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
awal 2014
400
akhir 2016
300 200
140
120 100
60
90
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%)
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LABA KOTOR JASA MEDIS GAJI KARYAWAN BIAYA OPERASIONAL
: 8,8 M : 2,5 M (25%) : 1,8 M (18%) : 0,8 M (8%)
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EBITDA DEPRESIASI
: 3,7 M : 0,5 M (5%)
BUNGA BANK
: 3,2 M : 0,1 M (1%)
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EBIT
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PENDAPATAN SEBELUM PAJAK : 3,1 M PAJAK :
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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 Margin (30%) : Rp. 300.000
Tarif INA CBG
:Rp. 1.200.000
Sisa Rp. 200.000 (20%)
PRICE = UNIT COST + MARGIN Tarif RS
Tarif INA CBG
: Rp. 1.000.000
: 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
Rivalry
Profitability
Substitutes
Prices Costs
Costs
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 • Safest • Most satisfying care • The lowest possible cost 2. Paper Industry to Digital Industry
Value =
Benefit ----------------
Cost
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: Market
A
• Spesialisasi lengkap, • Penunjang medis lengkap
Peserta JKN-KIS
B RS AN-NISA
C/D FKTP
Competitor: RS Kelas C
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 )
Manaje men
Pemilik
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)
1 2 3 4 5 6 7 8 9 10 11 Output (in unit)
Total fixed costs remain constant as activity increases.
Cost per unit of output ($)
Fixed cost ($)
Total Fixed Costs Curve
1 2 3 4 5 6 7 8 9 10 11 Output (in unit)
Cost per unit declines as activity increases.
Cost per unit ($)
Total Cost ($)
Variable Costs Curve
1 2 3 4 5 6 7 8 9 10 11 Output (in Unit)
Total variable costs increase as activity increases.
1 2 3 4 5 6 7 8 9 10 11 Output (in Unit)
Cost per unit is constant as activity increases.
Costs and Revenue in Dollars
Cost-Volume-Profit
Break-even Point
Loss
Volume in Units
Profit
Contoh FIX COST KAMAR OPERASI JUMLAH OPERASI PER BULAN
: 100 JUTA : 100
RATA RATA FIX COST PER OPERASI
: 1 JUTA
FIX COST KAMAR OPERASI JUMLAH OPERASI PER BULAN
: 100 JUTA : 500
RATA RATA FIX COST PER OPERASI
: 200 RIBU
POLIKLINIK ANAK
No 1 2 3 4 5 6 7 8 9 10 11 12
Jam 08.00 – 09.00 09.00 – 10.00 10.00 – 11.00 11.00 – 12.00 12.00 – 13.00 13.00 – 14.00 14.00 – 15.00 15.00 – 16.00 16.00 – 17.00 17.00 – 18.00 18.00 – 19.00 19.00 – 20.00
Dokter Dr. Denok Dr. Denok Dr. Denok Dr. Denok Dr. Ari Mulyani Dr. Ari Mulyani Dr. Amin Husni Dr. Amin Husni Dr. Amin Husni Dr. Arif Nasution Dr. Arif Nasution 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
