Estimating the Unit Cost of Non Capitation
RM Riadi and Gusnardi Gusnardi
Program Studi Pendidikan Ekonomi, , Fakultas Keguruan Ilmu Pendidikan, Riau, Indonesia
Keywords: Unit cost, cost driver, activity.
Abstract: The purpose of this study was to analyse the determination of the cost of hospitalization in the General
Public Hospital Arifin Achmad, Riau Province. This study is a descriptive analytical cross sectional one
carried out to calculate the cost of service through the use of activity based technique and the data relating to
the year 2015. The research result showed that the strategy of determining Activity Based Costing (ABC)
need to be calculated through cost driver of each department. For unit cost of service, it can be calculated
through identification clinical pathway and it also can be used as base unit cost of outpatient and also called
as non-capitation cost units. The use current unit cost at it hospital till today is by adopting with similar
hospital rates. As an implication, there is no conformity between the costs incurred at the prevailing tariff.
The results showed that the use of ABC system model on tariff determination was appropriate at it Hospital.
At least, there are a recalculation of the costs incurred by the level of service provided to the patient and as
results the hospital income becoming increase if compared to the previous unit cost.
1 INTRODUCTION
The problem in public health at this time is the
amount of service tariff charged to the public.
Hospital tariffs are an essential element for hospitals
that are not fully funded by the government or third
parties. All hospitals in Indonesia should be able to
establish a service tariff that may vary depending on
the form of the hospital itself. Consideration of the
condition of the surrounding community or the
targeted community is often very dominant in the
determination of the hospital tariff. This is related to
social functions and aspects of general commodities
in various health services.
There are several hospitals that are central to
treatment and is a reference for the general public in
Riau Province, especially in the city or district in
Riau Province. Starting from hospitals that are
considered low end class capacity up to high-end
hospital capacity is available at this time. Of course,
this distinction becomes the people's choice. The
problem at this time, whether the services provided
by each hospital whether it has been in accordance
with tariffs that should be given to patients. With
Arifin Achmad General Public Hospital established
with type B Education and status of Public Service
Agency starting in 2010, the public hospital area
Arifin Achmad should develop a model that became
the basis of determining the tariff of services
provided to the public.
If the management of Arifin Achmad General
Public Hospital misplaced the tariff, the amount of
income will decrease or if the tariff is too expensive
and not comparable with the quality of service
provided, people will be reluctant to seek treatment.
Regional General Hospital Arifin Achmad in this
case still use the old tariffs charged to the people in
accordance with Riau Governor Regulation of 2012.
The first tariff regulation issued by Minister of
Health Decree no. 1165/SK/X/2007 dated 31
October 2007 concerning the tariff pattern of
hospitals of the Public Service Board, where in
Article 1 (28) stating unit cost is the unit cost of each
hospital service activities calculated based on
Hospital Accounting Standards and article 2(7)
stating that the Health Insurance tariff should be
adjusted to hospital rates.
On January 30, 2013 the Ministry of Health
Regulation No. 12, the tariff of the Public Hospital
Service Board in the Ministry of Health stipulates
the hospital tariff covers the service component and
the amount of service is the same as for all types of
treatment. Then the Minister of Health issued
Ministerial Regulation no. 69 dated November 1,
Riadi, R. and Gusnardi, G.
Estimating the Unit Cost of Non Capitation.
In Proceedings of the 2nd International Conference on Economic Education and Entrepreneurship (ICEEE 2017), pages 607-616
ISBN: 978-989-758-308-7
Copyright © 2017 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
607

2013 effective on January 1, 2014 as amended by
Decree of the Minister of Health No. 59 dated 22
August 2014 which contains that the service uses
capitation and non-capitation rates. From the
exposure, it can be seen that the hospital has not
implemented the service tariff adjustment while the
government regulation has changed.
Many techniques to counting are carried out by
other researchers in unit cost calculations. (Conteh
& Walker, 2004) uses SDCA (Step down Cost
Accounting) which offers a relatively easy method
to generalize the cost and unit cost data at the
facility level, but only for a small hospital. Carey &
Stefos) 1992 uses a cost-function approach
(measuring inpatient and outpatient costs) in the
determination using complete data such as number
of beds, major teaching, minor teaching and non-
teaching, visitors (major urban, small urban and
rural), classification of hospitals (non-profit, for
profit or government). Adam & Evans (2006) also
used the same model for unit cost determination in
different countries i.e. the average cost of the ratio of
inpatients and outpatients is based on GDP per
capita, hospital size, ownership and occupancy rate.
