost of tonsillectomy using the ABC method in RS PKU
Muhammadiyah Yogyakarta?
2. What is the difference between the ABC method of tonsillectomy rates in RS
PKU Muhammadiyah Yogyakarta with INA rates CBG?
3
MATERIALS AND METHODS
Types of Research
The study was conducted using qualitative descriptive method by
conducting case studies at PKU Muhammadiyah Hospital of Yogyakarta.
Calculation of unit costs were calculated using activity based costing (ABC).
Subject and Object Research
Subjects of this study was the Chief Financial Officer, Doctor Specialist of
ENT, Head of Medical Records, Nurse of ENT clinic, administration section,
Laboratory Chief Pharmacist, Head of Radiology, cashier, Physician Anesthesia
Specialist, Head of Surgery Central of Surgical Installation , Laundry to obtain
comprehensive data on the RS PKU Muhammadiyah Yogyakarta.
Object of this study is all activity that occurs when the patient entered the
hospital to go home. Tosilektomi in patients on government health insurance
Jamkesnas with a diagnosis of chronic tonsillitis and tonsillectomy in action
diagnosis of PKU Muhammadiyah Yogyakarta Hospital
Research Variables
The variables of this study is the unit cost and activity in the unit
tonsillectomy in ENT clinic, Arafah, Central of Surgical Installation , Admission.
Research Instruments
1. Studies of document that is to examine the documents that are related to cost
analysis of tonsillectomy actions
2. Interview guide: The interview is one method of data collection by asking
directly or communicate directly with the respondent.
3. Observation guide using clinical pathways by direct observation on the object
of research.
4. Stopwatch to count of length of time of each activity undertaken, ranging from
enrolling patients until the patient home.
4
Stages Of Research
Table 1 Stages of Analysis Research Unit Cost Calculation
Tonsillectomy Action in PKU Muhammadiyah Hospital of Yogyakarta
Name of Activity
June
2013
July
2013
Month
Ags Sep
Okt
2013 2013 2013
Nov
2013
Des
2013
Jan
2014
Administering licensing
Preparation of a research
proposal
Research proposal exam
Implementation research
Calculating and
analyzing data
Exam results of research
Revision
The data collected is secondary data from the financial and medical
records of the period of January to December in 2012. Data collection was
conducted during the months of May to December 2013.
Data Analysis
Analysis of secondary data tonsillectomy action period January to
December 2012 in the RS PKU Muhammadiyah Yogyakarta.
1. Determine the activity centers and cost drivers related to the unit.
2. Direct charge consumed in the act of tonsillectomy.
3. Determining the cost of direct and indirect resource overhead of resource
overhead consumed each time the proportion of activity per ENT Clinic ,
Central Surgical Installation, Arafah.
4. Determine the activity centers associated actions contained in Tonsillectomy
Clinial Pathways.
5. Overhead charge into each activity centers Tonsillectomy Clinical Pathways.
6. Summing the direct and overhead costs are included in Tonsillectomy Clinical
Pathways.
5
7. Compare the unit cost of tonsillectomy rates with ABC method and payment
of INA CBG from government.
RESULTS
Picture of Research Subjects
Based on interviews with a number of parts of the medical record
tonsillectomy action during the year 2012 as many as 67 action. Tonsillectomy
action is divided into three major parts, namely: Actions in ENTClinic, Actions in
Arafah and Actions in Central of Surgical Installation.
