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Abstract
Methods : This study is a qualitative study that calculate the unit cost (unit cost)
Phacoemulsification in INA CBGs services using Activity Based Costing (ABC) that
can occur based on the ABC method of cost comparison with INA CBG's claim.
Result : Based on the calculation, the unit cost of service Phacoemulsification with
activity-based costing method in CBG's is Rp. 3.152.637. With the difference
between the cost of the unit Phacoemulsification in CBG's and INA rates CBG's
Phacoemulsification is Rp. 413.155.
In the aspect of services, in the year 2011 introduced a package of INA CBGs.
The application of packet-based packet way casemix payment system Cased Based
Group Indonesia (INA CBGs) in Jamkesmas program requires health providers to use
resources efficiently, including drugs and rational but effective. To achieve good
patient satisfaction and efficiency in terms of cost it is necessary to keep the
procedures that have been made by the hospital in the form of clinical pathways3.
In calculating unit costs that occur in the hospital service, with the
development of science, in the late 1800s and early 1900s was born of a system of
determining the cost of the activity-based products designed to overcome distortions
in traditional cost accounting. The accounting system is called Activit Based Costing.
Definition of Activity Based Costing (ABC) is a costing system that first trace costs
to activities and then to products4.
INA CBGs package rates are also included in the tariff applied to act as a case
Phacoemulsification surgery at the highest science of eye diseases which are handled
by the hospital. In 2012 there were 44 patients who underwent cataract
hospitalizations in RS PKU Muhammadiyah and get cataract surgery, 16 of whom is
a health patients who had cataract surgery with Phacoemulsification technique. With
the rate that has been applied then the hospital needs to make adjustments to the
tariff. It is necessary for its analysis of the cost of the service Phacoemulsification
actions that the hospital did not get the loss. From the above background, the
formulation of the problem can be formulated as follows:
Data analysis
This study collected data on primary and secondary data. From the results of the
primary and secondary data collection on top, the next step is processing the data of
direct and indirect costs on Phacoemulsification action that is cost allocation of units
(services, support and non-medical). The data obtained and analyzed by the method
of activity-based costing, the results of the analysis described later became:
1. Determine the activity centers on the unit.
2. Determine the the cost categories and cost of drivers of each cost category
3. Direct charge consumed in the act of Phacoemulsification action.
4. Determining the cost of direct and indirect resource overhead and total
overhead of resource overhead consumed each activity by using the
proportion of time that is related to the outpatient unit Eyes, Installation
Central Surgery, inpatient ward Arofah.
5. Determine the activity centers terait Phacoemulsification actions contained in
Clinial Pathways.
6. Overhead charge into each activity centers in clinical pathways.
7. Summing the direct and overhead costs are included in clinical pathways.
8. Comparing the cost of CBG using ABC tally with INA CBGs set fee if the
government Determine the the cost categories of patients on clinical
pathways, namely the template group that raises the cost of the service charge
Phacoemulsification.
RESULTS
Picture of Research Subjects Based on the interview with the Head of Finance and
Head of the Unit of Ophthalmology Clinic at PKU Muhammadiyah Hospital of
Yogyakarta. Each study subject was given the opportunity to express opinions.
Cataract surgery services provided by RS PKU Muhammadiyah Yogyakarta
performed in patients with Phacoemulsification method. Regarding the calculation
system is applied in the hospital service PKU Muhammadiyah Yogyakarya for
Phacoemulsification is the conventional method which is based consumables and
labor costs.
After knowing the proportion of loading of each functional unit, then the next step
can be performed to calculate the imposition of any one patient who received
phacoemulsification action. In this stage will be divided by 3 units related to the
service are as follows Phacoemulsification.
1) Outpatient
Based on Table 3 . for indirect costs of resource overhead outpatient units get
a load of Rp . 1510814899 which will be charged to all outpatients . For that if
all patients during 2012 was 74 935 patients for loading the resource overhead
and indirect costs to any one action is Rp . 20 162 .
2) Hospitalization
Based on Table 3 . then for inpatient unit gets the biggest burden for indirect
costs Rp resource overhead . 7554074494 which will be charged to all
inpatient units . Based on the proportion based on the number of beds , the
inpatient unit Arafah that has 24 beds compared with the rest of the bed is 207
beds in the inpatient unit of the inpatient units Arafah got the imposition of
resource overhead and indirect cost of Rp . 875 834 724 . Indirect overhead
costs charged to the patient resource will be proportioned imposition of
resource overhead and indirect costs per patient per day . Arafat 's own
inpatient unit in 2012 the number of days of inpatient hospitalization 9,168
days , so that for each day of hospitalization , the patient will receive the
indirect imposition of resource overhead cost of Rp . 95 532 .
3) Installation of the Central Surgical
Based on Table 3. then for a surgical installation gets imposition central
resource for indirect overhead cost of Rp. 1007209933 which will be charged
to all surgical patients central installation. Resource overhead indirect costs
charged to the installation will be borne by the central surgical patients by
charging base that has been done by RS PKU Muhammadiyah Yogyakarta,
which is based on the type of surgery. Loading large proportion and number
of patients can be seen in Table 4.
Table 4. Table burden surgery based on the type of operation.
3) Surgery unit
From the above calculation to obtain the unit cost Phacoemulsification action by the
ABC method on CBG's system is Rp. 3,152,367.
DISCUSSION
Jamkesmas bill payments to hospitals based on INA CBG 's package , which
is based on the diagnosis or the type of disease in which a specified rate of each
diagnosis of the disease , the patient's hospital as a waitress Jamkesmas need to make
efficiencies in the management of these services . Packages here have been included
in the administration of drugs to patients Jamkesmas , both outpatient and inpatient5 .
Phacoemulsification included in a health service in the system CBG 's INA in 2011
with the code H26.9 rate of Rp.2.739.482 for hospital type B as RS PKU
Muhammadiyah Yogyakarta . But if you use action fare Phacoemulsification in a
health action on the INA CBG 's 2014 with its tariff H.130.2 code is Rp.4.225.236 for
hospital type B as RS PKU Muhammadiyah Yogyakarta . While the results that
emerged from the calculation of the action Phacoemulsification with Activity Based
Costing method is Rp.3.152.367. This shows the difference between the negative
charges Phacoemulsification rates CBG 's INA in 2011 which has been adopted by
the government on a health service with a unit cost incurred by RS PKU
Muhammadiyah Yogyakarta at Rp.413.155 . It is also consistent with previously
studies conducted by6, it is concluded that the cost of medical services operative
measures undertaken in Mohammad Hussein Hospital Palembang 98.6 % do not fit
and greater than the rate INA DRG.
The second cost structure that emerges is overhead. Overhead costs are
divided into two general categories: direct and indirect resource overhead and
resource overhead9. Within overhead cost structure that appears like-functional
payroll payroll costs in the eye outpatient unit, inpatient surgical Arafat and
installation of central if based on the number of existing nursing workforce , ie 215
nurses, then this has been in accordance with10.
CONCLUSION
Based on research conducted Phacoemulsification action unit costs obtained by the
method of activity-based costing is Rp.3.152.637 and the difference between unit cost
and rates INA Phacoemulsification Phacoemulsification CBG's is Rp. 413 155.
BIBLIOGRAPHY