Kiffer et al (2015) conducted a study based on
the IRAS Brazil Project using the Monte Carlo
Method which is the estimated occupation day cost
associated with Healthcare Associated Infection
(HAI). The result of his research concludes that total
inpatient with HAI, unit cost produced is quite
expensive compared to using total inpatients without
HAI. This is because the impact of HAI on
occupation costs in high complexity Brazilian
hospitals. Rezapour et al (2012) applies cost center
data adopted from Shepard (1998), which outlines
the seven steps required for implementing step-down
cost accounting.
Hex et al (2012) used a top-down approach to
estimate costs for type 1 diabetes-adult, type 1
diabetes-child, type 2 diabetes-adult and type 2
diabetes-child. In addition, the results of this study
using sensitivity analysis as a tool for underlying
uncertainty of providing an estimate of costs of
diabetes. Riewpaiboon et al (2016) compared three
methods. I.e., method 1: Economic methods with a
3% discount rate and fixes useful life for capital
assets; Method 2: Economic methods with extended
useful life to study year in case working time was
beyond the reference useful life; And Method 3:
Accounting methods with fixed useful life and no
cost beyond the useful life. Choudhary et al (2013)
uses break-even analysis in healthcare setup.
Aboagye et al (2010) in his research using the cost
burden (full costing), Barnet (2009) conducted a
study on the determination of unit cost in the form of
cost-effectiveness analysis. In research cost
effectiveness analysis using four principal methods
of cost determination, i.e. Method 1: micro costing
requires direct measurement and is ordinarily
reserved to cost novel interventions; Method 2: ABC
systems have the promise of finding accurate costs
of all services provided; Method 3: Cost adjusted
charges or Total Reimbursement need analysis
Method 4: Gross costing methods specify the
quantity of services used an employ a unit cost but
not homogeneous services.
Many researchers suggest using ABC in hospital
research such as Sugiyarti (2013), Zinia (2013); Aris
et al (2012), Riadi (2012); Jeina (2013), , Tabita
(2013), Shita and Syarifah (2014) while Ronnie
(2009) stated that the total cost of care based on the
Diagnosis Related Groups (DRG) is better. Asri
(2012) Research also provides a new way of using
modified activity based costing method which is a
combination of step down costing and activity based
costing method. Dian et al (2011) stated that at
Muhammadiyah Unit I implemented a real cost
method in determining the tariff. Primadinta et al
(2011) suggests the need for cost sharing so that the
tariff price is not too cheap or well below the real
cost price. Ryryn et al (2013) using a double
distribution model based on the relative value unit
(RVU) in his research.
A Rajabi et al (2012) used the calculation of cost
price based on unit level, batch level, hospital level
and sustaining level cost are one the important
conclusion their research, Kazemi et al (2015) made
conclusion ABC is a suitable tool to determine cost
price for services and allow the cost of each activity
and therapy or combination therapies, to be
determined and aids measures to improve
management. It is recommended to use this costing
method to determine of Diagnosis Related Groups
(DRGs).
Nouroozi et al (2013) conclusion that ABC puts
a price on service system and recognize the
opportunities for saving the cost. Popesko (2013)
analyses the specifics of application of ABC method
in hospital management especially have face a
number of obstacles, very complex structure of
outputs (products), customers, perform activities and
financing flows than an ordinary enterprise.
Popesko & Novák
(2011) made conclusion that
ABC application in healthcare have a great deal in
methodology, data collection technique and the
setting. Because of the important differences
between individual procedures and departments in
hospital, the complex application of ABC which
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could replace the obsolete costing and accounting
systems are very unique. Barnet (2003) determinate
unit cost of U.S Department of Veteran Affairs (VA)
with Decision Support System (DSS). On DSS using
an ABC system. As DSS becomes more accurate, it
will become the standard sources of follow-up costs
and population costing.
This study is using ABC model, this is due to the
complex service provided by the General Public
Hospital Arifin Achmad, Riau Province. Due to the
limited data possessed and not yet systemized
properly, the researcher assumes it is appropriate to
use the ABC model. ABC system is expected to
have efficiency and effectiveness to remember
health financing payment system which has changed
according to requirement.