Presentation of Data in Action Tonsillectomy
1. Determine the activity centers on the each unit and cost drivers of each cost
category
2. Direct charge consumed in the act of tonsillectomy
Table 2 Direct Costs Tonsilekomi PKU Muhammadiyah Yogyakarta in 2012
Kategori Biaya
ENT Clinic
Registration
Spesialist of ENT consultation
Central of Surgical Installation
Spesialist of ENT Actions
Spesialist of Anesthesia Actions
Instruments
Instruments Sterilisation
Laundry
Medicine and Consumable Thing
Braunol Sol
Kasa Lipat 5 X 7 X 16ply
Handscoend St 6,5 Gamex
Handscoend St 7,5 Gamex
Catgut Pln 1 Resorba
Aquadest Opls 25cc
Satuan
Jumlah
Satuan(b)
Biaya
Satuan(c)
(Rp)
12.500
27.500
Jumlah(a)
(Rp)
Activity
Activity
1
1
12.500
27.500
Activity
Activity
Count
Count
Kg
1
1
1
1
6.3
300.000
120.000
87.190
108.000
5.000
300.000
120.000
87.190
108.000
31.500
Cc
Pcs
Pcs
Pcs
M
Flb
50
24
1
2
2
2
110
673
14.880
14.880
13.960
2.200
5.520
16.160
14.880
29.760
27.920
4.400
6
Spuit Terumo 2,5 Cc
Spuit Terumo 5 Cc
Ringer Lactate 500ml
Ondansetron 4mg/2ml Inj
Ett Non Kingking 7 Rusch
0.3
Fentanyl 0,05mg/Ml/2ml
Ketorolac 30mg Inj
Recofol 20mg/Ml 0.65
Atracurium Hammeln
2,5mg/5ml
Tramadol Inj
Forane 250 Ml
N2o 25 Kg
O2 Kap 6
Cefotaxime 1 G
Ketorolac 30mg Inj
Aquadest Opls 25cc# 2Flb
Pcs
Pcs
Flb
Ampul
1
1
1
1
2.960
3.520
9.520
7.760
2.960
3.520
9.520
7.760
Pcs
Ampul
Vial
Vial
1
1
1
1
72.960
32.400
26.800
63.680
72.960
32.400
26.800
63.680
Vial
Ampul
Cc
Cc
Cc
Ampul
Vial
Flb
1
1
1
200
200
4
5
2
75.920
6.480
144.000
97
11
7.700
13.376
2.200
75.920
6.480
144.000
19.360
2.160
30.800
66.880
4.400
count
visite
visite
Eat
Kg
Activity
1
2
2
2
2
1
12.500
35.000
35.000
25.200
5.000
58.500
12.500
70.000
70.000
50.400
10.000
58.500
Activity
Activity
Activity
Activity
Activity
Activity
1
1
1
1
1
1
44.000
45.600
45.600
14.400
40.000
64.000
44,000
45.600
45.600
14.400
40.000
64.000
Ringer Lactate 500ml
Flb
3
9.493
Cefixime Tab 100mg
Tab
10
2.880
Tramadol Cap 50mg
Tab
10
336
Total
Information: a=bxc, a= total cost, b= unit, c= unit price
28.480
28.800
3.360
1.934.070
Arafah
Materai
Spesiailist of ENT Visite
Spesialist of Anesthesia Visite
Nutritions
Laundry
Administration of Arafah
Supporting
Blood test
Ppt
Aptt
Strip Glucose
Hbsag (Rapid) Test
Thorax Examanation
Medicine
source: RS PKU Muhammadiyah Yogyakarta In 2012
7
1. Determining the cost of direct and indirect resource overhead consumed
resource overhead per each time the ENTClinic, Central of Surgical
Installation, and Arafah.
