ADMINISTRASI KEUANGAN DAN

PEMBIAYAAN KESEHATAN
 Rencana Kuliah

1. Penyamaan Persepsi / Pengertian tentang Administrasi

Keuangan dan Pembiayaan Kesehatan
2. Dari Sumber Pembiayaan sampai kepada penggunaan
anggaran
3. Pembiayaan Kesehatan pada berbagai Negara
4. Unit Cost dan Tarif
5. Menilai Keberhasilan Organisasi / Program
1. Penyamaan Persepsi / Pengertian

- Administrasi Keuangan
- Ruang Lingkup administrasi Keuangan
- Manajemen Keuangan
- Sehat
- Kesehatan
- Upaya Kesehatan
- Pelayanan Kesehatan
- Administrasi Keuangan dan Pembiayaan Kesehatan
PERTEMUAN / KULIAH PERTAMA

PENYAMAAN PENGERTIAN TENTANG

ADMINISTRASI KEUANGAN DAN
PEMBIAYAAN KESEHATAN
ADMINISTRASI KEUANGAN
Administrasi keuangan juga dapat berarti
rangkaian kegiatan penataan yang
berupa :
- penyusunan anggaran belanja,
- penentuan sumber biaya,
- cara pemakaian,
- pembukuan,
- dan pertanggungjawaban
 Dengan perkataan lain ;
Semua langkah yang lebih menjamin
penggunaan biaya yang tersedia itu
sehingga menjadi lebih efisien, efektif
dan ekonomis harus diambil.
 Cabang Ilmu Administrasi
Keuangan

- Planning-Programming-Budgeting
System yang terkenal dengan
singkatan PPBS. Sistem
Penganggaran Berdasarkan Program
- Pencatatan Keuangan
 Agar lebih efektif dan efisien dalam melaksanakan kegiatan
administrasi keuangan, maka perlu dibentuk suatu pengawasan
keuangan.
Pengawasan keuangan adalah kegiatan yang berhubungan dengan
pelaksanaan rencana keuangan.
Pengawasan keuangan bukan hanya sekedar mengecek aliran
uang/dana, akan tetapi juga behubungan dengan evaluasi rencana yang
sedang dilaksanakan.
Oleh karena itu, pengawasan keuangan meliputi 2 langkah pokok, yaitu :
1. Menentukan standar-standar kegiatan.
2. Membandingkan kegiatan nyata dengan standar seperti yang
telah
ditentukan
Langkah-langkah tersebut bukan hanya perlu untuk pengawasan
kegiatan yang telah direncanakan, akan tetapi juga dan bahkan tidak
kurang pentingnya untuk menyususn rencana yang akan datang
Dalam perkembangannya administrasi sering
dikaitkan dengan menejemen keuangan.
Dalam praktiknya, administrasi keuangan dan
manajemen keuangan memiliki beberapa
kesamaan. Di era globalisasi ini istilah
manajemen keuangan lebih popular dari
pada administrasi keuangan
 RuangLIngkup Administrasi Keuangan
1.Administrasi keuangan negara merupakan seluruh penerimaan dan
pengeluaran, baik yang menyangkut pemerintah pusat, pemerintah daerah,
BUMN, BUMD maupun institusi yang menggunakan modal atau kelonggaran
dari negara atau masyarakat.
2.Administrasi keuangan negara merupakan kekayaan negara berupa harta
berbentuk uang, hak-hak negara seperti hak menagih atas kontrak
pertambangan, hak penangkapan ikan, hak penguasaan hutan, kewajiban-
kewajiban atau utang-utang negara seperti dana pensiun, asuransi
kesehatan, jaminan sosial tenaga kerja, kekayaan bersih negara dan
kekayaan alam.
3.Administrasi keuangan negara merupakan kebijaksanaan-kebijaksanaan
anggaran, fiskal, moneter, berserta akibatnya dibidang ekonomi.
4.Administrasi keuangan negara mencakup keuangan lainnya yang
dikelola pemerintah pusat dan daerah, dan badan-badan yang menjalankan
kepentingan negara atas uang yang dimiliki negara maupun uang ataupun
dana yang dimiliki masyarakat.
MANAJEMEN
KEUANGAN
 Liefman
Manajemen Keuangan merupakan usaha untuk
menyediakan uang dan menggunakan uang untuk
mendapat atau memperoleh aktiva
 Suad Husnan

Manajemen Keuangan adalah manjemen

terhadap fungsi fungsi keuangan
 Grestenberg
Bagaimana bisnis yang diselenggarakan untuk
memperoleh dana, bagaimana mereka
memperoleh dana, bagaimana menggunakan
mereka dan bagaimana
keuntungan bisnis yang didistribusikan
 J.L.Massie

Manajemen Keuangan adalah kegiatan operasional

bisnis yang bertanggung jawab untuk memperoleh
dan menggunakan dana yang diperlukan untuk
sebuah operasi yang efektif dan efisien
 Howard & Upton

Manajemen Keuangan adalah penerapan fungsi

perencanaan dan pengendalian fungsi Keuangan
 JF Bradley
Manajemen keuangan adalah bidang manajemen
bisnis yang ditujukan untuk penggunaan model
Model
secara
bijaksana & seleksi yang seksama dari
sumber modal untuk memungkinkan unit
pengeluaran untuk bergerak ke arah mencapai
tujuannya.
 Definisi Umum

Manajemen Keuangan adalah suatu kegiatan

perencanaan,penganggaran,pemeriksaan,
pengelolaan, pengendalian, pencarian dan
penyimpanan dana yang dimiliki oleh organisasi
atau perusahaan
KESEHAT
AN
 Sehat adalah suatu keadaan sejahtera yang
sempurna dari fisik,mental dan social yang tidak
hanya terbatas pada bebas dari penyakit atau
kelemahan saja. Health is a state of complete
physical, social and mental well-being, and not
merely the absence of disease or infirmity. ( WHO)
Sehat adalah suatu keadaan sejahtera dari badan
,jiwa dan social yang memungkinkan setiap orang
hidup produktif secara social dan ekonomi ( UU
Kesehatan No 23 tahun 19920
 Kesehatan adalah keadaan sejahtera dari badan,
jiwa, dan sosial yang memungkinkan setiap orang
hidup produktif secara sosial dan ekonomi.

Pemeliharaan kesehatan adalah upaya

penaggulangan dan pencegahan gangguan
kesehatan yang memerlukan pemeriksaan,
pengobatan dan/atau perawatan termasuk
kehamilan dan persalinan.[2]
 Pelayanan kesehatan menurut Depkes RI
(2009)
adalah setiap upaya yang diselenggarakan sendiri
atau secara bersama-sama dalam suatu organisasi
untuk memelihara dan meningkatkan kesehatan,
mencegah dan menyembuhkan penyakit serta
memulihkan kesehatan perorangan, keluarga,
kelompok dan atupun masyarakat
 ADMINISTRASI KEUANGAN
DAN
PEMBIAYAAN KESEHATAN

Adalah :

Perencanaan,penganggaran,pemeriksaan, pengelolaan, pengendalian,

pencarian dan penyimpanan dana yang dimiliki oleh organisasi atau
perusahaan yang menyiapkan upaya yang diselenggarakan sendiri atau secara
bersama-sama dalam suatu untuk memelihara dan meningkatkan kesehatan,
mencegah dan menyembuhkan penyakit serta memulihkan kesehatan
perorangan, keluarga, kelompok dan ataupun masyarakat
PERTEMUAN /KULAIH KEDUA
 What Health Financing
system does

1. Revenue collection
2. Pooling
3. Purchasing
4. Labels can be misleading
5. People at the centre,
 Revenue collection

Rumah tangga.
Organisasi atau perusahaan
Sumber sumber luar negeri ( external resources )

- Melalui pajak
- Kontribusi asuransi wajib atau sukarela.
- Bayaran lansung ( direct out of pocket payments)
- Donasi
 Pooling

