Tarif pelayanan persalinan di Puskesmas Cimanggis Kota Depok yang berlaku saat ini adalah Rp. 75.000,0. Tarif ini sudah tidak sesuai lagi dengan kebutuhan operasional kamar bersalin di Puskesmas di mana Puskesmas harus melaksanakan tugas dan fungsinya sebagai tempat pertolongan persalinan yang bermutu dengan tidak hanya selalu bergantung kepada subsidi Pemerintah.Dengan penyesuaian tarif diharapkan terwujud maksimalisasi pelayanan, karena tarif yang sesuai dengan kemampuan membayar masyarakat akan meningkatkan utilisasi. Penyesuaian tarif dilakukan melalui analisa tarif yang berdasarkan biaya satuan pelayanan persalinan ,tingkat pengembalian biaya, tingkat kemampuan (ability to pay ATP) dan kebijakan tarif dan tarif pesaing yang setara.Penelitian ini merupakan studi kasus yang dilakukan di unit kamar bersalin Puskesmas Cimanggis Kota Depok, yaitu menganalisa biaya dengan menggunakan data tahun 2000 dan menggunakan metode double distribution. Adapun untuk menilai tingkat kemampuan dan kemauan masyarakat membayar yaitu dengan mengolah data hasil survei terhadap masyarakat Kabupaten Bogor. Kemampuan masyarakat menurut ATP adalah : 92 % masyarakat mampu membayar Rp 72.000,0 ; 72% masyarakat mampu membayar Rp 270.000,0.; 50% masyarakat mampu membayar Rp.504.000,00.Dari hasil analisa biaya kamar bersalin, didapatkan biaya satuan aktual Rp.585.593,00 dan biaya satuan normative Rp.524.626,00 Tarif pertolongan persalinan yang akan disarankan adalah Rp. 270.000,0. Saran perubahan tarif tersebut disambut baik oleh kepala Dinas Kesehatan Kota Depok serta Kepala Puskesmas Cimanggis, selanjutnya akan diusulkan ke Pemda untuk diproses lebih lanjut.Daftar Pustaka : 21 (1996 - 2001)

A Case Study of Birth Delivery Rational Price Analysis at Puskesmas Cimanggis, City of Depok, 2002The current price of delivery service at Puskesmas Cimanggis City of Depok is Rp75.000,-. Considering the tasks and functions of Puskesmas as quality delivery service place that does not depend on government's support, the current price is not suitable with operational need of birth delivery room in Puskesmas. It is expected that price adjustment would maximize the service, because the appropriate price that is in line with people's ability to pay would increase utilization.The price adjustment was conducted through price analysis based on the unit cost of birth delivery service, cost recovery rate, ability to pay (ATP), price policy, and competitor's price. This study is a study case that was conducted in Birth Delivery Room Unit at Puskesmas Cimanggis City of Depok by analyzing the cost using double distribution method. The assessment of the ability to pay and the willingness to pay of the people in the District of Bogor was conducted by processing data from the survey result. The ability to pay according to ATP1 was 92% of people were able to pay as much as Rp72.000, 00; 72% of people were able to pay as much as Rp270.000,00 and 50% of people were able to pay as much as Rp504.000,00.Based on the cost analysis of birth delivery room of this study, the actual unit cost was Rp585.593, 00 and normative unit cost was Rp524.626,00. Nevertheless, the recommended price of birth delivery service is Rp270.000, 00. The recommendation of the price change is accepted by the Head of District Health Office as well as the Head of Puskesmas Cimanggis. Furthermore, the next step would be proposing this pricing to the Local Government.References: 21 (1996 - 2001)

