ANALYSIS OF DETERMINATION OF PACKAGE RATE AND COST RECOVERY RATE FOR NORMAL DELIVERY SERVICES BASED ON UNIT COST IN
NASANAPURA MATERNITY HOSPITAL, PALU CITY
SITTI RAHMAWATI
DEPARTMENT OF ECONOMIC TADULAKO UNIVERSITY CENTRAL SULAWESI INDONESIA
Email siti131962@gmail.com ABSTRACT
Tariff is the price in value of money that must be paid by the consumer to obtain or consume a commodity, that is, good or service. The discourse studied in this research is the analysis of the determination of the tariff for the Class I of normal delivery at the Nasanapura Maternity Hospital, Palu City. To date, there has not been a study carried out based on unit cost and cost recovery rate.
This study used secondary data to examine the cost of a Class I inpatient ward with the calculation of investment costs, operating costs, and maintenance costs. The analysis was carried out using the Double-Distribution method. The results of the study revealed that the applicable tariff in the Class 1 inpatient ward was IDR 1,869,800 with an output of 45 people and an income rate of IDR 52,890,000 and the total costs incurred for health service in the inpatient ward. In the future, the maternity rate for class in Nasanapura Maternal Hospital is IDR 48,500,235 and the cost recovery rate is 92%. It is suggested that the Nasanapura Maternity Hospital can apply good and correct accounting principles in managing its finances. This makes it easier to calculate costs.
Keyword: Unit cost, Cost Recovery Rate, Normal Delivery.
A. Introduction
According to Law Number 36 of 2009, health development aims to increase awareness, willingness, and living healthy capability for everyone to realize the maximum community health degree as an investment in the development of socially and economically productive human resources. According to Law Number 44 of 2009, hospitals are capital-intensive, labor- intensive, and technology-intensive institutions. Hospital is an institution that provides diagnostic and therapeutic services for diseases and health problems. According to the decision of the Minister of the Republic of Indonesia number 560/Menkes/SK/IV/2003, a tariff is all costs charged to patients for the services received. With high economic growth, people’s demands have changed as the tariff system can be implemented and people are satisfied (KEMENKES RI, 2003).
Regarding the purpose of health development according to Law Number 44 of 2009, the hospital is a capital-intensive, labor-intensive, technology-intensive institution that provides inpatient services of main functions to provide services, diagnostics, and therapeutic treatment to patients for diseases and health problems, be it surgical and non-surgical (UU RI of 2009).
According to the Decree of the Minister of the Republic of Indonesia Number 560/Menkes/SK/IV/2003 that the tariff is part or all costs of providing services in hospitals, which are charged to patients in exchange for services received. A high economic growth in an area results in the change of demands due to primary needs and secondary needs that must be met (KEPMENKES RI, 2003).
Nasanapura Maternity Hospital is located in a strategic place on the outskirts of Palu City.
The services provided at the Nasanapura Maternity Hospital are antenatal care, episiotomy and sutures, postpartum and breastfeeding care, simple contraception services such as pills, family planning, IUD, contraceptive injection, immunization, and delivery assistance. In birth delivery assistance, the newborn delivery services is 30% x services from children, which consists of normal delivery and cesarean section (SC). In the maternity hospital, the calculation of the rate for normal delivery in the form of a package includes drug price plus 20% and resuscitation of newborns from children of 1/3 x operator services and for neonatal resuscitation.
At the Nasanapura Maternity Hospital, the calculation of the normal delivery rate is in the form of a package that includes the normal delivery rate at the referral hospital added to the costs incurred at the hospital. However, in reality, the patient is still charged outside the package such as medicines, neonatal resuscitation by children of 1/3 x operator services, and for neonatal resuscitation assistants of 30% x child services.
There are 2 delivery packages at the Nasanapura Maternity Hospital. They are Cesarean delivery and normal deliveries consisting of Class I and VIP depending on the request of post- delivery patients who are placed in the treatment ward.
Literature Review
Mursidi (2010) explains that cost accounting is a system to achieve three main objectives, including determining the price of products or services and the sacrifice of economic resources measured in units of money, which has occurred or is likely to occur for certain purposes. Cost accounting is a process of recording, classifying, ranking, and reporting the costs of manufacturing and selling goods and services, in certain ways, as well as interpreting the results.
This provides guidance that cost accounting is part of financial accounting that has a cost object and management accounting. According to Trisnnatoro (2010), in the economy of healthcare services, this has been occurring for a long time. Many people complain that hospital services have been infected by the commercialization virus. However, referring to the reality in the field, the extent to which hospital services are actually allowed to adopt economic shows that not many people know that economic products are very important in hospital management because they require a cost object to see the hospital’s feasibility in calculating the break event point whether it is profitable or losing.
There are four methods for the classification of costs (Bastian, 2009):
1. Classification of costs according to the object of expenditure is the basis for classifying costs:
A. Raw material costs B. Direct labor costs C. Overhead costs
2. Classification of costs according to the main function in the company:
A. Production costs are costs incurred to process raw materials into finished products that are ready to sell.
B. Marketing costs are costs incurred for marketing activities.
C. General and administrative costs are costs to coordinate the production and marketing of products.
3. Classification of costs according to the relationship between costs and unit costs A. Direct costs are costs incurred with the only cause of something is being financed.
