Pembiayaan Jasa Rumah Sakit

Era Baru Metode Pembayaran Rumah Sakit

Disampaikan dalam kuliah Blok XXIX

Fakultas Kedokteran UKDW
Heru Adi Prasetya, SE, Ak.,MM,.CA.
 Key points of
accrual accounting
1. Income (revenue) is earned when services are provided. A
patient in a bed is receiving a service.
2. Expenses are the costs of providing material and service
to the parties that receive the service, when the service is
being provided.
3. The timing of when an organization gets paid for the
services it renders, or when it pays for the materials and
services it purchases, is irrelevant to the accrual
accounting method. Cash flow is a separate issue for
consideration.
4. The accurate measurement of profits or losses depends
upon the correct matching of services provided and the
costs of providing these services
 Allocation of Revenue (Income)
• Per Diem:
– Under this type of reimbursement, the hospital or
health system receives an agreed-upon amount
per patient day. For a long time, per diem was the
only method of payment used, but it was cost per
diem. The provider set the price. Now it is
contractual per diem, and the payer generally sets
the price.
 Allocation of Revenue (Income)
• Capitation
– The hospital or health system receives a
fixed amount per enrolled individual per
month or year to cover a specified list of
medical services. The provider is paid
regardless of whether medical services are
used and conversely bears all cost overruns.
 Allocation of Revenue (Income)
• Case Basis:
– Also called prospective payment, this
has been the dominant
reimbursement method due to the
adoption by Medicare of diagnosis-
related groups (DRGs), now called
Medicare severity diagnosis-related
groups (MS-DRGs)
 Depreciation
• Buildings, major equipment, and computers are
fixed assets. They last for a relatively long time
and are disposed of when their productivity
declines due to advances in technology, the high
cost of repairs, and so forth.
• To recognize such items as expenses, we
allocate their cost over their estimated useful
life and enter that dollar amount on the
income statement.
• We call this depreciation.
 Accounting Reports
• Accounting reports are generated on a regular
basis to provide information on the hospital or
health system’s activities and performance.
Regular reporting is necessary for meaningful
comparisons by different audiences Standard
reports include:
1. Statement of Operations and Changes in Net Assets
(also referred to as the Statement of Profit and Loss
or the Statement of Revenue and Expenses)
2. Balance Sheet
3. Statement of Cash Flows
 How Hospitals Are Paid
• Hospitals receive payments from four chief
sources :
1. The federal government, which administers the
Medicare program through regional Medicare
intermediaries or carriers
2. State and local governments, which administer the
Medicaid program through approved carriers
3. Private payers, including non-profit Blue Cross Blue
Shield and commercial insurance companies, which
offer a wide range of healthcare plans.
4. Patients and their families
 How MS-DRG-Based Payment
• Diagnosis Related Groups (DRG) adalah salah
satu jenis sistem pembayaran rumahsakit yang
menggunakan metode casemix.
• Case mixartinya sistem klasifikasi yang
mengkategorisasikan pasien dalam group-
group yang menggunakan sumber-sumber
yang sama.
 Casemixdiklasifikasikan berdasarkan
kondisi pasien, menjadi
1. clinical homogeneity (Pasien yang
mempunyai kondisi klinis yang
sama)
2. resource homogeneity (pasien yang
menggunakan intensitas sumber-
sumber yang sama untuk
pengobatan/terapi)
• Diagnosis Related Groups (DRGs) mencakup
pasien rawat inap yang kondisinya akut (bukan
rawat jangka panjang seperti penyakit jiwa,
hemodialisis dll). Saat ini DRG sedang
dikembangkan di Amerika dan di Asia baru
Singapore yang mengimplementasikan. DRG di
Singapore diadopsi dari Australian National
Diagnosis Related Groups ( AN-DRG) Ver 3.1
menggunakan ICD-9CM diagnosis and
procedure codes.
• Secara mudahnya, dalam DRG, pembayaran
dijatah per diagnosis (yang dipakai diagnosis
akhir). Misal diagnosis akhirnya adalah
appendicitis. Dalam DRG appendicitis dijatah 7
jt. Jadi segala upaya untuk menangani
appendicitis tidak boleh menghabiskan dana
lebih dari 7 juta. Jika lebih, maka ditanggung
oleh RS / dokter yang bersangkutan.
 Length of Stay
• Length of stay (LOS) is used to measure the duration
of a single episode of hospitalization. It is measured on
a per-patient basis in whole numbers (days), and
calculated by subtracting day of admission from day of
discharge.
• Average length of stay (ALOS) is the average number of
days patients stay in a facility. It is calculated by dividing the
total number of days all patients stayed in the hospital by
the number of patients discharged for the same given
period of time.
• Length of stay has cost and revenue implications.
Consider what happens when a hospital’s management
team, during the financial and budget planning process,
establishes reduced LOS as an operational goal.
STRATEGIS COST
ANALYST
ANALISA BIAYA RUMAH SAKIT