Tingkat pemulihan biaya pada unit-unit produksi di RSUD sangat bervariasi yang dipengaruhi oleh masing masing tingkat pendapatannya. Diharapkan konsep subsidi silang dapat berjalan guna pemerataan pelayanan kesehatan.Penelitian ini merupakan penelitian kasus yang dilakukan di 2 RSUD di Propinsi Jawa Tengah (RSUD Sragen dan RSUD Wonogiri). Pengumpulan data dilakukan dengan melihat data yang sudah ada hasil dari penelitian penulis pada tahun 2000, dan untuk data keuangan tahun 2001 menggunakan penyesuaian (adjustment) dengan indeks harga konsumen dari data biaya tahun 2000. Perhitungan biaya dilakukan dengan dengan 2 Cara yaitu secara full cost maupun secara direct cost.Hasil penelitian menunjukkan bahwa pendapatan unit produksi yang tertinggi di RSUD Sragen pada tahun 2000 adalah rawat inap dan terendah elektro diagnostik, sedangkan tahun 2001 pendapatan tertinggi rawat inap dan terendah radiologi. Pada RSUD Wonogiri pada tahun 2000 pendapatan tertinggi rawat inap dan terendah diagnostik, untuk tahun 2001 pendapatan tertinggi juga rawat inap dan terendah kamar operasi (OK).Biaya total unit produksi pada tahun 2000 berdasarkan perhitungan full cost di RSUD Sragen tertinggi rawat inap dan terendah adalah fisioterapi, untuk tahun 2001 biaya total unit produksi tertinggi juga rawat inap dan terendah fisioterapi.Sedangkan biaya total unit produksi tahun 2000 di RSUD Wonogiri yang tertinggi adalah rawat inap dan terendah adalah tindakan diagnotik, tahun 2001 tertinggi rawat inap dan terendah diagnostik Jika perhitungan berdasarkan direct cost, biaya total unit produksi tahun 2000 di RSUD Wonogiri tertinggi rawat inap dan terendah elektro diagnostik, tahun 2001 tertinggi rawat inap dan terendah elektro diagnostik. RSUD Wonogiri tahun 2000 tertinggi rawat inap dan terendah diagnostik, tahun 2001 tertinggi juga rawat inap terendah diagnostik CRR RSUD Sragen tahun 2000 dan 2001 dihitung secara full cost, hanya satu unit produksi yang CRR > 100%, CRR hasil retribusi RSUD Sragen sebesar 35.54% dan 27.81% jika dihitung direct cost ada lima unit produksi yang CRR > 100%, CRR hasil retribusi RSUD Sragen sebesar 70.75% dan 54.31%. CRR RSUD Wonogiri tahun 2000 dan 2001 dihitung secara full cost, ada dua unit produksi yang CRR > 100%, CRR hasil retribusi RSUD Wonogiri sebesar 35.27% dan 29.95% jika dihitung direct cost ada di unit produksi yang CRR > 100%, CRR hasil retribusi RSUD Wonogiri sebesar 56.98% dan 47.09%.Dan perhitungan SHU unit produksi tahun 2000 dan 2001 dihitung secara full cost pads RSUD Sragen dan RSUD Wonogiri, hampir tidak ada unit produksi mempunyai SHU positif sehingga tidak terjadi subsidi silang. Jika dihitung secara direct cost ada beberapa unit produksi yang mempunyai SHU positif, jadi masih terjadi subsidi silang antar unit produksi. Namun SHU total dari hasil retribusi di kedua RSUD tersebut masih teriihat negatif.Terlihat adanya perbedaan besaran subsidi silang antara kedua RSUD pada tahun 2000 dan 2001, dimana unit produksi yang CRR >100% (SHU positif) berbeda antara RSUD Sragen dan RSUD Wonogiri. RSUD Sragen sebagian besar (5 unit produksi) yang mempunyai SHU positif, sedangkan di RSUD Wonogiri ada 2 unit produksi yang mempunyai SHU positif yaitu unit produksi laboratorium dan radiologi.