B. Indirect costs are costs incurred not only due to something that is paid for. Indirect costs in relation to the product are termed factory overhead costs.
4. Classification of costs according to the relationship behavior and changes in the activity volume
A. Variable costs are costs with total amount changes in proportion to changes in the activity volume.
B. Semi-variable costs are costs that change not proportional to changes in the activity volume.
According to Sugiyono (2007), the research method is a scientific way to obtain data for certain uses. While the qualitative method is a research method based on the philosophy of post-positivism used to examine natural objects.
B. Materials and Methods Research location and time
The research was carried out at Nasanapura Maternity Hospital, Palu City, Jalan Muhammad Yamin Petobo. The study was conducted in April 2009 (Profile of the Nasanapura Maternity Hospital, 2010).
Types of Research, Population, and Samples
This quantitative research was supported by qualitative data using a descriptive survey.
The population is all cost components from the distribution of costs found in the inpatient ward
for normal delivery in the inpatient ward. The sample of this study (Notoatmojo, 2003) is part of the population that is used as a research sample. The samples were 35 respondents.
Data Collection
Primary data was taken directly by researchers in the form of observations and interviews.
Secondary data was obtained by document study related to the data of Class I in the Nasanapura Maternity Hospital. However, the patient could request to be treated in the ward of VIP class by adding more payment.
C. RESULTS
The results show that there is an annual investment cost based on the cost per year which is the annual yield. From the operating costs and maintenance costs, the total cost of each ward for normal delivery services in 2010 can be identified. Class 1 care is US$ US$ 25,0581 consisting of fixed costs of US$ 2,139, operating costs of US$ 17.497, and maintenance costs of US$ 1915.
Annual Investment Cost
The calculation of the annual investment cost is based on the cost per year which is the annual value. The allocation of annual investment costs of building for each unit is calculated based on the building area in each unit multiplied by the purchase price of the asset according to the price of the year of purchase. This is in line with the results of the interview with the Head of the Public Relations Department of the Nasanapura Maternity Hospital.
Annual investment cost (AIC) analysis was carried out with the Double-Distribution method where the annual investment costs obtained from each supporting unit are distributed to other supporting units and then redistributed to production units so that there are no additional costs left in the supporting units.
The cost of employee salaries from April 2009 to April 2010 was US$ 16,552. Thus, the total AIC with a salary of US$ 2,139. with US$ 9,425 in 2009.
Operating Cost
The operating cost analysis carried out includes the cost of consumable medical materials/drugs, consumable office supply, and general costs (electricity, water, and telephone).
Specifically, the cost of consumable medical materials/drugs is only found in the production unit, which is in the inpatient ward. From the table above, it is seen that the operating costs for the Class I inpatient ward at the Nasanapura Maternity Hospital are US$ 1,761 which consists of the cost of consumable medical materials/drugs of US$ 671, the cost of consumable office supply of US$
105, and general expenses (electricity, water, and telephone) of US$ 986.
Maintenance Cost
Referring to Raymond (2001), the components of maintenance costs analyzed in this study include building maintenance, medical equipment maintenance, and non-medical equipment maintenance. The interviews with the Office of Public Relations at the Nasanapura Maternity Hospital reveal information on items that require routine maintenance.
Actual unit Cost (AUC)
Unit costs are costs that are calculated for one basic unit of service. Unit costs are obtained by dividing the total cost of the production unit by the output produced by that production unit (Ikhsan, 2010). The calculation of the actual unit cost used the following formula:
UAC: TC/Q Where UAC : Actual Unit Cost TC : Total Cost Q : Output produced UAC : US$ 25,227
--- 175
UAC : US$ 144
The cost obtained based on the calculation of the total cost divided by the number of patients is US$ 144. The costs in the total cost above are used to improve the quality of service according to service standards by optimizing the utilization of existing facilities and personnel. Thus, efforts to increase the quality of inpatient services are charged to the patient. Consequently, the funds or budget can be used to improve the quality of inpatient services optimally.
Actual Unit Cost
Cost identification is very necessary for the analysis of the cost of inpatient services for normal delivery in Class I and VIP which is carried out by identifying all costs incurred as a result of these service activities.
The next step was the identification of the details of the real costs of activities that must occur to provide services to patients that contribute to direct costs and indirect costs. Then, the total cost was calculated. The actual unit cost of the inpatient ward for Class I normal delivery of Nasanapura Maternity Hospital is US$ 144. Calculating the unit cost is the result of sensitivity analysis by dividing the total cost divided by the total current activity which is close to the rate applied in Nasanapura Maternity Hospital.
Cost Recovery Rate (CRR)
The expenses and income from the class I inpatient ward can be used to see the hospital’s ability to carry out its activities, which is the income divided by expenses from the Class I inpatient ward.