Kegiatan menghitung biaya seluruh jenis

pelayanan yang ditawarkan rumah sakit, baik
biaya total maupun biaya per unit / tindakan
/ layanan.
ANALISA BIAYA RUMAH SAKIT
Definisi Biaya (Cost):
“Pengorbanan Sumber daya yang diukur
dalam nilai moneter, untuk mencapai
tujuan, pada kurun waktu tertentu”
ANALISA BIAYA RUMAH SAKIT

Atas Dasar Fungsi dlm Proses Produksi

- Direct Cost : Biaya Langsung
- Indirect Cost : Biaya Tidak Langsung

Unit Penunjang Unit Pelayanan

Gaji Direktur RS Gaji Perawat

Gaji staf administrasi Biaya obat RJ/RI
Biaya ATK Biaya Alat Medis
 Classification of cost a nursing Unit
DIRECT INDIRECT

-Salaries of unit -Allocated

FIXED Managers depreciation
of facility
- Depreciation of
equipment - Allocated salaries
From administration
-Supplies -Laboratory
test
VARIABLE -Wages of for patients
nurses on call in the unit

2/04/2016 *
 HASIL AKHIR ANALISA
BIAYA

1. Informasi harga pokok (unit cost) untuk

setiap produk atau jasa;
2. Informasi biaya untuk tujuan pencapaian
efisiensi Rumahsakit,
3. Informasi biaya untuk tujuan
pengendalian biaya (berhubungan dengan
anggaran),
4. Informasi manejemn untuk untuk
pengambilan keputusan khusus
 ANALISA BIAYA RUMAH SAKIT
b. Menghitung BEP :
TR = TFC + TVC
Q x P = TFC + ( Q x VC )

Keterangan :
Q : Target produksi / jumlah setiap jenis layanan
P : Harga pokok (yang akan dicari) setiap satuan layanan
TFC : Total biaya tetap
VC : Jumlah variable cost yg digunakan utk tiap jenis layanan
ANALISA BIAYA RUMAH SAKIT

VII. Perhitungan Tarif

Tarif = HPP + % Margin

VIII. Perhitungan Harga Jual

Harga Jual = Tarif ---- Disesuaikan
dengan Harga
Pasar
ANALISA BIAYA RUMAH SAKIT

Harga pokok tiap unit

/ satuan layanan

PRICE Harga Jual

% MARGIN

Market Price
Pola
Penyusunan
Tarip dan
Pembebanan
Biaya Rumah
Sakit
 ACTIVITY-BASED COSTING
1. Mengidentifikasi aktivitas yang signifikan
dan membebankan biaya overhead ke
masing-masing aktivitas sesuai dengan
sumberdaya yang digunakan.
2. Mengidentifikasi pemicu biaya yang cocok ke
masing-masing akctivitas dan
mengalokasikan biaya overhead ke produk.
 Dimensi ABC

Sumberdaya

Cost Driver Aktivitas Performance

Obyek Biaya

Sumber: Turney 1992

CONTOH CP PASIEN TB
Customer Value

1-29
 Concept of Customer Perceived Value

Monroe (1991)

Perceived benefits
Customer-perceived value = -----------------------
Perceived sacrifice
Monroe, K.B. (1991), Pricing – Making Profitable Decisions, McGraw-Hill, New York, NY.

Kotler (2002)

Benefits Functional benefits + emotional benefits

Value = ---------- = --------------------------------------------------------------
Costs Monetary costs + time costs + energy costs + psychic costs

Philip Kotler (2002), Marketing Management, Millennium Edition

Quality
Customer-perceived value = -------------  creates Convenience
Price
1-30
 Schematic of Value and Pricing Policy Process

Competitive Analysis Consumer Analysis

(Differentiation) (Segmentation)

Product/Services
Positioning

Marketing Strategy
•Product
•Comunication
•Distribution

Competitive Perceived
Offering Customer Value

Price Cost

Profit

MarkPlus & Co
2/04/2016 *
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