Analysis Of Cross-Subsidy for Production Unit at Sragen District Hospital and Wonogiri District Hospital, 2000-2001Cost Recovery Rate (CRR) for production unit at District Hospital are various influenced by each income level to expect establishing cross-subsidy concept for equity of health care service.This case research performed at 2 District Hospital in Central Java Province (Sragen District Hospital and Wonogiri District Hospital). The data is collected by observing available research result of writer in 2000 and the financial data collection 2001 by applies adjustment with Consumption Price Index (CPI) of budget 2000. There are 2 methods of cost calculation namely full cost and direct cost.The research result shows that the highest production unit income at Sragen District Hospital 2000 is from hospital wards and the lowest electrical diagnostic; in 2001 the highest production unit income is from hospital wards and the lowest electrical diagnostic. At Wonogiri District Hospital 2000 the highest production unit income is from hospital wards and the lowest electrical diagnostic, in 2001 the highest also from hospital wards and the lowest operation room (OK).Full cost calculation defined that biggest total cost at production unit of year 2000 at Sragen District Hospital is hospital ward and the lowest is physiotherapy, in 2001 the biggest and the lowest also from hospital ward and physiotherapy. At Wonogiri District Hospital the biggest total cost at production unit of year 2000 is hospital ward and the lowest electro diagnostic, in 2001 the biggest and the lowest are also from hospital ward and electro diagnostic. If calculation with direct cost the biggest and the lowest total cost at production unit at Sragen District Hospital in 2000 are hospital ward and electro diagnostic, in 2001 the biggest and the lowest also from hospital ward and electro diagnostic. At Wonogiri District Hospital in 2000 the biggest is hospital ward and the lowest electro diagnostic, in 2001 the biggest and the lowest also from hospital ward and electro diagnostic CRR at Sragen District Hospital in 2000 and 2001 full cost calculation define that only one production unit having CRR > 100%, CRR percentage of retribution at Sragen District Hospital 35.54% and 27.81%, and direct cost calculation define that there are 5 production units having CRR > 100%, CRR percentage of retribution at Sragen District Hospital 7035% and 54.31%. CRR at Wonogiri District Hospital full cost calculation define that there are 2 units production unit having CRR > 100%, CRR percentage of retribution at Wonogiri District Hospital 35.27% and 29.95%, and direct cost calculation define that there are 2 unit production unit having CRR > 100%, CRR percentage of retribution at Wonogiri District Hospital 56.98% and 47.09%.Full cost calculation business yield remaining (SHU) of production unit at Sragen District Hospital and Wonogiri District Hospital in 2000 and 2001, production unit almost never have positive SHU more ever cross-subsidy was not establish there. Meanwhile direct cost calculation define that there are some units having positive S}JU where such cross-subsidy is establish among production units. However total SHU from total retribution of both District Hospital shows negative result.There is define difference cross-subsidy of both District Hospital of year 2000 and 2001, the production unit having CRR > 100% (positive SHU) between Sragen District Hospital and Wonogiri District Hospital was difference. Almost the production unit at Sragen District Hospital having positive SHU and only 2 production units at Wonogiri District Hospital having positive SHU there are Iaboratory and radiology.Reference: 24 (1980 - 2001)

Pembangunan kesehatan di negara sedang berkembang pada umumnya menghadapi masalah rendahnya alokasi anggaran untuk sektor kesehatan. Hal ini diperberat dengan tingginya laju inflasi di bidang kesehatan. Faktor lain yang mengakibatkan meningkatnya biaya kesehatan adalah transisi epidemiologi, semakin tingginya proporsi usia lanjut, meningkatnya teknologi kedokteran, serta sistem pembiayaan dan pembayaran yang tidak efisien.Ketika pasien tidak menanggung biaya karena dibayar oleh perusahaan tempat bekerja atau oleh perusahaan asuransi komersial dan pembayaran dilakukan secara fee .for service maka dengan mudah provider menciptakan permintaan baru. Situasi ini mendorong permintaan yang lebih tinggi oleh konsumen dan