Penentuan tarif Laboratorium Kesehatan Kabupaten Sintang dewasa ini tidak menggunakan perhitungan biaya satuan melainkan berdasarkan harga bahan reagens dan disesuaikan dengan tarif laboratorium lain. Hal itu mengakibatkan tarif yang berlaku tidak sesuai dengan biaya satuan. Produk pemeriksaan laboratorium kcsehatan adalah beragam schingga perhitungan biaya setiap jenis pemeriksaan bervariasi karcna pcmakaian bahan pengainbil spesimen, alat laboratorium, bahan reagens dan waklu pemeriksaan berbeda-beda. Penelitian ini adalah anal isis biaya yang hertujuan untuk mendapatkan garnharan hiaya total, biaya satuan dan alternatif penentuan tarif yang mempertimbangkan biaya satuan, tarif pesaing, subsidi, Cost Recovery Rate, dan ATP/WTP jenis pemeriksaan Laboratorium Kesehatan Kabupaten Sintang. Metoda analisis biaya yang digunakan adalah Activity Based Costing pada semua jenis pemeriksaan yang dilakukan di Laboratorium Kesehatan Kabupaten Sintang pada tahun 2005. Analisis biaya dibagi dalam tiga tahap yaitu tahap pra-analitik, tahap analitik dan tahap pasca analitik yang masing-masing tahap dijabarkan dalam biaya investasi, operasional dan pemeliharan. Dari basil penelitian didapatkan bahwa jumlah pemeriksaan Laboratorium Kesehatan Kabupeten Sintang tahun 2005 masih rendah yaitu bare mencapai rata-rata 41,45% dan biaya totalnya adalah Rp_ 225.831.631,-. Tarif Laboratorium Klinik Taruna lebih tinggi rata-rata 76,82% dibandingkan dengan tarif Laboratorium Kesehatan Kabupaten Sintang. CRR biaya total aktual sebesar 14%, sedangkan CRR biaya total dengan subsidi sebesar 20%. Sebaiknya penentuan tarif Laboratorium Kesehatan Kabupaten Sintang berdasarkan biaya satuan aktual dengan subsidi, penyediaan dana investasi (gedung, alat dan inventaris kantor), gaji dan insentif diperlukan sebesar Rp. 187.561.421,- pada tahun 2005.

Determination of health laboratory tariff in Sintang district recently doesn't use unit cost but based on reagents cost and adjusted to other laboratories tariff. That causes the tariff available doesn't in accordance with the unit cost. The health laboratory analysis products are varied so that the determination of each analysis cost is varied because the use of reagents for specimen preparation, Iaboratory instruments, reagents and analysis time are varied. This was a cost analysis research with the aims to gain the description of total cost, unit cost and determination of tariff alternative considering unit cost, competitor tariff, subsidy, Cost Recovery Rate, and-ATP/WTP of kind of health laboratory analysis of Sintang district. The used cost analysis method was Activity Based Costing to all kind of analysis performed in the Health Laboratory of Sintang district in year 2005. Cost analysis was divided into three steps, that were pre-analysis phase, analysis phase and post analysis phase, and each phase was presented in cost of investment, operational, and maintenance. The research showed that the number of analysis in the Health Laboratory of Sintang district was still low, which reached average 41.45% and the total cost was Rp. 225,831,631,-. The tariff of Laboratoriurn Klinik Taruna was average higher 76.82% compared with the tariff of the Health Laboratory of Sintang district. The CRR of total actual cost was 14%, whereas The CRR of total cost with subsidy was 20%. It is suggested that the tariff determination of the Health Laboratory of Sintang district is based on the actual subsidized unit cost, availability of investment fund (building, instruments and office inventory), and in year 2005 Rp. 187,561,421,- is needed for salary and incentive in year 2005.

