Pengelolaan Dana JKN Secara

Efektif dan Efisien Untuk

Menjamin Mutu Pelayanan
Kesehatan
PENGALAMAN RS AN-NISA TANGERANG

dr. Ediansyah
Direktur
2014 : RUMAH SAKIT AN-NISA TANGERANG
KELAS C, 100 TT
RUMAH SAKIT AN-NISA TANGERANG
KELAS C, 160 TT
DATA KUNJUNGAN
800
700
700
600
600

500

400 awal 2014

akhir 2016
300

200
120 140
90
100 60

0
Rawat Jalan/hari Rawat Inap/hari Operasi/bulan
KOMPOSISI PASIEN TAHUN 2016

NON BPJS
17,57%

BPJS 82,43%
KOMPOSISI PENDAPATAN TAHUN 2016

NON BPJS,
19.56

BPJS 80.44
,
SIMULASI LABA RUGI RS
PENDAPATAN : 10 M
HARGA POKOK PENJUALAN : 1,2 M (12%)
--------------------------------------------------------------------------------
LABA KOTOR : 8,8 M
JASA MEDIS : 2,5 M (25%)
GAJI KARYAWAN : 1,8 M (18%)
BIAYA OPERASIONAL : 0,8 M (8%)
------------------------------------------------------------------------------
EBITDA : 3,7 M
DEPRESIASI : 0,5 M (5%)
-----------------------------------------------------------------------------
EBIT : 3,2 M
BUNGA BANK : 0,1 M (1%)
-----------------------------------------------------------------------------
PENDAPATAN SEBELUM PAJAK : 3,1 M
PAJAK :
-----------------------------------------------------------------------------
LABA BERSIH : (15% - 20%)
PRICE = UNIT COST + MARGIN

Tarif RS : Rp. 1.300.000 Tarif INA CBG : Rp. 1.200.000

RS Rugi……. Rp. 100.000 ??

Unit Cost RS : Rp. 1.000.000 Tarif INA CBG :Rp. 1.200.000

Margin (30%) : Rp. 300.000

Sisa Rp. 200.000 (20%)

PRICE = UNIT COST + MARGIN

Tarif RS : Rp. 1.000.000 Tarif INA CBG : Rp. 1.200.000

RS untung….. Rp. 200.000 ??

• Tarif masih berdasarkan unit cost 2014

• Unit Cost 2017 : Rp. 1.500.000 Tarif INA CBG :Rp. 1.200.000

Kurang Rp. 300.000

PROFITABILITY :
THE FORCES IMPACT WHY

Threat of entry Profitability Costs

Supplier power Profitability Costs

Buyer power Profitability Prices Costs

Rivalry Profitability Costs

Substitutes
HEALTHCARE MEGATREND
Robert M Wachter MD, Professor and Chair of Department of Medicine, University of California,
San Francisco

1. Relentless Pressure to Deliver

• The highest quality Benefit
• Safest Value = ----------------
Cost
• Most satisfying care
• The lowest possible cost

2. Paper Industry to Digital Industry

Challanges in Implementing INA -CBG

1
• Business Strategy

2
• Growing Complexity

3
• Leadeship & Change Management

4
• Cost control & Quality control

5
• Information Technology
1. Business Strategy
Strategic question
1. What is our present situation?
• Resources and Capabilities
• Competitive strenghts and weaknesses
• Changes in business environment
2. Where do we want to go from here?
• Management vision of the company’s future direction
• What new customer groups to satisfy
• What capabilities to build
3. How are we going to get there?
• Guidelines for development
• Priorities for capital expenditure
• Growth modes: organic growth, M & A, Alliances
 Where to Compete
1. The product-market investment decision
(Product,Market,Competitor)

A BUSINESS
STRATEGY

How to Compete
2. Value proposition 3. Assets & competencies
4. Functional area strategy & program
(Aaker,2008)
RS AN-NISA: Where to Compete

Product/Service:
• Spesialisasi lengkap,
Market A • Penunjang medis lengkap
Peserta JKN-KIS

B
RS AN-NISA
Competitor:
C/D RS Kelas C

FKTP
RS AN-NISA: How to Compete
1. Tidak ada diskriminasi pelayanan untuk pasien BPJS dan
non BPJS

2. Fleksibilitas jam pelayanan rawat jalan (08.00 WIB –

20.00 WIB)

3. Tidak ada kuota tempat tidur untuk pelayanan rawat

inap pasien BPJS

4. Tidak ada urun biaya

5. Mendapat Benefit non medis: Gift, antar pulang gratis,

foto copy gratis.
(Porter,1980)
2. Managing Growing
Complexity
GROWING COMPLEXITY (INTERNAL )

Pemilik
Manaje
men

Dokter

Berapa % Jasa medis?