2. Determine the activity centers of tonsillectomy actions contained in clinial
pathways and overhead charge into each activity centers in clinical pathway
Table 3 Indirect Resource Overhead Cost Of Activity
in Tonsilectomi Service at ENT Clinic
Activity at ENT Clinic
Total
Trasaction(a)
Cost
Driver
Time
(Minute)
Indirect
Resource
OverheadCost
Per Activity
Unit
Total
Cost(b) Cost (c)
650
650
1.084
1.084
Patient acceptance
1
3
Vital sign examinations
1
5
Anamnesis, physical examination,
diagnosis, medical explanation,
doctor instructions
1
30
6.504
Doctor prescription
1
5
1.084
Charging administration hospitalized
patients who will be
1
15
3.252
Consultations to other part spesialist
1
15
3.252
Escort patient undergoing inpatient
1
20
4.336
Total Overhead Cost
Informations : c=a*b, a= Total transaction, b= unit cost, c= Tota cost
6.504
1.084
3.252
3.252
4.336
20.162
Table 4Direct Resource Overhead Cost of Activity in Tonsillektomy at ENT
Clinic
Activity in ENT Clinic
Patient acceptance
Vital sign examination
Anamnesis, physica Examination,
diagnosis, medical explanation,
Doctor Instruction
Total
Cost
Tran
Driver
saction(a)
1
1
3
5
1
30
Direct Resource
Overhead Cost Per
Activity
Unit
Total
(b)
Cost
Cost(c)
127
127
212
212
1.273
1.273
8
Doctor Prescription
1
5
212
Charging Administration
Hospitalized patient who will be
1
15
637
Consultation to the other spesialist
1
15
637
Escort patient undergoing inpatient
1
20
849
Total overhead cost
Information : c=a*b, a= Totaltransactions, b= unit cost, c= total cost
T
212
637
637
849
3.947
Table 5Indirect Resource OverheadCost Activity
in Tonsellectomy Service at Arafah
Activity at Arafah
Preparation room
Patient Acceptance
Handover medica record
Room orientation
Mounting identity bracelet
Vital sign examination
Assesment of patient history of pain
score, risk of fall, and allergy
Intra vena line
Filling medical record (nursing
care)
Pre operation preparation
Preparation and administration of
drugs
Bleeding observation
Wound care
Fluid Balance
Assesment of gastrointestinal
function
Personal hygiene
Remove the identity bracelet and
intravena line
Return the excess drug to the
pharmaceutical
Preraration of patient to go home
Providing cover letter
administrative settlement
Total
Tran
saction(a)
1
1
1
1
1
5
Indirect Resource Overhead
Cost Per Activity
Cost
Unit
Total(c)
Driver Cost (b)
15
6.426
6.426
5
2.142
2.142
3
1.285
1.285
15
6.426
6.426
5
2.142
2.142
5
2.142
10.710
5
1
15
15
6.426
6.426
32.130
6.426
5
1
5
20
2.142
8.568
10.710
8.568
3
3
3
4
15
5
15
5
6.426
2.142
6.426
2.142
19.278
6.426
19.278
8.568
3
5
5
20
2.142
8.568
6.426
42.839
1
5
2.142
2.142
1
1
15
10
6.426
4.284
6.426
4.284
1
5
2.142
2.142
9
Delivering patient
1
15
6.426
6.426
221.908
Total
Informations: c=a*b, a= Total Transactions, b= unit cost, c= total cost
Tabel 6 Direct Resource OverheadCost Of Activity
in Tonsilectomi Service at Arafah
Activity Arafah
Preparation room
Patient acceptance
Handover of medial record
Room orientation
Mounting identity bracelet
Vital sign examination
Assessment of patient history of
allergy, risk of fall, pain score
Intra vena line
Medical Record filling (nursing
care)
Pre operation preparation
Preparation and administration of
drug
Bleeding observation
Wound care
Fluid balance observation
Assesment of gastrointestinal
fungtions
Preparation of medical drugs
Personal hygiene
Remove the identity bracelet
Return the excess drug to the
pharmaceutical
Preraration of patient to go home
Providing cover letter
administrative settlement
Delivering patient
Total
Total
Transactiona)
1
1
1
1
1
5
Direct Resource
OverheadCost Peraktivity
Second
Unit
Sage
Total(c)
Cost(b)
Cost
(Rp)
(Rp)
Driver
15
634
634
5
211
211
3
127
127
15
634
634
5
211
211
5
211
1.056
5
1
15
15
634
634
3.168
634
5
1
5
20
211
845
1.056
845
3
3
3
4
15
5
15
5
634
211
634
211
1.901
634
1.901
845
5
5
1
1
20
5
5
10
845
211
211
422
4.224
1.056
211
422
1
1
5
15
211
634
211
634
1
1
3
10
194
581
194
581
22.654
10
Informations: c=a*b, a= Total Transactions, b= unit cost, c= total cost
Table 7Indirect Resource Overhead Cost Of Activity