Dinas Kesehatan Provinsi Sulawesi Tengah memiliki berbagai masalah dart keterbatasan antara. lain menyangkut SDM perencana, S1K, dan dana. Belum adanya dana yang khusus dialokasikan untuk membiayai proses perencanaan dan penganggaran merupakan salah satu masalah yang penting diperhatikan. oleh sebab itu, penelitian ini bertujuan melakukan analisis biaya menggunakan konsep Activity Based Costing (ABC) terhadap proses perencanaan dan penganggaran program kesehatan tahunan Dimas Kesehatan Provinsi Sulawesi Tengah serta menganalisis berbagai faktor yang mempengaruhinya dan hambatan masalah yang dihadapinya. Penelitian ini adalah penelitian studi kasus, dengan pendekatan deskriptif menggunakan metode kualitatif. Melalui vvawancara. mendalam, Focus Group Discussion (FGD), telaah dokurnen danobservasi langsung. Seluruh tahapan aktivitas pereneanaan, mulai dari analisis situasi, identifikasi masalah, penetapan prioritas masalah, penetapan tujuan„ penentuan altematif pemeeahan masalah, penyusunan Reneana Operasional Proyek/Program (ROP), pengerjaan RICA—KL dan RKA—SKPD, asistensi, Koreksi dan revisi serta finalisa.si dokumen perencanaan dan penganggaran sarnpai penyu.sunan draft DIPA dan DPA Dinas Kesehatan Tahun 2007. walaupun implementasinya, tidak selalu dilakukan seeara berumtan atau terpisah tahap demi tahapnya. Beberapa aspek yang mempengaruhi perencanaan dan penganggaran adalah ketersediaan, kecukupan dan kesesu.aian serta kelengkapan berbagai sumber daya, seperti SDM perencana, saran; waktu, dana, jadwal, juklak, Kebijakan OTDA yang mendukung, Sistem Informasi Kesehatan (SIK) dan standar harga satuan barangijasa. Kegiatan perencanaan dan penganggaran selanria ini, merupakan bagian dari Prograrn Kebijakan dan Manajemen Pembangunan Kesehatan (PICMPK). Alokasi dana tahun anggaran 2007 sebesar Rp. 6.706.789.494,- terdiri dari Rp. 5.166.347.000,- APBN dan Rp. 1.540.442.494,-. APBD. Hasil perhitungan dan analisis biaya yang dilakukan temyata diperoleh biaya total proses perencanaan dan penganggaran Dinas Kesehatan Provinsi Sulawesi Tengah sebesar Rp. 259.794.844,- yang keseluruhannya merupakan biaya operasional kegiatan per tahapan aktivitas tersebut. Permasalahan dan hambatan yang dihadapi dalam proses perencanaan dan penganggaran adalah 1)sektor kesehatan belurn menjadi prioritas 2)Belum optimalnya S1K, 3)belum adanya SK Kadis tentang SDM perencanaitim penyusun dokumen perencanaan dan penganggaran dinas. 4)Da.ftar harga satuan barangijasa belum sepenuhnya dimanfaatkan sebagai acuan.5) Belum adanya Juklak perencanaan clan penganggaran, 6)belum semua personil yang terlibat proses perencanaan dan penganggaran belum teriatih secara tehnis maupun. manajerial. 7)Koordinasi Lintas Program (LP) belum optimal. 8) Perencanaan & penganggaran yang dilakukan selama ini belum terpadu, terpisah antara perencanaan APBN dengan APBD. Begitu pula dengan tenaga perencananya. APBN oleh Seksi Penyusunan Program sedangkan APBD oleg Subag Keuangan. 9)Belum adanya dana yan khusus dialokasikan untuk aktivitas perencanaan clan penganggaran. 10)Belum adanya risetistudi sejenisnya mengenai analisis biaya programikegiatan untuk acuaniperbandingan kearah perbaikan. 11)Masalah yang sifatnya spesifik lokal yakni seringkali terjadi pemadarnan lampu oleh PLN. Penelitian ini menyimpulkan perlu dilakukan berbagai upaya dan penataan sena pembenahan baik secara temis maupun manajerial dala.m proses perencanaan dan penganggaran. Upaya sosialisasi dan advokasi yang lebih intensif kepada stakeholder/decision maker setempat juga masih perlu ditingkatkan.