2 METHODS
This study is an analytic-descriptive study through
observation and review financial documents; data
from hospital management system information;
filling costs and services form from different parts of
hospital extracted. Study the cost price of service has
been carried out regarding Activity Based Costing
(ABC) by having information for the year 2015.
2.1 Subject and Data
The subject in this research is Arifin Achmad
General Public Hospital that located in Pekanbaru
City, Riau Province, on Diponegoro Streets number
2. The data was collected by using collection forms
based on services, hospital expenditure, outputs and
activities.
2.2 Design and Analyse Data
This study uses quantitative data in the form of
financial statements and operational reports of
companies in the form of medical records and also
use qualitative data in the form of an interview is
about the implementation of service delivery in
relation to quantitative data to be taken.
Unit Cost, essentially, compares the sum of
activities with cost driver. For the calculation of
non-capitation unit cost are using Activity Based
Costing (ABC) in order to avoid distortion in
charging cost so that it can assist management in
taking decision as base of determination of tariff of
inpatient. For that, the following steps to
determination non-capitation unit cost are;
2.2.1 Classification of Costs into Various
Activities
Classification of cost into various activities consist
of two (2); first, based on on unit level activity cost.
This activity is carried out for each unit of
production. Unit-level activity costs are proportional
to the number of production units. Activities
included in this category are the provision of
electricity, water and consumption nutrition costs.
This activity is carried out for each unit of
production. Unit-level activity costs are proportional
to the number of production units. Activities
included in this category are the provision of
electricity, water and consumption nutrition costs.
Second, based on batch related activity cost. This
activity is carried out every time a batch is processed
regardless of how many units are in the batch. This
activity depends on the number of batches
generated.
Costs in this activity include administrative costs
or medic records, patient care costs and cleanliness
costs. And third is based on facility sustaining
activity cost. This activity is related to activities to
maintain the facilities owned. Activities included in
this category include the cost of building
depreciation, the cost of preparation of facilities,
laundry fees and building maintenance costs.
2.2.2 Identifies Driver Cost
After these activities are identified in accordance
with the category, the next step is to identify the cost
driver of the activity cost. This identification is
intended in the determination of group and tariff per
unit cost driver.
2.2.3 Determine Per Rate Unit Cost Driver
After identifying the cost driver then determine the
tariff per unit cost driver. Because each activity has
a cost driver by dividing the amount of cost with the
cost driver. Tariff per unit cost driver can be
calculated by the following formula;
Unit cost driver tariff (UCD) = Sum of Activities
(SA) / Cost Driver (CD)
3 RESULTS AND DISCUSSION
This study is an analytic-descriptive study through
observation and review financial documents; data
from hospital management system information;
Estimating the Unit Cost of Non Capitation
609

filling costs and services form from different parts of
hospital extracted. Study the cost price of service has
been carried out regarding Activity Based Costing
(ABC) by having information for the year 2015.
3.1 Classification of Costs into Various
Activities
The first step is to classify the activity with the
cost driver used. The classification of cost drivers
implemented based on existing activities. The cost
driver classifications can be seen in table 1.
Table 1: Grouping of activity based costing.
Sub Activity Total Cost
Activity
Medical
service fees 41,398,879,656
Level activity
cost unit
Cost of
consum
p
tion 5,746,452,967
Level activity
cost unit
Laundr
y
fee 496,685,201
Batch Related
Activit
y
Cost
Building
maintenance
fee 793,678,700
Facility
sustaining
activit
y
cost
Cost of
inpatient
su
pp
lies 198,937,750
Facility
sustaining
activit
y
cost
Cost of
maintenance
of medical
devices 185,717,219
Facility
sustaining
activity cost
From table 1 indicates that the medical service fee
and cost of consumption are category activity
categories, laundry fee is categorized into batch
related activity cost, building maintenance fee, cost
of inpatient supplies and cost of maintenance of
medical devices including facility sustaining activity
cost category. After obtained cost driver and activity
hence the researcher can calculate base tariff of
inpatient patient.