Is the accumulation and management of

financial resources to ensure that the financial
risk of having to pay for health care is borne by
all members of the pool and not by the individual
who fall ill.
The main purpose is to spread the financial risk
They have to be paid before the illness occur.
Most Health financing system are prepayment +
 Purchasing

Purchasing is the process of paying for health services

( three main ways :
- One is for government to provide budget directly to his own
health service providers
- The second is for an institutionally separate purchasing
agency ( Health insurance fund or government authority )
to purchase services on behalf of population
- The third is for individual to pay a provider directly for
services
 Labels can be
misleading

How to raise revenues , how to pool them and how to

purchase services
The Choices consider
How: to
Effectiveness
How to, pool
Efficiency How
and to
equitable raise purchase
services
Effectivenss
Efficiency
Equitablity
 People at the
centre

How to People at the How to

raise centre poool

How to
spend
 PERTEMUAN / KULIAH KETIGA

PERMASALAHAN SEHUBUNGAN DENGAN

SISTEM PEMBIAYAAN KESEHATAN
 1.Universal Coverage
1. Alma Alta Declaration (Health For All by the Year 2000 ) Better quality of life and
also to global peace and security.
2. Health as the highest priority in most countries Political issues to get people
expectation
3. Access to health services is also critical This can not be achieved without well-
functioning health financing system

Member states of WHO committed in 2005 to develop their health financing systems so
that all people have access to services and do not suffer financial hardship paying for
them = Universal Coverage = Universal Health Coverage
Governments face three fundamental
questions Striving this goal

How is such a health system to be financed ?

How can they protect people from the financial
consequences of ill-health and paying for health
services ?
How can they encourage the optimum use of
available resources ?
 What is health financing?
Health financing refers to the function of a health
system concerned with the mobilization,
accumulation and allocation of money to cover the
health needs of the people, individually and
collectively, in the health system the purpose of
health financing is to make funding available, as well
as to set the right financial incentives to providers,
to ensure that all individuals have access to
effective public health and personal health care (1).
 Ada Tiga Area Kritis dalam
Pembiayaan Kesehatan

1. Meningkatkan kecukupan uang untuk kesehatan.

( raise sufficient money for health )
2. Menghilangkan hambatan pembiayaan dalam akses
serta menurunkan risiko pembiayaan pada penyakit.
( remove financial barriers to access and reduce financial
risk of illness)
3. Memanfaatkan lebih baik sumber sumber pembiayan
yang didapatkan ( make better use of the available
resources)
 2. Where are we now

The Gap between the rich and the poor.

Closing this coverage gap save lives of > 700 000 women
save > 16 million children ( 2010-2015)
Migrant, ethnic minorities and indigenous people use
services less than other population groups, even though their
needs my be greter
When people do use services, they often incur high,
sometimes catastrophic cost in paying for their care
 2. Where are we now

In some countries, up to 11% of the population suffers this type

of severe financial hardship each year, and up to 5% is forced
into poverty.
Globally, about 150 million people suffer financial catastrophe
annually while 100 million are pushed below the poverty line.
Only one in five people in the world has broad-based social
security protection that also includes cover for lost wages in the
event of illness, and more than half the worlds population lacks
any type of formal social protection, according to the
PERTEMUAN / KULIAH KEEMPAT
 3. How Do We Fix This ?

Three fundamental, interrelated problems restrict countries from

moving closer to universal coverage.
- The first is the availability of resources.
- The second barrier is an overreliance on direct payments at
the time people need care.
- The third impediment to a more rapid movement towards
universal coverage is the inefficient and inequitable use of
resources. At a conservative estimate,
2040% of health resources are being wasted.
 How Do We Fix This ?

The path to universal coverage, then, is relatively simple at least

on paper.

Countries must :
- raise sufficient funds,
- Reduce the reliance on direct payments to finance services,
and
- Improve efficiency and equity.
 1.Raising Sufficient Resources For
Health

49 low-income countries, suggest that, on average

(unweighted), these countries will need to spend a little
more than US$ 60 per capita by 2015, considerably
more than the US$ 32 they are currently spending.
The first step to universal coverage is : to ensure that
the poorest countries have these funds , and these fund
and that funding increase consistently over the coming
years to enable the necessary scale-up
 1.Raising Sufficient Resources For
Health

High- income countries are continually

seeking fund to satisfy growing demand and
expectation from their populations and to pay
fo rapidly expanding technologies and option
for improving health
 1.Raising Sufficient Resources For
Health

1.1.Increase the efficiency of revenue

collection. Even in some high-income countries, tax
avoidance and inefficient tax and insurance premium
collection can be serious problems.

Indonesia has totally revamped its tax system with

substantial benefits for overall government
spending, and spending on health in particular.
1.Raising Sufficient Resources For Health

1.2. Reprioritize government budgets.

Governments sometimes give health a relatively low priority when
allocating their budgets.
For example, few African countries reach the target, agreed to by
their heads of state in the 2001 Abuja Declaration, to spend 15% of
their government budget on health;
19 of the countries in the region who signed the declaration al-
locate less now than they did in 2001.
The United Republic of Tanzania, however, allots 18.4% to health
and Liberia 16.6%
1.Raising Sufficient Resources For
Health

1.3. Innovative financing.

Attention has until now focused largely on helping rich
countries raise more funds for health in poor settings.
The high- level Taskforce on Innovative International
Financing for Health Systems included increasing
taxes on air tickets, foreign exchange
transactions and tobacco in its list of ways to raise
an additional US$ 10 billion annually for global health.
1.Raising Sufficient Resources For
Health

1.4. Development assistance for health.

While all countries, rich or poor, could do more to
increase health funding or diversify their funding
sources, only eight of the 49 low-income countries
described earlier have any chance of generating
from domestic sources alone the funds required to
achieve the MDGs by 2015. Global solidarity is
required.
 2. Removing financial risks and
barriers to access

Almost all countries impose some form of direct payment,

sometimes called cost sharing, although the poorer the country,
the higher the proportion of total expenditure that is financed in
this way.
The most extreme examples are found in 33 mostly low-income
countries, where direct out-of-pocket payments represented more
than 50% of total health expenditures in 2007.
3. PROMOTING EFFICIENCY AND
ELIMINATING WASTE

About 20 -24 % of resources spent on

health
are wasted,
resources that could be redirected toward
achieving universal coverage
3. PROMOTING EFFICIENCY AND
ELIMINATING WASTE

Reducing unnecessary expenditure

on medicine and using them more
appropriately , and improving
quality control , could save
countries up to 5 % of their health
expenditure.
PERTEMUAN /KULIAH KELIMA
PERMASALAHAN PEMBIAYAAN
KESEHATAN
DI DUNIA

1. KETERBATASASN SUMBER SUMBER

PEMBIAYAAN YANG COST EFECTIVE
2. PENDISTRIBUSIAN YANG TIDAK MERATA
3. PENGALOKASIAN YANG TIDAK ADAIL
Recommended core indicator

1a: Total expenditure on health

1b: General government expenditure on health
as a proportion of general government
expenditure (GGHE/GGE)
2: The ratio of household out-of-pocket payments
for health to total expenditure on health
 REFORMASI PEMBIAYAAN
KESEHATAN
( HEALTH FINANCE REFORM )
PADA
BEBERAPA NEGARA
 Financial risk protection and income
replacement: maternity leave