Berapa % Obat?
Berapa % Penunjang?

Bagaimana Mengelola Tarif Paket ?

Kolaborasi Manajemen dan Staf Medis
• Jasa Medis
• Konsep : Fee For Services
• Konsultasi : Rp. 70.000
• Visite : Rp. 70.000 (kelas 3,2,1 sama)

• Kebijakan pemakaian obat dan pemeriksaan penunjang

“Pasien yang butuh banyak diberikan banyak,
yang butuh sedikit diberikan sedikit.”
GROWING COMPLEXITY (EKSTERNAL)

Rumah Sakit

Kem
Pasien
Kes

BPJS • Tarif INA-CBG

• Verifikasi Claim
• Rujukan Berjenjang
Kompleksitas
Memiliki keterkaitan dan saling
berhubungan antara satu pihak dengan
pihak lainnya. (tidak bisa hidup sendiri)
3. Leadership & Change
Management
LEADERSHIP: Transforming your Organisation
4. Cost Control & Quality
Control
The Meanings of Quality
(does higher quality cost more or does it cost less?)

1. Quality means those features of products which

meet customer needs and there by provide
customer satisfaction. The meaning of quality is
oriented to income.

2. Quality means freedom from deficiency. The

meaning of quality is oriented to cost.
(GRANT, 2013)
Total Fixed Costs Curve

Cost per unit of output ($)

Fixed cost ($)

1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11
Output (in unit) Output (in unit)

Total fixed costs Cost per unit

remain constant as declines as
activity increases. activity increases.
Variable Costs Curve

Total Cost ($)

Cost per unit ($)

1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11
Output (in Unit) Output (in Unit)

Total variable Cost per unit

costs increase as is constant as
activity increases. activity increases.
 Cost-Volume-Profit

Costs and Revenue

Break-even Profit
Point
in Dollars

Loss

Volume in Units
Contoh
FIX COST KAMAR OPERASI : 100 JUTA
JUMLAH OPERASI PER BULAN : 100

RATA RATA FIX COST PER OPERASI : 1 JUTA

FIX COST KAMAR OPERASI : 100 JUTA

JUMLAH OPERASI PER BULAN : 500

RATA RATA FIX COST PER OPERASI : 200 RIBU

 No Jam Dokter
POLIKLINIK ANAK
1 08.00 – 09.00 Dr. Denok
2 09.00 – 10.00 Dr. Denok
3 10.00 – 11.00 Dr. Denok
4 11.00 – 12.00 Dr. Denok
5 12.00 – 13.00 Dr. Ari Mulyani
6 13.00 – 14.00 Dr. Ari Mulyani
7 14.00 – 15.00 Dr. Amin Husni
8 15.00 – 16.00 Dr. Amin Husni
9 16.00 – 17.00 Dr. Amin Husni
10 17.00 – 18.00 Dr. Arif Nasution
11 18.00 – 19.00 Dr. Arif Nasution
12 19.00 – 20.00 Dr. Arif Nasution
5. Information Technology
Momentum / Energi
Contoh
Dengan Bantuan Information Technology pekerjaan diselesaikan 2 kali
cepat.
Rumus : E = m.V
100 =100.1
200 = 100.2
KESIMPULAN
• Financial performance di ukur menggunakan Laba Rugi
• Target market rumah sakit adalah peserta JKN-KIS
• Membangun value proposition sesuai target market
• Kompleksitas diatasi dengan meningkatkan kolaborasi dengan
seluruh stakeholder terutama dengan dokter
• Pemimpin mendapatkan trust dari seluruh stakeholder
• Pengendalian biaya bukan hanya di variable cost tetapi juga di
fix cost
• IT yang kuat sangat mendukung strategi efisiensi
TERIMA KASIH