Based on unit level activity cost, there are
several costs. That cost consist of; 1) medical service
fees, 2) cost of consumption, 3) laundry fee, 4)
building maintenance fee, 5) cost of maintenance of
medical devices, 6) cost of inpatient supplies and 7)
other relevant costs. In this study, there are two
types of cost drivers used i.e. cost driver number of
patient days treated and cost driver number of
patients treated. In table 2, the unit cost driver used
shows that sum of days about 138,200 days and total
patients about 29,338 patients.
3.2 Identifies Driver Cost
The next step is to determine the cost driver as a
divisor in the determination of unit cost. There are
two (2) types of cost drivers in this case i.e. the cost
driver in the form of days and the number of
inpatients. The data cost driver number of days is
obtained from the LoS or Length of Stay of the
patient in the hospital in each class. So also with the
number of patients is the number of inpatients from
each class. For more details the data can be seen in
table 2.
Table 2: Cost driver.
Activity Cost Driver
Sum of days 138,200 days
a. Ro
y
al VIP / VIP 15,699 da
y
s
b
. First Class 13,799 days
c. Second Class 21,935 days
d. Third Class 73,460 da
y
s
e. ICU 1,422 days
f. CVCU 1,235 days
g
. PICU 1,280 da
y
s
h. SCN 6,152 days
i. HCU 3,218 days
Total of
p
atients 29,338
p
atients
a. Royal VIP / VIP 3,562 patients
b
. First Class 3,038 patients
c. Second Class 4,778
p
atients
d. Third Class 15,162 patients
e. ICU 456 patients
f. CVCU 557
p
atients
g. PICU 214 patients
h. SCN 798 patients
i. HCU 773
p
atients
3.3 Determine Per Rate Unit Cost
Driver
Unit cost obtained from the total cost divided by the
cost drivers that have been set as in table 2. For
example Royal VIP / VIP class obtained unit cost of
4,702,756,959 rupiahs. This figure is obtained from
the total cost of Medical service fees amounting to
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41,398,879,656 rupiahs divided by 138,200 days. So
we get unit cost per unit for Medical service fees of
299,557 rupiahs. Then medical service fee for Royal
VIP / VIP class is 299,577 rupiahs multiplied by
15,699 days so that obtained 4,702,756,959 rupiahs.
Similarly, the calculation for unit cost of each other
cost driver such as cost of consumptions, laundry
fee, building maintenance fee, cost of inpatient
supplies and cost of maintenance of medical devices.
Table 3: Basic tariff determination.
Activity Cost Driver
Unit Cost
(IDR)
Medical service
fees 138,200 da
y
s 41,398,879,656
a. Royal VIP /
VIP 15,699 da
y
s 4,702,756,959
b
. First Class 13,799 days 4,133,597,253
c. Second Class 21,935 da
y
s 6,570,799,025
d. Third Class 73,460 da
y
s 22,005,511,574
e. ICU 1,422 days 425,971,106
f. CVCU 1,235 da
y
s 369,953,809
g
. PICU 1,280 da
y
s 383,433,907
h. SCN 6,152 days 1,842,879,216
i. HCU 3,218 da
y
s 963,976,807
Cost of
consum
p
tion
29,338
p
atients 5,746,452,967
a. Royal VIP /
VIP
3,562
p
atients
697,691,236
b
. First Class
3,038
p
atients
595,055,018
c. Second Class
4,778
p
atients
935,869,939
d. Third Class
15,162
p
atients
2,969,790,711
e. ICU 456 patients
89,317,014
f. CVCU 557
p
atients
109,099,949
g. PICU 214 patients
41,916,318
h. SCN 798 patients
156,304,774
i. HCU 773
p
atients
151,408,008
Laundry fee
29,338
p
atients 496,685,201
a. Royal VIP /
VIP
3,562
p
atients
60,303,793
b
. First Class
3,038
p
atients
51,432,601
c. Second Class
4,778
p
atients
80,890,377
d. Third Class
15,162
p
atients
256,688,971
e. ICU 456
p
atients
7,719,969
Activity Cost Driver
Unit Cost
(
IDR
)
f. CVCU 557 patients
9,429,874
g
. PICU 214
p
atients
3,622,968
h. SCN 798
p
atients
13,509,946
i. HCU 773 patients
13,086,702
Building
maintenance
fee 138,200 days
793.678.700
a. Royal VIP /