Most industrialized countries allocate considerable

resources for maternity leave.
In 2007, Norway spent more than any other, allocating
US$ 31 000 per baby, per year, for a total US$ 1.8 billion.
In contrast most low- and middle-income countries report
zero spending on maternal leave, despite the fact that
several have enacted legislation guaranteeing it. This
may be due to laws going unenforced but may also be
explained by the fact that in some countries, maternity
leave does not come with any income replacement
element.
 Thailand redraws the line in
health-care coverage
When, in 2002, Thailand introduced its universal coverage
scheme, which was then called the 30 bhat scheme, it offered
comprehensive health care that included not just basics, but
services such as radiotherapy, surgery and critical care for
accidents and emergencies. It did not, however, cover renal-
replacement therapy.
In 2006 Noksakul founded the Thai Kidney Club, which has raised
kidney patients awareness of their rights and put pressure on
the National Health Security Office to provide treatment.
Finally, in October 2008, the then public health minister, Mongkol
Na Songkhla, included renal-replacement therapy in the scheme.
 Perbaikan Perpajakan di
Indonesia
Even before the 19971998 Asian crisis, non-oil tax collection in
Indonesia was on the decline, reaching a low of 9.6% of GDP in 2000.
The tax policy regime was complicated and tax administration weak.
At the end of 2001, the Directorate General of Taxation (DGT) decided to
simplify the tax system and its administration. The aim was to
encourage voluntary compliance, whereby taxpayers would self-assess,
then pay the tax on income declared.
Performance and efficiency were improved partly by digitizing a
previously paper-based process. Positive results followed, with the tax
yield rising from 9.9% to 11% of non-oil GDP in the four years after
implementation.
The additional tax revenues meant that overall government spending
could be increased; health spending rose faster than other.
 To hypothecate or not to
hypothecate?
Hypothecated taxes, sometimes called earmarked taxes, are those
designated for a particular programme or use. Examples include TV
licence fees that are used to fund public broadcasting and road tolls that
are used to maintain and upgrade roads.
The Western Australian Health Promotion Foundations Healthway was
created in 1991 on this basis, funded initially out of an increased levy on
tobacco products,
while the Republic of Korea instituted a National Health Promotion Fund
in 1995 funded partly from tobacco taxes (40).
The Thai Health Promotion Fund, established in 2001, was financed with
a 2% additional surcharge on tobacco and alcohol (41, 42). Ministries of
health are often in favour of these taxes because they guarantee
funding, particularly for health promotion and prevention.
 Strength in numbers
Policy-makers planning to move away from user fees and other forms of direct payments have three
interrelated options.
The first is to replace direct payments with forms of prepayment,
The second is to consolidate existing pooled funds into larger pools, and
The third is to improve the efficiency with which funds are used (this is the topic of Chapter 4).
In most high-income countries, collecting and pooling happens at the level of central government with the
collecting and pooling functions split between the ministry of finance, or the treasury, and the ministry of
health.
The Republic of Korea, for example, chose to merge more than 300 individual insurers into a single national
fund (59). But there are exceptions.
Swiss citizens have voted overwhelmingly to keep multiple pools rather than go for a single caisse unique and
resources are pooled for smaller groups of people (60).
The Netherlands has had a system of competing funds since the early 1990s (61). In both cases, insurance
contributions are compulsory and both governments seek to consolidate the pools, at least to some extent,
through risk equalization, whereby money is transferred from insurance funds that service a greater
proportion of low-risk people to those that insure predominantly high-risk people and thereby incur higher
costs.
Nevertheless, experience suggests that a single pool offers several advantages, including greater efficiency
(see Chapter 4) and capacity for cross-subsidization within the population.
The people and businesses in richer regions with fewer health problems generally contribute more to the pool
in taxes and charges than they receive, while those living in poorer regions with greater health problems
receive more than they contribute. Some countries also use complex allocation formulae to decide what are
fair allocations to the various geographical areas and facilities (63).
 The Republic of Moldova entitlement issues
The Republic of Moldova introduced a national system of mandatory
health insurance in 2004.
The shift in the basis of entitlement from being a citizen of the Republic of
Moldova to being an individual who pays a premium has meant that about
one quarter of the population (27.6% in 2009) has inadequate access to
health care.
Another law was passed in February 2009, which ensures that all those
registered as poor under the recently approved Law on Social Support will
automatically receive fully subsidized health insurance.
Coverage concerns were further addressed through legislation approved in
December 2009 that expanded significantly (e.g. all primary care) the
package of services for all citizens regardless of their insurance status.
Despite some persisting equity issues, the centralizing of all public funding
for health care and the split between purchasing and providing functions
has led to greater geographical equity in government health spending per
capita since the health insurance reform was introduced in 2004 (90).
Core ideas for reducing financial barriers
Pooling pays Countries can make faster progress towards universal coverage by introducing
forms of prepayment and pooling to take advantage of the strength in numbers.
Consolidate or compensate There are opportunities for improving coverage by consolidating
fragmented pools, or by developing forms of risk compensation that enable the transfer of funds
between them.
Combine tax and social health insurance Where the funds come from does not have to determine
how they are pooled. Taxes and insurance contributions can be combined to cover the population
as a whole, rather than being kept in separate funds.
Compulsory contribution helps Countries that have come closest to universal coverage use some
form of compulsory contribution arrangement, whether they are funded by general government
revenues or mandatory insurance contributions. This allows the pooled funds to cover the people
who cannot pay found in all societies.
Voluntary schemes are a useful first step Where the wider economic and fiscal context allows for
only low levels of tax collection or compulsory insurance contributions, voluntary schemes have
the potential to provide some protection against the financial risks of ill health and might help
people understand the benefits of prepayment and pooling. But experience suggests that their
potential is limited.
Drop direct payment Only when household direct payments get to 1520% of total health
expenditures does the incidence of financial catastrophe decline to negligible levels, although
countries and regions might wish to set themselves intermediate targets as we reported earlier for
the South-East Asia and the Western Pacific Regions of WHO.
The relative efficiency of public and private service
delivery
Most available studies have focused on the efficiency of hospitals, responsible for about 4569%
of government health spending in subSaharan Africa (42).
Hollingsworth (41) recently conducted a meta-analysis of 317 published works on efficiency
measures and concluded that, if anything, public provision may be potentially more efficient
than private. However, country studies suggest that the impact of ownership on efficiency is
mixed.
Lee et al. (43) determined that non-profit hospitals in the USA were more efficient than for-profit
hospitals.
On the other hand, Swiss hospital efficiency levels did not vary according to ownership (44, 45).
In Germany, some studies found private hospitals less technically efficient than publicly owned
hospitals, others concluded the inverse, while yet others found no difference at all (46, 47).
There is a dearth of studies measuring the relative efficiencies of public and private health
facilities in low- and middle-income countries.
Masiye (48) is perhaps the only study that has reported on the significantly positive effect of
private ownership on efficiency in Zambian hospitals (mean efficiency for private hospitals was
73% compared with 63% for public hospitals).
 Lebanons reforms: improving health system
efficiency, increasing coverage and lowering out-
of-pocket spending
In 1998 Lebanon spent 12.4% of its GDP on health, more than any other country in
the Eastern Mediterranean Region. Out-of-pocket payments, at 60% of total health
spending, were also among the highest in the region, constituting a significant
obstacle to low- income people.
Since then, a series of reforms has been implemented by the Ministry of Health to
improve equity and efficiency. The key components of this reform have been: a
revamping of the public-sector primary-care network; improving quality in public
hospitals; and improving the rational use of medical technologies and medicines.
The latter has included increasing the use of quality-assured generic medicines.
Utilization of preventive, promotive and curative services, particularly among the
poor, has improved since 1998, as have health outcomes.
Reduced spending on medicines, combined with other efficiency gains, means that
health spending as a share of GDP has fallen from 12.4% to 8.4%. Out-of-pocket
spending as a share of total health spending fell from 60% to 44%, increasing the
levels of financial risk protection.
 Global variation in recourse to
Caesarean section
The number of Caesarean sections varies enormously between countries,
with richer ones and those in transition having excessive recourse to the
procedure, and economically deprived countries, mainly in Africa, failing to
meet demand.
Data for Caesarean sections performed in 137 countries in 2007 show that
in 54 countries, Caesarean births represented less than 10% of all births;
in 69 countries, the percentage was more than 15%. Only 14 countries
reported rates in the recommended 1015% range.
Unnecessary global Caesarean sections in 2008 outnumbered necessary
ones. Because of the overwhelming concentration of excess Caesarean
sections in countries with high income levels (and therefore high price
levels), the cost of the global excess Caesarean sections in 2008 could
have potentially financed needed procedures in poorer countries nearly 6
times over.
PERTEMUAN KULIAH KEENAM