in Tonsilectomi Service at Central of Surgical Installation
ActivityCentral of Surgical
Installation
Total
Transaction(a
)
Indirect Resource
Overhead Cost Per activity
Cost
Unit
Total (c)
Driver
Cost (b)
5
1.004
1.004
5
1.004
1.004
5
1.004
1.004
3
602
602
Patient identification
1
Medical record handover
1
Checks surgery tools and materials
1
Pre operation check
1
Checks anesthesia equipment and
materials
1
15
3.011
3.011
Do time in,durante, time out
1
15
3.011
3.011
Implement anesthetic by a specialist
anesthetist
1
15
3.011
3.011
Carry out operations
1
30
6.022
6.022
Write operation report
1
5
1.004
1.004
Writing instruction postoperative
1
5
1.004
1.004
Monitoring patients after surgery
1
30
6.022
6.022
Decision permission to get out of
recovery room by anesthesia
specialists
1
5
1.004
1.004
To call into the inpatient room to pick
up patient
1
2
401
401
Medical record handover
1
5
1004
1004
29.106
Total
Informations: c=a*b, a= Total Transactions, b= unit cost, c= total cost
Table 8 Direct Resource Overhead Cost Of Activity
in Tonsilectomi Service at Central of Surgical Installation
ActivityCentral of Surgical
Installation
Patient identification
Medical record handover
Checks surgery tools and materials
Jumah
Transaksi(a)
1
1
1
Direct Resource Overhead
Cost Per activity
Cost
Unit
Total(c)
Driver
Cost(b)
5
1.168
1.168
5
1.168
1.168
5
1.168
1.168
11
Pre operation check
1
3
701
701
Checks anesthesia equipment and
materials
1
15
3.505
3.505
Do time in,durante, time out
1
15
3.505
3.505
Implement anesthetic by a specialist
anesthetist
1
15
3.505
3.505
Carry out operations
1
30
7.011
7.011
Write operation report
1
5
1.168
1.168
Writing instruction postoperative
1
5
1.168
1.168
Monitoring patients after surgery
1
30
7.011
7.011
Decision permission to get out of
recovery room by anesthesia
specialists
1
5
1.168
1.168
To call into the inpatient room to
pick up patient
1
2
467
467
Medical record handover
1
5
1.168
1.168
33.885
Total
Informations: c=a*b, a= Total Transactions, b= unit cost, c= total cost
3. Summing the direct and overhead costs are included in clinical pathway
Table9 Unit Cost of Tonsillectomy Service on 2012
Kind of Cost
Cost (Rp)
Direct Cost
1.934.070
Indirect
Direct
Overhead Cost
Resource
Resource
Overhead
Overhead
3.947
Overheadcost at ENT Clinic
20.162
Overhead cost at Arafah
221.908
22.654
33.885
Overheadcost at Central of Surgical Installation
29.106
2.265.732
Total cost
DISCUSSION
1.
Expanses in the calculation of the unit cost of tonsillectomy service
From above calculations to obtain unit cost of tonsillectomy with ABC
Methot is Rp. 2.265.732. Tonsellectomy cost consist of :
12
a. Direct Cost in Unit Cost ofTonsillektomy service
Direct cost in unit cost of tonsillectomy service is Rp. 1.934.070
or 85 % total tonsillectomy cost .Cost of medicine and consumable thing
Rp. 686.804 (36% of total direct cost), the cost of medica service specialist
is Rp 767.500 (40% of total direct cost), the cost of other facilities is Rp.
479.766 (24% of total direct cost).
The cost of drugs and the cost of consumable materials are the
biggest cost in tonsillectomy services, yet when traced the use of drugs
and consumables materials are in accordance with formulary Jamkesnas
that the use of generic drugs. In this case can not be done to more
efficiency because drug should right dose, right time, right quantity.
Physicians in providing medication compliance in accordance with
formulary Jamkesnas influence on the quality and cost-efficiency
measures in the hospital 7.
Salary of ENT specialist and anesthetist also consume a
considerable cost burden that medical services in outpatient, like
otolaryngology consultation, preoperative visite, visite post surgery,
tonsillectomy surgery and anesthesia procedures inCentral of Surgical
Installation. Hospitals only provide physician salary for Jamkesmas
service by 50% of patients other general medical services. So it can not be
done in terms of the magnitude of the efficiency of medical services.
b. Overhead costs in the calculation of unit cost of tonsillectomy service.