VIP 15,699 days
90,158,914
b
. First Class 13,799 da
y
s
9,247,268
c. Second Class 21,935 days
125,972,086
d. Third Class 73,460 days
421,878,707
e. ICU 1,422 da
y
s
8,166,506
f. CVCU 1,235 days
7,092,570
g. PICU 1,280 days
7,351,004
h. SCN 6,152 da
y
s
35,330,762
i. HCU 3,218 days
18,480,883
Cost of
inpatient
su
pp
lies
29,338
p
atients 198,937,750
a. Royal VIP /
VIP
3,562
p
atients 24,153,530
b
. First Class 3,038
p
atients 20,600,344
c. Second Class 4,778
p
atients 32,399,092
d. Third Class
15,162
p
atients 102,811,854
e. ICU 456 patients 3,092,086
f. CVCU 557
p
atients 3,776,956
g. PICU 214 patients 1,451,110
h. SCN 798 patients 5,411,150
i. HCU 773
p
atients 5,241,628
Cost of
maintenance of
medical devices 138,200 da
y
s 185,717,219
a. Royal VIP /
VIP 15,699 da
y
s 21,096,777
b
. First Class 13,799 days 18,543.501
c. Second Class 21,935 da
y
s 29,476,897
d. Third Class 73,460 da
y
s 98,717,706
e. ICU 1,422 days 1,910,925
f. CVCU 1,235 da
y
s 1,659,629
g
. PICU 1,280 da
y
s 1,720,102
h. SCN 6,152 days 8,267,238
i. HCU 3,218 da
y
s 4,324,443
Estimating the Unit Cost of Non Capitation
611

After the results of the counting unit cost per driver
is obtained, then we do a calculation of each digit in
the same class even though it has a different cost
driver. For example, the Royal VIP class is
5,596,161,209 rupiahs.
This figure is derived from the Royal VIP / VIP
sub-activity of each unit cost driver. Figures
5,596,161,209 rupiahs obtained sub activity medical
services fees 4,702,756,959 rupiahs plus sub activity
class Royal VIP / VIP from cost of consumption
equal to 697,691,236 rupiahs plus sub activity class
Royal VIP / VIP from laundry fee equal to
60,303,793, plus sub activity class Royal VIP / VIP
From building maintenance fee of 90,158,914
rupiahs, plus Royal VIP / VIP class activity sub
from cost of inpatient supplies amounted to
24,153,530 rupiahs and added Royal VIP / VIP class
sub activity from cost of maintenance of medical
devices amounted to 21,096,777 rupiahs. For more
clearly shown by table 4 and the number of units
cost per class can be seen in table 5.
Table 4: Sub activity unit cost for royal VIP / VIP class.
Sub Activity
Unit Cost
(IDR)
Medical service fees 4,702,756,959
Cost of consum
p
tion
697,691,236
Laundry fee
60,303,793
Building maintenance fee
90,158,914
Cost of inpatient supplies
24,153,530
Cost of maintenance of medical
devices
21,096,777
Total Unit Cost Royal VIP /
VIP
5, 596,161,209
Table 5: Number of units cost per class.
Class Total Unit Cost
a. Royal VIP / VIP 5,596,161,209
b
. First Class 4,898,475,984
c. Second Class 7,775,407,417
d. Third Class 25,855,399,522
e. ICU 536,177,606
f. CVCU 501,012,787
g. PICU 439,495,409
h. SCN 2,061,703,087
i. HCU 1,156,518,471
After the number of unit cost per class is obtained,
the researcher divides it by the normal amount of
capacity of the existing class at Arifin Achmad
Provincial General Hospital. After that it can be
known ABC tariff if it is distributed with the number
of activity days.
As for the reason the divider using the patient is
due to the current financing system, should be able
to predict the number of patients suffering from
illness from the time of entry until healed. Every
hospital should be able to predict how many patients
will stay, this means the concept of effectiveness and
efficiency goes. Unlike the previous hospital
financing system, however long the patient started to
get sick until healed it will still be paid.
For classroom standards, a patient in a hospital
may be different in number. It depends on the policy
of the hospital. In Table 6 shows the normal number
of patients in a room that depends on the type of
class and sum of activity days
Table 6: Number of units cost per class.