PEMBIAYAAN KESEHATAN PADA FASILITAS

APAKAH EFISIENS ?
PEMBIAYAAN SEKTOR
KESEHATAN

PELAYANAN PUBLIK
PELAYANAN PERORANGAN

Public goods

:
Pertama, pemakaian jasa kepada seseorang tidakmengurangi jatah bagi orang lain yang ingin
menggunakannyasehingga tidak perlu berebut. Sifat ini disebut non-rivalry

Sifatkedua non-excludable,
artinya adalah tidak mungkin ataumahal sekali untuk mencegah orang menggunakannya, walaupun
yangbersangkutan tidak mau membayar jasa pelayananan ini. Contoh yangpaling terlihat adalah
penyuluhan kesehatan melalui radio atau televisiyang tidak mungkin mencegah orang menikmati jasa
pelayananpenyuluhan walaupun yang bersangkutan tidak membayar biaya penyuluhan

Sifat ketiga, adanya eksternalitas positif

yaitu pelayananjasa publik kepada seseorang akan menimbulkan pengaruh kepadaorang lain yang tidak
menggunakan. Contoh eksternalitas yang positifadalah pemberian jasa imunisasi kepada satu anak akan
mengurangirisiko penularan penyakit kepada anak lain

Katzand Rosen (1998)

 Private goods

Mempunyai sifat sebaliknya yaitu pemakaian

jasakepada seseorang akan mengurangi jatah bagi
orang lain yang inginmenggunakannya,
Bersifat excludable
Walaupun mungkin mempunyai eksternalitas positif
 Informasi
Pada tahun 2000 , Bidan Agnes membangun sebuah Rumah Bersalin ( Bidan
Praktek Swasta ) seluas 300 m2 dengan biaya pembangunan Rp 3 juta / m2 ,
diatas lahan seluas 1000 m2 yang dia beli seharga Rp 100.000 /m2. Selain
membangun gedung pada tahun 2001 dia juga membeli peralatan medis yang
umur pemakaiannya selama 3 tahun senilai Rp 500 juta serta perabot senilai Rp
250 juta.Rumah Bersalin ini mulai difungsikan pada tahun 2002. Selain Bidan
Agnes , pada RB tersebut dipekerjakan pula 6 orang Bidan yang digaji Rp 3 juta/
bulan. Tenaga administrasi 3 orang dengan gaji Rp 2 juta/ bulan , serta 2 orang
tenaga pembantu lainnya yang digaji Rp 1, 5 juta/ bulan. Untuk operasional RB
tersebut dia membelanjakan untuk obat2an dan alkes habis pakai sebesar Rp 5
juta / bulan , makanan ibu bersalin sebesar Rp 5 juta/bulan. Membayar biaya
listrik sebesar Rp 1 juta perbulan dan telpon Rp 250 ribu/bulan. Setelah
berfungsi pada tahun 2002 melayani pemeriksaan ibu hamil sebanyak 20 orang
ibu hamil perhari kerja . Serta persalinan sebanyak 10 orang rata rata perbulan .
Dia mempergunakan tariff konsultasi Ibu hamil sebesar Rp 50.000/ kunjungan.
Serta tariff persalinan sebesar Rp 5 juta/ ibu bersalin.
Dengan kehadiran Rumah Bersalin Agnes , maka jumlah kematian Ibu yang
selama ini rata rata 3 orang / tahun turun menjadi 2 orang /pertahun
 Tugas

Apa saran anda terhadap

bidan Agnes ??
 RB Bidan Agnes
Tanah = 1000 x Rp 100 000 = Rp 100 juta
Gedung = 300 x 3 juta = Rp 900 juta Rp 45 juta
Peralatan Medis = Rp 500 juta Rp 167 juta
Perabot = Rp 250 juta Rp 84 juta
Gaji = 6 x Rp 3 juta + 3 x Rp 2 juta + 2 x Rp 1,5 juta = Rp 27 juta x12= Rp
324 juta
Listrik = 12 x Rp 1 = Rp 12 jta
Telpon = 12 x Rp 250 ribu = Rp 3 juta
Fixed Cost = Rp 45juta + Rp 167 juta + Rp 84 juta + Rp 324 juta + Rp 12 juta+ Rp 3 Juta
= Rp 635 juta
Obat2an+ Alkes = 12 x Rp 5 juta = Rp 60 juta Variable cost = Rp 60 juta
Makanan = 12 x Rp 5 = Rp 60 juta
Total Cost = Rp 635 juta + Rp 60 juta = Rp 695 juta
Pemeriksaan Ibu hamil = 12 x 24 x 20 orang = 5760 ibu hamil x Rp 50 000 = Rp 288 juta
Persalinan = 12 x 10 = 120 orang x Rp 5 juta = Rp 600 juta
Penerimaan ( revenue ) = Rp 288 juta + Rp 600 juta = Rp 888 juta
Net Profit = Revenue - Cost
 Break Even Point ( BEP )

In simple words, the break-even point can be defined

as a point where total costs (expenses) and total sales
(revenue) are equal. Break-even point can be described as
a point where there is no net profit or loss. The firm just
breaks even. Any company which wants to make
abnormal profit, desires to have a break-even point.
Graphically, it is the point where the total cost and the
total revenue curves meet
 Penerapan
Perhitungan Nilai Profit Margin Ratio di Rumah Sakit
Lihat table 12.1

DEFINITION of 'Profit Margin'

A ratio of profitability calculated as :
net income divided by revenues,
or
net profits divided by sales.
It measures how much out of every dollar of sales a company actually keeps in earnings.
Net income atau earning di Rumah Sakit dapat diartikan sebagai keuntungan
sedang revenues dapat diartikan sebagai Penerimaan Rumah Sakit dari Pelayanan
yang diberikan kepada pasien
Penerimaan RS dari pelayanan yang diberikan kepada pasien =
( jumlah pelayanan dari masing masing pelayanan X tariff dari masing masing pelayanan )
 Keterangan
- Profit margin ratio = pendapatan setelah keluar pajak/ jumlah penerimaan dari
pelayanan yang diberikan
- Gross Profit = Laba kasar = Penjualan atau Penerimaan) belanja ( biaya )
- Gross Profit Ratio = Laba Kasar / Net Sales
- Return of Investment = Pendapatan keseluruhan / total aset
- Return of equity = Pendapatan setelah keluar pajak/ equity
- Cost Efficiency = (Belanja pasar + Administrasi + biaya umum) / penerimaan
- Employees ratio = gaji / penerimaan
- Operating rationya = (Biaya pelayanan yang diberikan + Belanja pasar + adm
dan
biaya umum ) / penerimaa.
 Profit Margin Ratio
Provit Margin Ratio = Earning after Tax / Net Sales
= pendapatan setelah keluar pajak/ penjualan
murni
Penjualan Murni = adalah total penerimaan dikurangi biaya penjualan biaya
kompensasi - potongan harga penjualan .
(Net sales is total revenue, less the cost of sales returns,
allowances, and discounts.)
Earning = The amount of profit that a company produces during a
specific period, which is usually defined as a quarter
(three calendar months) or a year
Dengan definisi ini maka earning dapat juga diartikan sebagai keuntungan atau Profit
 1. Profit

Laba kasar(Gross Profit ) = Penerimaan Belanja

= Rp 888 juta Rp 755 juta = Rp
133 juta
Gross Profit Ratio = ( Rp 133 juta / Rp 888 juta ) 100 %
= 14,9 %
Net Profit = ( Rp 888 Rp 88,8 ) juta Rp 755
juta = Rp 44.2 juta
Profit Margin Ratio = ( Rp 44.2 / Rp 888 ) 100 % = 4,98 %
NET PROFIT MARGIN
RETURN OF INVESTMENT
 1.PROFIT RATIO