The overhead on tonsillectomy service is Rp. 331.662 or 15% of total
costs of tonsillectomy service . The costs are divided into, the overhead
tonsillectomy at ENT Clinic is Rp. 24.109 or 1%, at Arafah is Rp. 144
562 or by 11%, and at Central of Surgical Installation is Rp. 62.991 or 3%
of the total cost of tonsillectomy.
Overhead costs for each unit is divided into indirect and direct
resource overhead. At the ENT clinic unit of indirect resource overhead
13
costs in the amount of Rp. 20.162 greater than the direct resourceoverhead
that is Rp. 3.947. In Arafah, indirect resource overhead costs in the
amount of Rp. 221. 908 greater than the direct resource overhead that is
Rp. 22.654. In Central of Surgical Installation unit of indirect resource
overhead costs in the amount of Rp. 29.106 is smaller than the direct
resource overhead that is Rp. 33.885. The small overhead costs than direct
costs on consumption due to depreciation expense tonsillectomy medical
devices, non-medical, and buildings which are already depleted in
economic value.
Direct resource overhead costs in tonsillectomy service greater than
indirect overhead costs, mean that are non functional unit consume
expanse more. Costs of indirect resource overhead to maintance non
functional, they are directors, training, support, procurement, security, etc.
The consumption cost in nonfunctional caused by a number of
nonfunctional employees is equal to 264 employees of 581 employees or
45% of total employees in PKU Muhammadiyah Hospital of Yogyakarta.
The cost of direct overhead resources consumed largely reflect the
employee directly in contact with patients such as nurses. In calculating
the unit cost of the direct costs of resource overhead is smaller than the
indirect resource overhead in the ENT clinic and Arafah. If traced further
then the number of nurses compared to the number of beds has been 1:1,
with details of the number of nurses is 215 and number of beds is 207.
This is in accordance with government regulations is the ratio of nurses
and hospital beds for type B is 1:18.
2. Tonsillectomy service prices with the ABC method and price INA CBG
The results of the calculation of unit cost measures tonsillectomy using the
ABC is Rp. 2.265.732 and from the rate calculation ( unit cost + margin ) use
management policy with a profit of approximately 10 % was Rp. 2.484.605 .
14
While claims of Jamkesmas is Rp . 1.699.571 in 2012 . In 2014 Jamkesnas
claim to tonsillectomy service is Rp . 2.301.4639 .
Unit cost of tonsillectomy service with the ABC method is Rp. 2.265.732
with direct costs in the amount of
Rp. 1.934.070 and overhead of Rp.
331.662. While the rate INA Claims CBG is Rp. 1.699.571 which means only
able to finance the operational costs ( direct costs ), while the overhead
expenses of Rp . 331.662 is very small due to the cost of building and medical
and non-medical equipment has run out, which means that the economic value
of its large CBG INA rates can not be used for investment in private hospitals
In the calculation of cost are not all originators cost margin of 10% , it is
a kind of stamp duty and registration . Stamp duty and registration does not
calculate a margin at all.