Central Sulawesi Provincial Health Office, have many problems and scarcity of many aspect like planning officer, SIK and budget. Have not budget allocaction for the planning and budgeting process. This study aim to conduct a special cost analysis for the process of health planning and budget by using Activity Based Costing (ABC) concept. This study is a qualitative design, researcher used a framework system which covered input, process and output to analyze various aspect which related to planning and budget process. Public Health Service in the Central Sulawesi Province has conducted all planning activities steps, starting from situation analysis, identify problem, decision of problem priority, decision of aim, determination of trouble-shooting alternative, arrangement of Project Operational Planning. (ROP), Making of RICA - ICL and RICA - SKPD, assistance, correction and revision, final document of planning and budget until draft arrangement of DIPA and DPA at Public Health Service in 2007. Although their implementation are not always conducted alternately or separated step by step. Some aspects which affected to planning and budget at Public Health Service in the province of Sulawesi Tengah is availability, sufficiency, compatible and also the equipment of various resources, such as Human Resources Development planner, medium, timing, fund, schedule, implementation guide (Juklak), supported decentralisation policy, Health Information System (5I1C) and standard price of service unit. Available planning and budget activity is part of Policy Program and Health Development Management at Public Health Service. Available fund allocation in this program is destined for some Subdin, department, section and sub section at Public Health Service in the province of Sulawesi Tengah. Fund allocation of this prograrne in 2007 are 6.706.789.494,- rupiahs which consist of 5.166.347.000,- rupiahs from APBN and 1.540.442.494,- rupiahs from province APB1). From calculation result and cost analysis which has conducted was obtained total cost of planning and budget process at Public Health Service in the province of Sulawesi Tengah are 259.794.844,- rupiahs which all of them are operational cost in every activities steps. Problems and resistances which are faced on planning and budget process such as: 1) Health sector does not become a priority yet concerning a local OTDA policy, because Kamtibrnas is more important aspect. 2) SIK is not optimal yet, 3) There is no SK ICadis concerning Human Resources Development of planner or compiler team of planning and budget document at Health Service. 4) Price list of material or service unit is not fully exploited as reference yet 5) There is no Juklak of planning and budget, 6) All personals who concerned on planning and budget process are not trained yet both technically and managerial. 7) Program pass coordination (LP) is not optimal yet. 8) Planning and budget which conducted are not solid yet, separated between APBN and APBD planning and also their planner. APBN is arranged by section of program arrangement while APBD is arranged by sub department of financial. 9) There are no funds which are allocated especially for planning and budget activity. 10) There is no study which concerns on cost analysis program or activity for reference on repair. 11) Local problems specifically are often happen extinction of electric by PLN. This study concluded that it was important to be conducted various effort and administration and also correction both technique and managerial on planning and budget process at Public Health Service in the province of Sulawesi Tengah. Socialization effort and more intensive advocation to stakeholder or decision maker is also improved.

DBD merupakan penyakit menular, dapat menyerang semua orang, rnengakibatkan kematian, serta sering menimbulkan wabah. DBD menunjukkan beban ekonomi signifikan pada masyarakat yang terkena. Tujuan penelitian ini diperolehnya informasi tentang biaya per DRG's berdasarkan Clinical Pathway pada penderita DBD yang dirawat inap di RSU Dr. Soedarso Pontianak tahun 2005. Jenis penelitian kuantitatif dengan desain survei. Data dikumpulkan dari biaya-biaya yang dikeluarkan oleh penderita DBD yang di rawat inap di RSU Dokter Soedarso bulan Januari sampai Desember 2005. Penelitian dilaksanakan bulan Februari-Juni 2006, menggunakan data sekunder dan rekam medis pasien rawat inap DBD dan unit penunjang serta data primer dari wawancara dengan dokter, perawat, kepala ruangan dan kepala rekam medis tentang penatalaksanaan DBD. Unit cost dihitung berdasarkan direct cost dengan Activity Based Costing dan indirect cost