2014 2015

PROFIT RATIO 25 % 53 %

RUMAH SAKIT A RUMAH SAKIT B

PROFIT RATIO 42 % 27 %
2. Return of Investment

Rp 888.000 000 Rp 755000 000

____________________________ X
100 % = 7,6%
Rp 1 750 000 000

Butuh waktu 100 : 7,6 = 13 tahun

 3. Waktu yang diperlukan untuk BEP

Belanja = Rp 635 juta + X x Rp 120 juta

Penerimaan = Rp 888 juta / tahun
Rp 635 juta + X x Rp 120 juta = X x Rp 888 juta
Rp 635 juta = X ( Rp 888 juta 120 juta )
X = Rp 635 juta / 768 juta
= 0.83 tahun = 10 bulan
Jumlah Pelayanan = 10 x 24 x20 = 4800 ibu hamil
= 10 x 10 persalinan = 100 persalinan
Adapun rumus untuk menghitung Break Even Point ada 2 yaitu :
1. Rumus BEP untuk menghitung berapa unit yang harus dijual agar terjadi
Break Even Point :

Total Fixed Cost

__________________________________
Harga jual per unit dikurangi variable cost
Contoh :
Fixed Cost suatu toko lampu : Rp.200,000,-
Variable cost Rp.5,000 / unit
Harga jual Rp. 10,000 / unit
Maka BEP per unitnya adalah

Rp.200,000
__________ = 40 units
Rp 10,000 5,000

Artinya perusahaan perlu menjual 40 unit lampu agar terjadi break even point.
Pada pejualan unit ke 41, maka toko itu mulai memperoleh keuntungan
2. Rumus BEP untuk menghitung berapa uang penjualan
yang perlu diterima agar terjadi BEP :
Total Fixed Cost
__________________________________ x Harga jual
/ unit
Harga jual per unit dikurangi variable cost

Dengan menggunakan contoh soal sama seperti diatas

maka uang penjualan yang harus diterima agar terjadi BEP
adalah

Rp.200,000
 6.Employee Ratio

Jumlah Gaji / Jumlah Penerimaan

= ( Rp 324 juta / Rp 888 juta ) x 100 % = 36,5 %
 Penerapan
Perhitungan Employees Ratio di
Rumah Sakit

Employee Ratio
=
Employee Salaries / Net Sales
 Penerapan
Perhitungan Operating Ratio
Lihat Tabel 12.6

Operating Ratio
=
Cost of Goods Sold + Adm.& Gen.
Expences/ Net Sales
=
Jasa Pelayanan + Biaya Umum dan Adm./
PERTEMUAN / KULIAH KETUJUH

UNIT COST DAN TARIF

 JENIS BIAYA PADA FASILITAS
Biaya awal ( Modal ) adalah biaya-biaya
yang harus dikeluarkan pada awal sebelum
kegiatan produksi diselenggarakan.
Biaya operasi dan perawatan sistem adalah
biaya untuk mengoperasikan sistem agar
sistem dapat beroperasi dengan baik dan
juga merupakan biaya untuk merawat
sistem dalam masa pengoperasionalannya.
 Fixed Cost

Biaya tetap adalah biaya yang timbul akibat

penggunaan sumber daya tetap dalam proses produksi.
Sifat utama biaya tetap adalah jumlahnya tidak
berubah walaupun jumlah produksi mengalami
perubahan (naik atau turun). Keseluruhan biaya tetap
disebut biaya total (total fixed cost,TFC). Contoh dari
biaya tetap yaitu membeli mesin produksi dan
mendirikan bangunan .
 Variabel Cost

Biaya variable atau sering disebut biaya variable

total (total variable cost, TVC) adalah jumlah biaya
produksi yang berubah menurut tinggi rendahnya
jumlah output yang akan dihasilkan. Semakin besar
output atau barang yang akan dihasilkan, maka
akan semakin besar pula biaya variable yang akan
dikeluarkan.
 Modal Operasion
al
Tanah , Gedung , Gaji, Pemeliharaan ,
Fix Cost ( Biaya Tetap Peralatan , listrik , air ,telpon
) Pendidikan

, obat-obatan ,
Variable Cost (Biaya makanan
Peubah )
 Incremental atau Marginal Cost
Biaya marginal adalah perubahan biaya total akibat
penambahan satu unit output (Q). Biaya marginal timbul akibat
pertambahan satu unit output

Oleh karena tambahan produksi satu unit output tidak akan

menambah atau mengurangi biaya produksi tetap (TFC), maka
tambahan biaya marginal ini akan menambah biaya variable total
(TVC).
 Biaya Lansung ( Direct cost )
Biaya Langsung merupakan biaya yang dapat dengan
mudah dan meyakinkan ditelusuri ke objek biaya tertentu.
Konsep biaya langsung tidak hanya mencakup biaya
bahan baku dan biaya tenaga kerja saja.
Jika sebuah perusahaan membebankan biaya ke berbagai
kantor di berbagai wilayah penjualan, maka gaji manajer
di kantor penjualan pada suatu wilayah merupakan biaya
langsung bagi wilayah penjualan tersebut.
Direct costs refer to materials, labor and expenses related
to the production of a product.
 Biaya tidak langsung (indirect cost)

Biaya tidak langsung (indirect cost) merupakan biaya yang

tidak dapat dengan mudah dan meyakinkan ditelusuri ke objek
biaya tertentu. Contoh: dikaitkan dengan produk, gaji manajer
pabrik merupakan biaya tdk langsung, karena biaya ini sama
sekali tidak disebabkan oleh proses pembuatan produk.

Other costs, such as depreciation or administrative expenses,

are more difficult to assign to a specific product, and therefore
are considered indirect costs.
There are two types of indirect costs:

- One are the fixed indirect costs which contains

activities or costs that are fixed for a particular
project or company like transportation of labor to the
working site, building temporary roads, etc.

- The other are recurring indirect costs which contains

activities that repeat for a particular company like
maintenance of records or payment of salaries.
 Direct Cost
Tenaga
( gaji)

Manajemen ( gaji ) Listrik , air , telepon

( tagihan )

Peralatan ( harga) Laboratorium Bahan ( harga )

Gedung
( harga )
 Total Cost

Biaya total (total cost) adalah

keseluruhan biaya yang terjadi pada
produksi jangka pendek. Biaya total
diperoleh dari :
TC = TFC + TVC
 Recurring and Nonrecurring Cost

Recurring cost (biaya berulang) adalah biaya-biaya

operasi dan pemeliharaan yang terus terjadi
selama masa hidup system. Contoh dari recurring
cost ialah pembelian suku cadang dari mesin
produksi.