Class
Sum of Days
Activity
People in
Room
a. Ro
y
al VIP / VIP 15,699 1
b
. First Class 13,799 2
c. Second Class 21,935 3
d. Third Class 73,460 4
e. ICU 1,422 1
f. CVCU 1,235 1
g
. PICU 1,280 1
h. SCN 6,152 1
i. HCU 3,218 1
After the standard of each class and the number of
days of activity are known, we can calculate the unit
cost of ABC per class. Unit cost ABC is obtained
from the unit cost per class divided by the number of
days of class activity divided by the number of
patients in one class.
For example, to determine the unit cost of first
class ABC is done by dividing the unit cost per class
by 4,898,475,984 rupiahs divided by the number of
class activities day 13,799 days divided by the
number of patients in one class that is two (2)
persons are 177.494 Rupiahs. Similarly for other
class unit calculations, for more details, see Table 7.
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Table 7: Unit cost ABC.
Class ABC Tariff
a. Ro
y
al VIP / VIP 356,466
b
. First Class 177,494
c. Second Class 118,158
d. Third Class 87,991
e. ICU 377,059
f. CVCU 405,678
g
. PICU 343,356
h. SCN 335,127
i. HCU 359,390
3.4 Comparison between Unit Cost
ABC with Current Tariff
Table 8: Difference of cost unit ABC with applicable rate
(IDR).
Class
Unit Cost
ABC
Applicable
Rate
Difference
a. Royal VIP /
VIP 356,466 350,000 6,466
b
. First Class
177,494
125,000 52,494
c. Second
Class
118,158
75,000 43,158
d. Third Class
87,991
45,000 42,991
e. ICU
377,059
250,000 127,059
f. CVCU
405,678
350,000 55,678
g
. PICU
343,356
200,000 143,356
h. SCN
335,127
200,000 135,127
i. HCU
359,390
300,000 59,390
After the estimated unit cost ABC at the hospital, the
researchers tried to compare with the current rate.
There is a difference, but this is only the unit cost
calculated, while the pricing has not been done. If
seen from table 8, it can be concluded that Arifin
Achmad General Public Hospital Riau Province
suffered losses because there are price difference.
The estimation of loss can be done through the
difference of unit cost with the current rate that is by
multiplying the number of days multiplied by the
difference in price between unit cost and the
prevailing rate.
Table 9: Loss Prediction
Class Difference
Sum of
Activity
Days
Amount
a. Royal
VIP / VIP
6,466 15,699 10,150,973
b. First
Class
52,494 13,799 72,436,471
c. Second
Class
43,158 21,935 94,667,073
d. Third
Class
42,991 73,46 31,581,189
e. ICU
127,059 1,422 1,806,779
f. CVCU
55,678 1,235 6,876,233
g. PICU
143,356 1,28 18,349,568
h. SCN
135,127 6,152 8,313,013
i. HCU
59,39 3,218 19,111,702
Total 6,386,018,262
From the calculation data, the prediction of loss
of 6,386,018,262 rupiahs in one year of study if the
hospital does not adjust the ABC tariff. One of the
causes that Arifin Achmad General Public Hospital
of Riau Province is still running is because the
amount of salary has been paid by the government
and assets derived from government funds.
However, for the improvement of performance, it is
necessary to adjust the unit cost as the basis for
determining the tariff.
3.5 Non Capitation Rate
3.5.1 Cost Variable per Service Unit Cost
In this study, we can calculate the variable cost unit
cost per service based on the identification of
services provided to the patient. The variable cost of
unit costs in this case the researcher takes on the
basis of the medical consumables used. Based on the
results of the identification and clinical pathway in
the service area at Arifin Ahmad General Public
Hospital obtained only from 3 (three) existing
services provide good enough information. The part
is part haemodialisa, radiology, dentistry and
obstetrics and gynecology. The results of the
analysis on the obstetrics and gynecological content
and parts of the dental service that the service
provided is only the outpatient, not inpatient
services. So that researchers can only analyze on the
Estimating the Unit Cost of Non Capitation
613

haemodialisa and radiology. In the haemodialisis the
lowest cost is 7,356 rupiahs and the highest cost is
575,289 rupiahs. In the radiology of the lowest cost
is 9,524 rupiahs and the highest cost is 1,956,227
rupiahs.