memberi insentif kepada provider untuk memberikan pelayanan kesehatan secara berlebihan.Untuk memotret perbedaan biaya dari ke tiga jenis pembayar dalam penanganan pasien penyakit demam tifoid yang dirawat inap di kelas satu rumah sakit MMC Jakarta tahun 2001. Dilakukan studi perbandingan penanganan pasien antara ke tiga jenis pembayar tersebut.Desain penelitian ini menggunakan desain non eksperimental dengan pendekatan deskriptif kuantitatif. Penelitian dilakukan terhadap pasien demam tifoid yang dirawat inap di kelas satu rumah sakit MMC Jakarta pada tahun 2001. Jumlah pasien 65 orang karena adanya kriteria inklusi penelitian maka jumlah populasinya tinggal 56 orang. Oleh karena populasinya yang relatif kecil maka dilakukan pengambilan sampel secara total sampling.Dari hasil penelitian dapat disimpulkan bahwa: Tidak ada perbedaan pemberian pemeriksaan penunjang medis dan biaya pemeriksaan penunjang medis antara ke tiga jenis pembayar, di antara subvariabel pengobatan dan jenis pembayar ditemukan satu perbedaan bermakna dalam pemberiaan obat antitusive dan ekspektoran namun secara keseluruhan tidak ada perbedaan dalam pemberiaan obat dan biaya obat antara ke tiga jenis pembayar tersebut, tidak ada perbedaan rata-rata lama hari rawat dan biaya sewa kamar antara ke tiga jenis pembayar. Tidak ada perbedaan total biaya perawatan pada ketiga jenis pembayar.Saran yang diberikan adalah bagi rumah sakit sebaiknya perlu kehati-hatian dalam menulis resume kelas perawatan dan kode ICD pasien yang di rawat, bagi pihak asuransi perlu melakukan kesepakatan dengan rumah sakit dalam hal penentuan biaya administrasi dan penetapan jenis obat yang diberikan pada pasien, sedangkan bagi rumah sakit perlu mengadakan resume medis bila rata-rata biaya perawatan demam tifoid melebihi rata-rata total biaya perawatan demam tifoid di kelas satu.

Treatment Cost Analyses for Typhoid Fever Patient at Inpatient Hospitalized at MMC Jakarta Based on type of Payment Determined for Year 2001Health development in developing country in general is facing the problem of low budget allocation for health sector. It also burdened by the high rate of inflation on the field of health. Which also affect the risk of epidemiological transition, the proportion of elderly, and medical technology, also inefficiency on the fee and payment system.When the patient is not paying for the fee since it is paid by the company where they work or the health insurance company and the payment is conducted by fee of service, so the provider easily create new request. This situation in encourages to the high of request by consumer and gives the provider incentive in providing unnecessary health services.To describe the different cost form three kinds of payment in handling the patient of typhoid fever that hospitalized at I-class of MMC Hospital in 2001, it has been conducted comparison study in handling the patient among the three kinds.The study design used non-experimental with quantitative approach. This study is conducted on the patient of typhoid fever that hospitalized at I-class of MMC Hospital in 2001. The number of patient is 65 people, since there were criteria in inclusion study, so the population is only 56 peoples. Because the sample is relatively small, so the study is conducted on the sample total sampling.Based on this study, it can be concluded that there is not many different in giving medical support examination and the fee of medical supporting examination among the three kinds of payment system. Between sub-variable of treatment and the kind of payment, it was found one significant different in giving antitusive medicine and expectorant, however in the entire perspective there is no different in giving medicine and medicine fee among the three kinds of payment system. There is no different on the average between the day of hospitalized and fee of room rental among the three payment system. So it can be concluded that there are no significant different in on the total fees of treatment on the three kinds of payment system.It is recommended to the Hospital that it code ICD patient must be written with care. For insurance party should conduct agreement with the hospital in stating the administration fee and kind of medicine that should be given to the patient. While for hospital, should conduct medical summary if the average cost of treatment of typhoid fever went over the average total cost of treatment of typhoid fever at I-class.