Sedangkan nonrecurring cost (biaya tidak

berulang) merupakan kebalikannya, ialah biaya-
biaya yang hanya terjadi sekali. Contoh dari
nonrecurring cost ialah biaya pembuatan pabrik.
 Sunk or Past Cost

Sunk cost ialah Biaya-biaya yang telah

dikeluarkan/diterima sebelum terjadinya suatu
keputusan. Contoh dari sunk cost ialah biaya
yang dikeluarkan rapat dan penelitian
 Contoh kasus untuk dihitung
pembiayaannya
Rumah sakit A dibangun pada tahun 2000- th 2004 dengan biaya Rp 40 Milyar
Luas Rumah Sakit ini adalah 5300 m2 diatas lahan 4 Ha.
Bersamaan dengan pembangunan Rumah Sakit ini diadakan pula peralatan medis dan non medis senilai
Rp 30 Milyar. Peralatan ini memerlukan biaya pemeliharaan pertahun sebesar Rp 6 00 000 000.
Sejak tahun 2004 Rumah Sakit yang memiliki 100 tempat tidur ini mulai difungsikan dengan jumlah
pegawai 135 orang dengan jumlah gaji pertahun sebesar Rp 4 860 000 000.
BOR Rumah Sakit meningkat secara pelahan mulai 45 % , 56 % , 60 % , 65 % dan 70 % pada tahun 2004,
2005, 2006,2007 dan 2008. Jumlah pasien rawat jalan ada 2250 , 2700,2900,3000 dan 3250 kunjungan
pertahun.
Biaya operasional yang dipakai oleh Rumah Sakit ini pada tahun 2008 adalah Rp 9,5 M dari rawat inap dan
Rp 5 M dari rawat jalan .Sedang penerimaan dari pelayanan pasien adalah sebesar 15 Milyar.
Setiap hari Loundry mencuci 100 buah baju operasi biaya Total sebesar Rp 100 000.- Kalau akan mencuci
sebanyak 120 buah maka perlu penambahan biaya sebesar Rp 10 000.-
Setiap tahun Rumah Sakit ini membeli obat obatan sebesar Rp 8 M
 Isi kotak yang sesuai
Rp
40M 30 M 8M 0,6 M 4,86 M 500 1000 3 jt /bln
Capital Cost V v
Operational Cost V V V V
Direct cost V
Non Direct cost V
Fixed Cost V V V V V
Variable cost V
Incremental Cost V
Unit Cost V
Maintenance Cost V
Sun Cost
Recurring cost V V V
Non Recurring cost V V
 Unit Cost

Secara sederhana unit cost dapat diartikan sebagi

biaya per unit produk atau biaya per pelayanan.
Sedangkan menurut Hansen&Mowen (2005) unit
cost didefinisikan sebagai hasil pembagian antara
total cost yang dibutuhkan dengan jumlah unit
produk yang dihasilkan. Produk yang dimaksud
dapat berupa barang ataupun jasa.
 Tarif = Unit Cost + Constant
Constanta = benefit
~ Ability to pay
+ Willingness to pay + benchmarking
 PERSIAPAN PERHITUNGAN UNIT
COST

1. Bentuk Tim Perhitungan Unit Cost dengan SK

Direktur Semua Unit pelayanan dan
Bagian/Bidang harus diikutkan.
2. Tentukan Tugas masing anggota Tim
3. Buat jadwal kegiatan.
 PRAKTEK PERHITUNGAN UNIT
COST
1. Tentukan unit pelayanan yang berproduksi
( contoh : Unit Pelayanan Radiologi )
2. Tentukan jenis jenis produksi atau pelayanan pada Unit tersebut
( Contoh : Foto thoraks , CT Scan , USG dan lain-lain )
3. Hitung biaya yang terpakai pada setiap unit tersebut
- Direct cost.
- Indirect cost
- Overhead cost
4. Jumlahkan seluruh biaya yang terdistribusi ke Unit Pelayanan tersebut
5. Tentukan jumlah biaya yang terdistribusikan pada setiap jenis produksi /
pelayanan 6. Bagi jumlah biaya untuk setiap jenis pelayanan dengan jumlah
prodiksi pada setiap pelayanan ( Jumlah biaya / jumlah pelayanan foto thorax )
 1. Direct cost directly to cost
Capit 2. Capital cost to cost center
center
al 2 3. Support cost to other support
cost cost
4. Support Center to other cost
1 Suppor center
t 3 5. Cost each patient based
Suppor
t
Suppor 4
t
Servic
Direct e
cost
Servic
e 5
Servic
e
Patien
t
care
Patien
4.1 Cost Allocation data
Baiaya Unit Biaya Dasar Jam Luas m2 Kg cucian
lansung Output lansung pengalokasi produksi pertahun
pertahun pertahun perunit an pertahun
Overhead
Departement
- Administrasi 2 000 000 Jam - 200 000 30 000 0
produksi
- Rumah Tangga 1 500 000 m2 300 000 4 80 000
000
- Cuci 1 300 000 kilogram 200 000 8 0
000
- Lain lain 10 200 000 300 000 158 120 000
000
Sub total 15 000 000 1000 000 200 000
Final Departement
- Laboratorium 4 000 000 8000 000 0,5 / DBS 250 000 30 000 25 000
Unit
4.2. Method 1 Ignore
overhead

Lab Cost / DBS Unit = $ 4000 000 /8000 000

=
$ 0,5 /DBS Unit
DBS = Dominion Bureau of Statistic
NICU Cost /patient day = $ 500 000 /5000
4.3 . Method 2. Direct Allocation cost

Baaya Lab = Biaya lansung + bagian dari administrasi+ bagian dari

rumah tangga + bagian dari cuci = 4000 000 + 250 000/2000 000 ( 2000
000 ) + 30 000/600 000 ( 1500 000) + 25 000/1 300 000 ( 1 300 000 ) = 4000 000
+ 250 000 + 75 000 + 25 000 = 4 350 000 . Biaya Laboratorium / DBS Unit =
4350 000/ 8000 000 = $ 0,54 / DBS unit

Biaya NICU = Biaya lansung + bagian dari administrasi + bagian dari

rumah tangga + bagian dari cuci
= 500 000 + 50 000/ 2000 000 ( 2000 000 )+ 8 000 / 600 000 ( 1 500 000) + 75
000/ 1 300 000/ ( 1 300 000 ) = 500 000 + 50 000 + 20 000 + 75 000 = $ 645 000
Biaya NICU /pasien/hari = $ 645 000 / 5000 = $ 129 / pasien/hari
4.4. Metod 3. Step down allocation of overhead
(Note: Allocation denominator = sum of remaining department in the step down sequence)
Admn Rum.Tan Cuci Lain Lab NICU Lain-lain v
gga lain
Biaya Lansung 2 000 000 1 500 000 1 300 10 200 4000 500 000 30 500 50
000 000 000 000 M
Allokasi Administrasi 2 000 000 3/28= 2/28= 3/28= 2.5/28= 0,5/28= 17/28=
214 286 142 857 214 286 178 571 35 714 1 214 286
Allokasi Rumah 1 714 286 8/766 = 158/766= 30/766= 8/766 = 562/766=
Tangga 17 904 353 599 67 139 17 904 1 257 740

Allokasi Cuci 1460 120/1420 25/1420 75/1420 1200/1420

761 = 123 445 = 25 = 77 =
718 153 1 234 446
Biaya Total 10 891 4 271 630 771 34 206 50M
330 428 472
Unit 8000 5000
000
Unit Cost = biaya $ $ 126
perunit 0.53 15
/DBS /pasien/h
unit r
4.5. Method 4Step down with iterations ( Note; Allocation denominator = sum all departments except the
one being allocated
Admn. R.tangg Cuci Lain-lain Labor. NICU Lain-lain v
a
Iteration 1

Biaya lansung 2000 000 1 500 000 1 300 000 10 200 000 4000 000 500 000 30 500 000 50 M
Allokasi Administrasi 2000 000 3/28=214 286 2/28=142 3/28=214 286 2.5/28=178 571 0.5/28=3571 17/28=1214286
857 4
Allokasi Rumah Tangga 30/796=64 1 714 286 8/796=172 158/796=340 30/796=64 609 8/796=17 562/796=1 210
609 29 273 229 338
Allokasi Cuci 0/1500=0 80/1500=778 1460086 120/1500=116 25/1500=24335 75/1500=730 1200/1500=116
71 807 04 8069
Jumlah baru 64 609 77 871 0 10 871 360 4 267 515 625 947 34 092 693 50 M
Iteration 2

Allokasi Administrasi 64 609 3/28 = 6 922 2/28 = 4 3/28 = 6 922 2.5/28 = 5 769 0.5/28 = 1 17/28 39 227
615 154
Allokasi Rumah Tangga 30/796 = 3 84 793 8/796 = 158/796=16 30/796 = 3 196 8/796 = 852 562/796 = 59
196 852 831 869
Allokasi Cuci 0 / 1 500 = 80/ 1 500 = 5 467 120/1 500 = 25/1 500 = 91 75/1 500 = 1 200/1 500 = 4
0 292 437 273 374
Jmulah baru 3 196 292 0 10 895 556 4 276 571 628 226 34 196 160 50 M
Iteration 3