3.5.2 Determination of Non-Capitation Rate
According to Minister of Health Regulation no. 59
of 2014, the Non-Capitation Rate is the amount of
payment of claims by the Social Security Assurance
Body to the First Level Health Facility based on the
type and amount of health services provided. In
practice, non-capitation tariffs should be filed by the
Arifin Achmad public hospital in Riau Province in
accordance with the tariff determined by unit cost
calculation. Although the maximum payment using
INA CBG's tariff after through verification. As an
illustration of an inpatient patient in class II with
hemodialysis identification and should be through
radiology. The unit cost calculation is as follows;
Unit Cost = Class II rate multiplied by three days
plus the cost of haemodialisa5 service plus
Abdomen USG
Unit Cost = (118.158 x 3) + (20.148) +
(356.987)
Unit Cost = 731,609.
The calculation result of 731,609 rupiahs is unit
cost so that the management of Arifin Achmad
General Public Hospital must take the percentage of
profit. In addition, they also must calculate the use
of consumables that are small, such as gloves and
masks. There is a significant difference between
prevailing inpatient tariffs and unit cost calculations,
so there is a need for tariff adjustments. To calculate
unit cost of non-capitation tariff the researcher
determine the following formula;
Unit Cost = (Class Rate x number of days of service)
+ (unit cost non-capitation tariff per service)
In this study can be concluded that ABC is very
appropriate to be done as an effort to calculate unit
cost, so that they can make the right decision. This is
in line with the research of Agus (2006), Asri
(2012), Primandita (2011) and Ronnie (2009) in the
development of unit cost calculations using DRG
(related group's Diagnosis) or related diagnostic
groups referring to the Australian DRG. INA-DRG
here, what is meant by the tariff setting should be the
total cost per inpatient disease that has been
calculated based on the clinical pathway was added
with the possibility of margin expected by the
hospital or simply with the Break Even Point (BEP)
pattern where the tariff is set Quite the same as the
cost that has been issued by the hospital. Or with the
short term determination of unit cost is to use the
ABC method with the method of simple distribution.
The results also in addition to determining the use of
ABC calculations based on clinical pathway for the
determination of unit cost also with Ability to pay
and Willingness to Pay.
4 CONCLUSIONS
There is a difference between the ABC unit cost
calculation and the current tariff, this is caused by
the increase of electricity price and the maintenance
of the building cost for example. The tariff of the
services of the facilities does not need to be
calculated anymore because ABC principle is
already included in the cost component of tariff-
making service facilities such as maintenance cost.
As for the cost of consumable medical materials is
one of the separate components but is the forming of
non-capitation tariffs at the Regional General
Hospital Arifin Achmad. The lack of information
and the difficulty of clinical pathway information
causes the difficulty of information as a unit of cost.
The part of the sample is the haemodialisa,
radiology, dentistry and obstetrics and gynecology.
The results of the analysis on the obstetrics and
gynecological content and parts of the dental service
that the service provided is only the outpatient, not
inpatient services. So that researchers can only
analyze on the haemodialisa and radiology. The unit
cost non-capitation tariff calculation strategy is the
class rate multiplied by the number of hospitalized
days plus the unit cost of non-capitation tariff per
service. What distinguishes this research from others
is that unit cost calculation at Arifin Achmad
Hospital is not done by calculating fixed cost and
variable cost, but through behavior cost approach.
This is because existing data such as depreciation
costs are not obtained. Arifin Achmad General
Public Hospital is a government hospital so that for
their employees have been paid by the government
and not considered a hospital burden. So that the
calculation of government hospitals with private
hospitals can be implemented differences, especially
government hospitals must carry out healthy
business according to legislation
.
As the implication, Arifin Achmad General
Public Hospital needs to implement unit cost
adjustment through unit cost calculation. The
revamping of existing data through existing hospital
management information systems is essential. Due
to the existence of good data then the management
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can take decisions well too, especially with the
determination of unit cost. The changes in
government policy on health insurance has been
made loss for hospital in several times as long as
they are not applying adjusted unit i.e. ABC system.
For further research it is better to consider the use of
unit cost model that is adjusted to the state of the
data at Arifin Achmad General Public Hospital as a
comparative decision-making material. Not only
that, in the case of unit cost ABC can also predict
the amount of losses due to not implementing price
adjustment. So it opens up opportunities for further
research.
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