Table 10 Comparison Between Rate Method of Activity Based Costing
(ABC) + gain with ± 10% and INA CBG Real Cost Claims
Cost Type
ENTClinic
Indirect Resource Overhead
Direct Resource Overhead
Direct Cost
Registration
Medical salary
Stamp duty
Central of Surgical Installation
Indirect Resource Overhead
Indirect Resource Overhead
Direct Cost
Drugs and Consumables Thing
Tonsillectomy payment
Salaries of doctors for surgery
Tonsillectomy
salaries of doctors for
anesthesia
Laundry
Unit Cost ABC
± Margin 10%
Real
Cost
INA CBG
22.178
4.342
-
-
12.500
30.250
6.000
12.500
55.000
6.000
-
32.017
37.274
-
-
735.064
35.300
- 1.560.000
-
330.000
-
-
132.000
-
-
34.650
-
-
15
sterilization of instruments
Equipment
Arafah
Indirect resource overhead
Indirect resource overhead
Direct cost
Arafah price
Administrative inpatient
Drugs ang consumable thing
ENT Spesialist salary for visite
Anesthesia Spesialist salary for
visite
Laundry
Nutritions (food and snack)
Supportings
Routine blood checks
Ppt
Aptt
Glucose checks strip
Hbsag (Rapid) Test
Thorax x ray
Total cost
118.800
95.909
-
-
244.099
24.919
-
-
58.500
66.704
77.000
75.000
58.500
75.800
140.000
-
77.000
140.000
-
11.000
55.440
-
-
48.400
55.000
50.160
57.000
50.160
57.000
15.840
18.000
44.000
50.000
70.400
80.000
2.484.605 3.275.100
1.699.571
Table 11 Differences Between ABC Unit Cost + Margin ± 10% with cost INA
CBG (Jamkesnas) Tonsilektom Claims In 2012
INA CBG Claim
Differences Differences
(Jamkesmas)
(Rupiah)(c)
(%)(d)
(Rupiah)(b)
2.484.605
1.699.571
785.034
32%
information: c=a-b, d=c:a*100%, a= unit cost abc± 10%, b= jamkesmas claim c=
differences in rupiah , d= differences in percentage
Unit Cost ABC± 10%
(Rupiah)(a)
It is also in accordance with previous studies conducted. Based on the
results of research on the suitability of the cost of medical operative action
Mohammad Hussein Hospital in Palembang isn’t appropriate with INA CBG
claim (Jamkesmas claim). it is concluded that the cost of medical action
operative measures undertaken in Mohammad Hussein Hospital Palembang
98.6% do not fit and greater than the rate INA DRG10.
16
Difference that arises between the unit cost is calculated by using the
method of activity based costing (ABC) with the amount of claims due
Jamkesnas calculation method used is not the same. The amount of claims
fare price Jamkesnas given by the government obtained from the calculation
of some hospitals according to hospital type, Calculation of Jamkesmas claim
is influenced by factors such as BOR, hospital base rate, extreme tariffs,
adjusting the level of severity, type B Hospital Education and non-education,
and regionalization region 11.
Determination of
cost of health measures such as hospitals are
complex. This is due to the number of variables or factors that need to be
considered so difficult to find a practical formula to calculate it, even to some
extent, the tariff determination hospitals also use the "trial and error" 11. How
many actions that has only a minimal profit or even not have a profit in
hospital , but because of the actions at the hospital is very complex and the
products are sold diverse services so that hospitals always apply a system of
cross-subsidies to cover some kind of action is minimal profits, such as for
example is the action tonsillectomy operations that keep the hospital running.
Under these conditions, it is necessary to efficiency costs. Efficiency in
economics is used to refer to a number of concepts related to usability and
maximizing the utilization of all resources in the production process of goods
and services. Under these conditions, the RS PKU Muhammadiyah need to
know what the cost structure is not efficiency so as to reduce their costs.
Badan Penyelenggara Jaminan Sosial (BPJS) membership maps
illustrate the framework that the new 2014 will be the start of diversion
participants Jamkesmas, Jamsostek, Askes PNS. Askes Sosial, Jaminan TNI
dan POLRI into SJSN where 148.2 million participants have secured a range
of insurance and 90.4 million have not been guaranteed by any insurance.
257.5 million in 2019 as many participants (all of Indonesia's population) will
be managed by BPJS kesehatan2. To face BPJS, hospital must be readiness to
manage the action as possible if they do not want to defisit.
17
Implementation of the national security system in private hospitals,
especially RS PKU Muhammadiyah Yogyakarta is not run expected because
of differences between the private and government management cost. The
presence incongruity between the unit cost of PKU Muhammadiyah Hospital
and INA CBG cost to Tonsillectomy Rp. 706 866 (31%) requiring hospitals
to re-evaluate the waiter tonsillectomy. The evaluation is based on clinical
pathways in order to be able to clearly see the non-value added so as to reduce
costs.
CONCLUSION
Unit cost tonsillectomy service at RS PKU Muhammadiyah Yogyakarta by
using activitybased costing method is Rp. 2265732
Value unit cost calculated by the method of activity based costing RSU PKU
Muhammadiyah Yogyakarta plus a margin (profit 10%) smaller than the cost of
INA CBG claim (Jamkesmas) for tonsillectomy service. The difference is Rp.
785 034 (32%).
18
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19