Allokasi Admin 3 196 3/28 = 342 2/28 = 228 3/28 = 342 2,5/28 = 285 0.5/28 = 57 17/28 = 1 940

Allokasi Rumah Tangga 30/796 = 24 634 8/796 = 6 158/796 = 126 30/796 = 24 8/796 = 6 562/796 = 448

Allokasi Cuci 0/1 500 = 0 80/1 500 =12 234 120/1 500 = 19 25/1 500 = 4 75/1 500 = 1 200/ 1 500
 Tabel 4.6. Method 5-Simultaneous Allocation ( reciprocal method)
(Note ; Allocation denominator= sum of all departments
Admin C1 = 2000 000 + (2/30) C1 + (30/800) C2
Rumah Tangga C2 = 1 500 000 + ( 3/30 ) C1 + ( 4/800 ) C2 + ( 80/1 500) C3
Cuci C3 = 1 300 000 + ( 2/30 ) C1 + ( 8 / 800 ) C2
Laboratorium C4 = 4000 000 + ( 2.5/30 ) C1 + ( 30/8000 ) C2 + ( 25/ 1 500 ) C3
NICU C5 = 500 000 + ( 0.5/30 ) C1 + 8 /800 ) C2 + ( 75/1 500 ) C43
( 28/ 30 ) C1 ( 30/800 ) C2 = 2000 000
- (3/30 ) C1 + ( 796/800 ) = 2000 000

(-2/30)C1 + (-8/800)C2 + C3 = 1 300 000

( - 2.5/30 ) C1 ( 30/800 ) C2 (25/1500 ) C3 + C4 = 4000 000

( 0.5/30 ) C1 ( 8/800 ) C2 ( 75/ 1500 ) C1 + C5 = 500 000

Penyelesaian persamaan persamaan Ini adalah :

C1 = 2 215 531

C2 = 1 808 772

C3 = 1 465 790

C4 = 4 276 886

C5 = 628 304

Untuk itu biaya per unit dari out put adalah :

Table 4.7. Method 6-Patient-day allocation of
overhead

This is the simple method described in the footnote 1 and 2.

It may be useful in some cases.
Laboratory cost would be charged without overhead $ 0.50/DBS
unit.
NICU cost would be the direct cost of S 500 000. plus a share of all
relevant other departments ( 2,0M + 1,5 M + 1.3 M = 4.8 M) in
proportion to patient day
( 5 000/500 000 where the denominator is total annual hospital
patient- days). Thus,
NICU cost = $ 500 000 + 4 800 000 ( 5000/500 000) = $ 548 000.
Footnote 1.
In principle and (with great effort), in practice, it is possible to identify, measure,
and value each depleted resource( eg drugs,nursing time,light,food , etc) in
treating a specific patients or group of patients. While this yields a relatively
accurate cost estimate, the detailed monitoring and data collection are usually
prohibitively expensive . The other broad alternative costing start with the
institutions total cost for particular period and then to improve upon the method
of simply dividing by the total patient-day to produce an average cost-per-day .
Quite sophisticated methods of cost allocation to individual hospital departments
or ward have been developed, as illustrated by Boyle, Torrance, Horwood, and
Sinclair ( 1982) with respect to neonatal intensive care. An intermediate method
involves acceptance of the component of the general per diem relating to hotel
cost ( since these are relatively invariant across patients) combined with more
precise calculation of the medical treatment cost associated with specific patients
in question. Foe an example of this intermediate approach see Hull, Hirsh, Sackett,
and Stoddart ( 1982 ). Of course , the effort devoted to accurate perdiem
estimates depends upon their overall importance in the study; however ,
unthinking use of perdiem on average cost should be guarded against
Footnote 2 Cost analysis
If a more detailed concideration of cost is required, various methods for allocating
shared( or overhead) costs are available , namely:

(a). Direct allocation ( ignore interaction of overhead department).Each overhead

cost(e.g.central administration, housekeeping) is allocated directly to final cost
centres( e,g.programmes like day surgery; department like wards or
radiology)Program Xs allocated share of central administration is equal to central
administration cost times Program Xs proportion of the allocation basis ( say ,paid
house). Note, Program X s proportion is Program Xs paid hours divided by total paid
hours of all final cost centers, not total paid hours for the whole organization The
latter method would underestimate the cost an all final cost centers.

(b). Step down allocation ( partial adjustments for interaction of overhead

departments). The overhead departments are allocated in a stepwise fashion to all
of the remaining overhead departments and to the final cost centers.
Footnote 2 Cost analysis
( c ) .Step down with iteration ( full adjustment for iteration of
overhead departments). The overhead departments are allocated
in a stepwise fashion to all of the other overhead departments
and to the final cost centers. The procedure is repeated a number
of time ( about three ) to eliminate residual allocated amounts.

( d ) . Simultaneous allocation ( full adjustment for interaction of

overhead departments ). This method uses the same data as (b) or
(e) but it solves a set of simultaneous linear equation to give the
allocation . It gives the same answer as method ( c ) but involves
less work.( The method is shown diagrammatically in fig 4.1 )
 Soal Ujian Administrasi Keuangan dan Pembiayaan
Kesehatan ( 15-12-2014)

1. Hitunglah unit cost dari output pelayanan yang

diberikan pada unit
pelayanan tempat saudara memberi pelayanan.

2. Apa saran saudara terhadap informasi yang

saudara peroleh dari
Rumah Bersalin saudara Agnes berikut ini :
 Pada tahun 2000 , Bidan Agnes membangun sebuah Rumah Bersalin ( Bidan
Praktek Swasta ) seluas 300 m2 dengan biaya pembangunan Rp 3 juta / m2 ,
diatas lahan seluas 1000 m2 yang dia beli seharga Rp 100.000 /m2. Selain
membangun gedung pada tahun 2001 dia juga membeli peralatan medis
yang umur pemakaiannya selama 3 tahun senilai Rp 500 juta serta perabot
senilai Rp 250 juta.Rumah Bersalin ini mulai difungsikan pada tahun 2002.
Selain Bidan Agnes , pada RB tersebut dipekerjakan pula 6 orang Bidan yang
digaji Rp 3 juta/ bulan. Tenaga administrasi 3 orang dengan gaji Rp 2 juta/
bulan , serta 2 orang tenaga pembantu lainnya yang digaji Rp 1, 5 juta/
bulan. Untuk operasional RB tersebut dia membelanjakan untuk obat2an dan
alkes habis pakai sebesar Rp 5 juta / bulan , makanan ibu bersalin sebesar
Rp 5 juta/bulan. Membayar biaya listrik sebesar Rp 1 juta perbulan dan
telpon Rp 250 ribu/bulan. Setelah berfungsi pada tahun 2002 melayani
pemeriksaan ibu hamil sebanyak 20 orang ibu hamil perhari kerja . Serta
persalinan sebanyak 10 orang rata rata perbulan . Dia mempergunakan tariff
konsultasi Ibu hamil sebesar Rp 50.000/ kunjungan. Serta tariff persalinan
sebesar Rp 5 juta/ ibu bersalin.
Dengan kehadiran Rumah Bersalin Agnes , maka jumlah kematian Ibu yang
selama ini rata rata 3 orang / tahun turun menjadi 2 orang /pertahun
 Distinguishing characteristics of health
care evaluation
Are both costs ( input ) and consequences ( outputs ) of
the alternatives examined
It NO YES
NO
is Examines only Examine only cost
consequences
comparison 1A. PartIal EvaluatIon 2. PARTIAL EVALUATION
Of 1B Cost- outcome description
Outcome description Cost Description
Two
YES 3A. PARTIAL EVALUATION 3 B 4.FULL ECONOMIC EVALUATION
or
Efficacy or Effectiveness Cost analysis Cost- minimization analysis
More Evaluaition Cost- effectiveness analysis
Cost- utility analysis
Alternatives Cost-benefit analysis
TYPES OF ANALYSIS

