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.

Malaria merupakan salah satu penyakit yang menjadi ancaman masyarakat di daerah tropis dan sub tropis terutarna pada bayi, anak balita dan ibu melahirkan. Sejak krisis ekonomi 1997 daerah endemis malaria bertambah luas bahkan menimbulkan kejadian luar biasa pada daerah yang telah berhasil menanggulangi malaria. Kejadian penyakit malaria di Propinsi Kepulauan Bangka Belitung yang merupakan Propinsi barn di Indonesia masih menunjukkan angka kesakitan malaria cukup tinggi. Dari data Departemen Kesehatan tahun 2005 untuk Iuar Jawa dan Bali, data 2001 - 2003, Propinsi Kepulauan Bangka-Belitung masih masuk dalam kategori Medium Incidence Area dengan AMI 45,85. Total anggaran bidang kesehatan selama orde baru hanya 2,5%-3% dan setelah krisis ekonami sangat tergantung kebijakan pemerintah daerah. Kabupaten Bangka Tengah di tahun 2006, anggaran biaya obatnya 1 milyar, untuk obat malaria 45 jutaan, Adanya obat baru Artesunate Combination Therapy (ACT) yang harganya lebih mahal dengan anggaran obat malaria masih kccil maka perlu melakukan studi efektititas-biaya dengan obat yang sudah lama dipakai. Penelitian ini merupakan evaluasi ekonomi kuantitatif bersifat deskriptif dengan melakukan studi perbandingan (comparative study) obat CO + PQ dan obat ACT + PQ secara prospektif di Puskesmas Koba. Diharapkan mendapatkan variasi biaya pengobatan malaria vivax dengan analisis efektifitas-biaya serta perhitungan biaya dilakukan dengan metode activity based costing (ABC). Tujuan penelitian untuk memilih biaya pengobatan malaria vivax yang lebih efektif antara obat CQ + PQ dan obat ACT + PQ di Puskesmas Koba. Dari basil penelitian di Puskesmas Koba selama bulan Pebruari sampai dengan April 2006 didapatkan aktifitas biaya investasi terbesar adalah pembacaan sediaan DDR dengan jenis investasi terbesar ruang laboratoriurn, mikroskop. Aktifitas biaya operasional langsung terbesar obat CQ + PQ adalah anarnnesis dan pemeriksaan fisik dan komponen operasional terbesar gaji dan kartu medical record. Obat ACT + PQ biaya operasional langsung terbesar adalah aktifitas menulis cara makan obat di etiket dengan komponen operasional terbesar obat dan gaji. Biaya operasional tidak langsung terbesar kedua alternatif obat adalah aktifitas anarnnesis dan pemeriksaan fisik dengan komponen gaji tak langsung. Biaya pemeliharaan terbesar adalah aktifitas anamnesis dan pemeriksaan fisik di ruang periksa. Dari biaya total yang terbesar adalah biaya operasional. Efektifitas cakupan makan obat CQ + PQ 27 orang dan ACT + PQ 26 orang, selesai makan obat CQ + PQ 25 orang dan obat ACT + PQ 24 orang, turun panas hari pertama obat CQ + PQ 16 orang dan obat ACT + PQ 10 orang dan respon klinis memadai obat CQ + PQ 24 orang dan obat ACT + PQ 22 orang. Hasil analisis rasio obat CQ + PQ lebih kecil daripada obat ACT + PQ, simulasi analisis sensitifitas rasio obat CQ + PQ lebih kecil dari pada obat ACT + PQ dan dari analisis cost recovery rate obat CQ + PQ Iebih sedikit yang disubsidi pernerintah dibandingkan obat ACT + PQ. Obat CQ + PQ lebih cost effective daripada obat ACT + PQ untuk semua analisis dengan semua efektifitas yang didapat. Obat CQ + PQ tetap pilihan utama pengobatan malaria vivax sedangkan obat ACT + PQ untuk malaria falsiparum. Perlunya penyuluhan cara makan obat dengan dosis yang tepat untuk pengobatan malaria vivax dan perlu melakukan penelitian dengan sampel yang lebih banyak sesuai standar.

Malaria was one of disease which becoming a public risk in tropical and sub tropical area. especially for baby, child under five years and child birth's mother. Since economic crisis in 1997, endemic area of malaria increased, even became extraordinary occurrence in the area which has succeeded to overcome of malaria Occurrence of malaria in Province of Archipelago of Bangka Befitting representing new Province in Indonesia still show the malaria index enough was high. In 2005 health data to outside Java and Bali, data 2001 - 2003, Province of Archipelago Bangka-Belitung still enter in category of Medium Incidence Area by AMI 45,85. Totally budget of health service during Orde Baru regime was only 2,5 - 3% and after economic crisis was most depend on locals government : policy. Drug budget of Bangka Tengah district was I billion rupiahs and drug. therapy of malaria was over 45 million rupiahs in 2006. The existence of new drug of Artesunate Combined Therapy (ACT) where its price was more expensive and in the other hand drug budget of malaria was not enough, so it need to cost-effectiveness study with drug which have been used before. This research was a descriptive quantitative economic evaluation with a comparative study of CQ + PQ and ACT + PQ prospectively. Expected to be got a variation of drug therapy of malaria vivax with cost-effectiveness analysis and calculating has been done with Activity Based Costing (ABC) method. These research was to calculated which one more effective in Koba community health center between Cloroquine + Primakuin (CQ + PQ) or Artesunate + Amodiaquine + primakuin (ACT + PQ). The resulth of research in Koba Community Health Center from February until April 2006 was got that the biggest activity investment cost is read of available DDR, with biggest investment component is laboratory room and microscope. The biggest of direct operational cost of CQ + PQ drug were anamnesis and physical examination and the biggest component of operational cost was salary and medical record card. The biggest activity cost of direct operational ACT + PQ was write etiquette of dosage and the biggest operational component was medicine and salary. The biggest cost of indirect operational both drug alternative were anamnesis and physical examination activity and indirect salary component The biggest maintenance cost were anamnesis and physical examination activity and polyclinic. The biggest total, cost was cost of operational. Effectiveness of respondence CQ + PQ were 27 people and ACT + PQ were 26 people; complete treatment CQ + PQ were 25 people and ACT + PQ were 24 people; afebris in the first day CQ + PQ were 16 people and ACT + PQ were 10 people; and the adequate clinical and parasitological response (ACPR) of CQ + PQ were 24 people and ACT + PQ were 22 people. Result analysis drug ratio of CQ + PQ was smaller than ACT + PQ ; analysis simulation of ratio sensitivity drug of CQ + PQ were smaller than ACT + PQ and analysis cost recovery rate drug of CQ + PQ was smaller subsidized by government compared with ACT + PQ. Drug of CQ + PQ was more cost effective than ACT + PQ for all analyses with all of their effectiveness. CQ + PQ was still remain to drug of choice a malaria vivax while ACT + PQ was drug of choice for malaria falcifarum. The importance was counseling of correct dosages for therapy malaria vivax and its importance to research with more minimal samples.