Does the class I inpatient ward work with a large subsidy or break event point or surplus? it will
be seen from the value of the cost recovery rate (CRR). If the CRR value is less than 100, it means that the Class III inpatient wards are deficit and must be subsidized. If the CRR is more than 100, it means that Class III inpatient wards are surplus without having to be subsidized. The results of the study show that the CRR is 94%, which means that the cost is not adequate to meet the needs of Class I care.
Inpatient Rates for Class I of Normal Delivery Services
The rate of inpatient ward of Class I at the Nassnapura maternity hospital is the labor cost added to the treatment cost, which is US$ 785 with the total output during April 2010 of 35 patients.
Thus, the applicable rates at the Nasanapura Maternity Hospital can have price competition and make it a place for labor with normal delivery by improving the cost quality and quality control services.
D. Conclusion and Suggestion
Based on research conducted in the inpatient ward for a cesarean section of Class I at the Nasanapura Maternity Hospital, it can be concluded that:
1. The total costs incurred for normal delivery services in the Class 1 inpatient ward of the delivery ward was US$ …
2. The actual unit cost in the Class I inpatient ward is US$ 144, added to the operating costs at the partner hospital making the applicable rate for maternity services for 35 patients is US$ 795 with a cross-subsidization of US$ 5.2.
3. The cost recovery rate for normal delivery services at the Nasanapura Maternity Hospital is 94%
Suggestion
For Maternity Hospital
In the future, it is expected that maternity hospitals applying good and correct accounting principles in managing assets and costs to make cost analysis easier, be it carried out by hospitals or outside parties that can be used to determine healthcare costs. Based on this research, Nasanapura Maternity Hospital may consider increasing the rate of normal delivery to meet the operational cost required.
For Future Researchers
Future studies are expected to conduct similar research in all production units in the Nasanapura Maternity Hospital to provide an overview of the actual delivery rates.
REFERENCES
Bastian, Indra (2010). Akutansi Kesehatn penerbit Erlngga
Ikhsan , A Dkk.2010 Akutansi dan manajemen keuangan rumah sakit , Graha Ilmu Yogyakarta Kepmenkes Republik RI no 560/Menkes/SK/IV/2003 Pengertian Tarif Kepmenkes No.
282/Menkes/SK/III/1993 tentang Pola tarif rumah sakir swasta
Mursidi 2010. Akutansi biaya Conventional Costing, Just in time , dan activity based costing, PT Refika Aditama, Bandung
Notoatmojo, 2003. Metodologi Penelitian Kesehatan , Rineka Cipta, Jakarta Notoatmojo S , 2010. Metodologi Kesehatan Rineka Cipta, Jakarta
Profil Rumah Sakit Nosonapura 2010. Rumah Sakit Nosonapura Kota Palu
Raymond T, 2010. Analisis biaya pelayanan rumah sakit untuk sisitem pelayanan dan pembayaran rumah sakit . Workshop Pusat Manajemen Pelayanan Kesehatan FK-UGM .Yogyakarta.
Sugionao, 2007. Memahami penelitian kuantitatif CV Alberta Bandung
Trisnantoro, S .2009. Memahami penggunaan ilmu Ekonomi dalam Manajemn rumah sakit Gadjah MAda University Press Yogyakarta.
Undang-uandang Republik Indonesia Nomor 36 tahun 2009 tentang Kesehatan (online) Http://html-pdf
KEMENTERIAN RISET, TEKNOLOGI DAN PENDIDIKAN TINGGI UNIVERSITAS TADULAKO
Kampus Bumi Tadulako Tondo Palu - Sulawesi Tengah 94111 JI. Soekarno Hatta Km. 9 Telp : (0451) 422611 – 422355 Fax: (0451)
422844
email: untad@untad.ac.id SURAT IZIN
Nomor: 5166/UN.28/KP/2015
Yang bertanda tangan dibawah ini :
Nama : Prof Dr.Ir Muhammad Basir , SE.,M.Si
NIP : 19610202 198903 1 001
Jabatan : Rektor Universitas Tadulako Dengan ini memberikan izin kepada :
Nama : Dr.Sitti Rahmawati,SE.,M.Si
NIP : 196209131990012001
Pangkat/Gol : Pembina Tkt I , IV/b
Unit Kerja : Fakultas Ekonomi Universitas Tadulako
Untuk mengikuti dan menjadi pembicara pada konferensi International (as presenter) Oral Presentation dengan judul “ “ Analisis Penetapan Tarif Paket dan Cost Recovery Rate Pelayanan Pasien Persalinan Normal Berdasarkan Unit Cost di Rumah sakit Bersalin Nasanapura Kota Palu :.Pada tanggal 14th-15th September Tahun 2015 di Faculty of Medicine University Kebangsaan Malaysia (UKM).
Demikian surat ini dibuat digunakan sebagaimana mestinya.
Palu, 5 September 2015
Tembusan:
1. Dekan Fakultas Ekonomi Untad
2. Ketua Jurusan Ekonomi Pembangunan