Cost - minimization analysis = Search for the least cost

alternative
Cost - effectiveness analysis = Cost are related to a
single , common effect which may differ in magnitude
between the alternatives program
Cost - benefit analysis = Measure the cost and
concequnces of alternatives in dollars.
Cost utility analysis = Employ utilities as
measure of the value of program effect.
Type of studies Measurement/ Identification of Measurement/
valuation of cost consequences valuation of
in both consequences
alternatives
Cost - Dollars Identical in all relevant respects None
minimization
analysis

Single-effect of interest , Natural unit ( e g life

Cost Dollars common to both alternatives, but years gained, disability-
achieved to different degree days saved. Point of
effectiveness
blood pressure reduction
analysis ect)
Single or multiple effects, not
necessarily common to both
Cost-benefit Dollars alternatives, and common effects Dollars
may be achieved to different by
analysis
the alternatives

Single or multiple effect, not Healthy days or ( more

Cost- Utility Dollars necessarily common to both often ) quality adjusted
alternatives, and common effects life years
analysis
may be achieved to different
1. Break Even Point

Total Fixed Cost

a.
Total Fixed Cost
__________________________________
Harga jual per unit dikurangi variable
cost Total Fixed Cost
b. _ Total Fixed cot________________ x
Harga jual / unit
Harga jual per unit dikurangi variable cost
 Profit margin is calculated with selling price (or
revenue) taken as base times 100. It is the
percentage of selling price that is turned into
profit, where as "Profit Percentage" or "Markup" is
the percentage of cost price that one gets as profit
on top of cost price. While selling something one
should know what percentage of profit one will get
on a particular investment, so companies calculate
profit percentage to find the ratio of profit to cost.
 Creditors and investors use this ratio to measure
how effectively a company can convert sales into
net income. Investors want to make sure profits
are high enough to distribute dividends while
creditors want to make sure the company has
enough profits to pay back its loans. In other
words, outside users want to know that the
company is running efficiently.
 The profit margin ratio, also called the return on
sales ratio or gross profit ratio, is a profitability
ratio that measures the amount of net income
earned with each dollar of sales generated by
comparing the net income and net sales of a
company. In other words, the profit margin ratio
shows what percentage of sales are left over after
all expenses are paid by the business.
 Goods and Services Matrix

excludable
Private Goods
A private good is both
rivalrous and excludable; I
own and drive my sports car.
rivalrous I paid for it, and I drive it.
While I'm driving it, no one
else can. And I don't let
people who didn't pay for my
car drive it anyway.
non-excludable
Common Goods
A common good is rivarlous but
non-excludable; in other words
the supply can be depleted, but
people are not restricted in their
use of the good. Natural
resources can be thought of as
common goods - their supplies
are not infinite, but their
utilization benefits all.
Common goods, because they are
limited but largely available to all,
are susceptible to the Tragedy of
the Commons.

Public Goods
Club or Toll Goods
A public good is both non-
A club or toll good is
rivalrous and non-excludable; you
excludable, but non-rivalrous
and I can enjoy this good at the
(at least to a point); this
non-rivalrous would involve things like
subscriptions to cable TV,
same time without diminishing its
utility, and we didn't have to pay
for it to enjoy it. Public goods are
access to private parks, or
things like breathing air or
even membership in the
enjoying a robust national
European Union.
defense system
Finance in the NHS: your questions
Where does the money come from?

The money for the NHS comes from the

Treasury. Most of the money is raised
through taxation.
What is the money spent on?

Nearly half (47%) of the NHS budget is spent on

acute and emergency care. General practice,
community care, mental health and prescribing
each account for around 10% of the total spend.
The NHS Mandate, issued annually from the
government to NHS
England, sets out what must be achieved in return
for the taxpayer investment in the NHS.
How is money paid to service providers?

Historically, service providers were paid an annual

lumpsum to provide a service locally. These were known
as 'block contracts', and were not linked to the number
of patients seen, the work actually carried out, or the
quality of care provided. In 2003/04 the government
introduced 'Payment by Results' (PbR), an activity based
system that reimburses providers for the work that they
carry out, at an agreed national price. Currently, PbR
represents almost 30% of NHS expenditure. Most of the
remainder is covered by old-style block contracts and
local variations on these. NHS England and local
commissioners are working towards a payment system
How is the budget for
the NHS calculated?

The Treasury holds a Spending Review

every two to three years, through which
the budgets for all major public services
are agreed. Health is a major national
issue: it receives around 107 billion a
year, compared with 53 billion for
education and 25 billion for defence.
 HM Treasury All figures based on HM Treasury
Spending Review 2010 Department of Health
107 billion 96 billion 64 billion NHS England
Clinical Commissioning Groups Locally
commissioned services Nationally commissioned
services Centrally managed projects and services
Arms Length Body funding Public health spending
How the money flows
How does the money flow from the Treasury to patient services?

The Treasury allocates money to the Department of Health, which in turn

allocates money to NHS England. The Department of Health retains a
proportion of the budget for its running costs and the funding of bodies
such as Public Health England.
NHS England currently receives around 96 billion a year from the
Department of Health (2012/13). Approximately 30 billion is retained by
NHS England to pay for its running costs and the services it commissions
directly: primary care (including GP services), specialised services,
offender and military healthcare. The remainder is passed on to clinical
commissioning groups (CCGs) to enable them to commission services for
their populations.
Service providers are paid in a number of different ways (see opposite for
further details). The diagram below illustrates the flow of money from the
Treasury to CCGs.
 How does NHS England decide
how much each CCG gets?

CCG budgets are allocated on a'weighted

capitation' basis. This means that budgets are
set based on the size of the population, and
adjusted for other factors: the age profile of
the population; the health of the population;
and the location of the population.
 S2 Wajo
N0 Nama MINGGU
1 2 3 4 5 6 7 8
1 Megawati
2 Bidya Marsi
3 Madyusri
4 !ndo Asse Tengnge
5 Mila Karmila
6 Kartini
7 Widiastuti
8 Baso Amri
9 Syamsu Marlin
10 Arsyad M
S2 Wajo
N0 Nama MINGGU
1 2 3 4 5 6 7 8
13 St.Dusfirah M
14 Nurhasanah
15 Andi Mammiwati
16 Husmiani
17 Anti Sari
 S2UMI
N0 Nama MINGGU
1 2 3 4 5 6 7 8
1 ERTI
2 DWI ISYANI
3 RITHA ALEA
4 KARTIKA AMIRUDDIN
5 ANDI SITTIMUTHIA DEWI
6 RAHMAWATI ANWAR
7 WAHDA MEIRIANTI
MUCHLIS
8 FAUZIA RIZQI TOUWE
9 RAHMATULLAH
10 YUSNITA NUR AMALIAH A
S2 Wajo
N0 Nama MINGGU
1 2 3 4 5 6 7 8
13 ANATNTO SUAR BAKTI
14 WIDYA NOVIKA
15 SITTI MARYAM
16 ASTIA NURDIN
17 ISMARIATI
18 EKA DEWI LESTARI I
19 HASRIADI A
20 MARIAM NASIR
21 NUR WAHIDA KASIM
22 AHMAD SYUAIB
S2 Wajo
N0 Nama MINGGU
25 1 2 3 4 5 6 7 8
25 NEVA BARRI
26 AGUSMIATY UMRO
H
27 ANDI MUHAMMAD
ALAMSYAH
28 ARWINI
29 AYU WULANDARI KAHAR
30 A.RAUDATUL JANNAH
31 NURUL ISMI SUDIARTI
32 ULFA MUTHMAINAH
33 YULISTIA