dengan simple distribution. Variabel yang mempengaruhi penetapan DRG's DBD di RSU Dr. Soedarso Pontianak tahun 2005 antara lain: karakteristik pasien: jenis kelamin, diagnosa utama, penyakit penyerta dan penyulit, lama hari rawat dan pemanfaatan utilisasi. Clinical Pathway DBD yang di rawat inap di RSU Dr. Soedarso Pontianak tahun 2005 terdiri dari tahapan berikut : I. Pendaftaran, II. Penegakan Diagnosa: tindakan oleh perawat, dokter, pemeriksaan penunjang, penegakan diagnosa utama, terapi dokter, pendaftaran rawat inap, III. Terapi: visite dokter, pemeriksaan penunjang, penegakan DBD berdasarkan casemix, penentuan terapi (dokter), asuhan keperawatan, penggunaan alat kesehatan habis pakai, obat-obatan dan akomodasi serta IV. Pulang. Rata-rata lama hari inap dan biaya DBD berdasarkan DRG's (T63B) di RSU. Dr. Soedarso Pontianak Tahun 2005 adalah: DBD Murni 4,01 hari, biaya Rp.565.948,- - Rp.2.471.298,-. DBD dengan penyerta 4,46 hari, biaya Rp.572.692,- - Rp.2.740.687,- DBD dengan penyulit 4,82 hari, biaya Rp.652.352,- - Rp.3.256.826,-. DBD dengan penyakit penyerta dan penyulit 5 hari, biaya Rp.662.385,- - Rp.3.467.237,-. Sampel pada DBD dengan penyakit penyerta dan penyulit hanya 2 orang (1,65%) sehingga lama hari rawat inap dan biaya kurang bervariasi. Rumah sakit dapat melakukan penerapan DRG's secara bertahap. Perlu koordinasi lintas program antara Depkes RI, Ikatan Profesi, Asuransi, YLKI dan Rumah Sakit (Private dan Public) dalam penyusunan Clinical Pathway yang baku dan penetapan biaya berdasarkan DRG's serta akhimya tercipta Indonesian DRG's. Perlu dilakukan penelitian lebih lanjut dengan diagnosa penyakit lain dan di rumah sakit lain (private maupun public) agar perhitungan unit costIDRG's dapat digunakan sebagai alat untuk pembayaran sehingga adanya kepastian biaya yang diperlukan bagi RS, asuransi, konsumen dan pemerintah.

DHF disease is contagious disease, could attack all people and cause death, and often cause epidemic. DHF show significant economical burden in infected society. This research aim is get the information about cost per DRG's based on Clinical Pathway of DHF patient that taken care at Dr. Soedarso General Hospital Pontianak in 2005. Research is quatitative with survey design. Data gathered from costs that spend by dengue haemorrhagic fever patient that taken care in Dr. Soedarso General Hospital from January to December 2005. Research done in February - June 2006, using secondary data from DHF inpatient medical record and supportive units and also primary data from interview with doctors, nurses, Hall Chief and Medical Record Chief toward dengue haemorrhagic fever menagery. Unit cost count based on direct cost by Activity Based Costing and indirect cost by simple distribution. Variables that affect DRG's DHF in Dr. Soedarso General Hospital Pontianak year 2005 such as: patient characteristics: sex, main diagnose, commorbidity and commortality disease (casemix), length of stay and utilization used. DHF's Clinical Pathway in Dr. Soedarso General Hospital Pontianak year 2005 consists of: I. Registration, IL Diagnose Straightening: action of nurse, doctor, supportive examiner, main diagnose straightening, doctor therapy, inpatient registration, III. Therapy: Visit Doctor, supportive examiner, DHF diagnose straightening with casemix, therapy determining (doctor), nursing education, after use health tools using, medication and accommodation and also 1V. Returning Home. Inpatient length of stay mean and DHF cost based DRG's (T63B) in Dr. Soedarso General Hospital Pontianak year 2005 are: Pure DHF is 4,01 days, with inpatient cost mean between Rp. 565.948,- to Rp. 2.471.298,-. DHF with commorbidity disease is 4,46 days. Inpatient cost mean between Rp. 572.692,- to Rp. 2.740.687,-. DHF with complicated disease is 4,82 days. Inpatient cost mean between Rp.652.352,- to Rp.3.256.826,-. DHF with casemix is 5 days. Inpatient cost between Rp.662.385,- to Rp.3.467.237,-. Sample on DHF with casemix only two people (1,65%) with the result that inpatient length of stay and cost less varying. Hospital can do DRG's implementation step by step especially in inpatient cases that often handled. Need cross program coordination between Depkes RI, Profession Band, Assurance, YLKI and Hospital (Private and Public) in arranging basic Clinical Pathway and cost determining based on condition in Indonesia and finally created Indonesian DRG's. Important to do the other research with other diagnostic and other hospitals (private and public) so unit costlDRG's can be used became tools to payment system So that cost certainty needed for hospitals, assurance, consumer and government created.