Pengelolaan Dana JKN Secara Efektif dan Efisien Untuk Menjamin Mutu Pelayanan Kesehatan

Transkripsi

1 Pengelolaan Dana JKN Secara Efektif dan Efisien Untuk Menjamin Mutu Pelayanan Kesehatan PENGALAMAN RS AN-NISA TANGERANG dr. Ediansyah Direktur

2 2014 : RUMAH SAKIT AN-NISA TANGERANG KELAS C, 100 TT

3 RUMAH SAKIT AN-NISA TANGERANG KELAS C, 160 TT

4 DATA KUNJUNGAN awal 2014 akhir Rawat Jalan/hari Rawat Inap/hari Operasi/bulan

5 KOMPOSISI PASIEN TAHUN 2016 NON BPJS 17,57% BPJS 82,43%

6 KOMPOSISI PENDAPATAN TAHUN 2016 NON BPJS, BPJS, 80.44

7 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%)

8 PRICE = UNIT COST + MARGIN Tarif RS : Rp Tarif INA CBG : Rp RS Rugi. Rp ?? Unit Cost RS : Rp Margin(30%) : Rp Tarif INA CBG :Rp Sisa Rp (20%)

9 PRICE = UNIT COST + MARGIN Tarif RS : Rp Tarif INA CBG : Rp RS untung.. Rp ?? Tarif masih berdasarkan unit cost 2014 Unit Cost 2017 : Rp Tarif INA CBG :Rp Kurang Rp

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11 PROFITABILITY : THE FORCES IMPACT WHY Threat of entry Profitability Costs Supplier power Profitability Costs Buyer power Profitability Prices Costs Rivalry Profitability Costs Substitutes

12 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 Value = Benefit Cost 2. Paper Industry to Digital Industry

13 Challanges in Implementing INA -CBG Business Strategy 1 Growing Complexity 2 Leadeship & Change Management 3 Cost control & Quality control 4 Information Technology 5

14 1. Business Strategy

15 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

16 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)

17 RS AN-NISA: Where to Compete Market Peserta JKN-KIS A B RS AN-NISA C/D FKTP Product/Service: Spesialisasi lengkap, Penunjang medis lengkap Competitor: RS Kelas C

18 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 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.

19 (Porter,1980)

20 2. Managing Growing Complexity

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23 GROWING COMPLEXITY (INTERNAL ) Manaje men Pemilik Dokter Berapa % Jasa medis? Berapa % Obat? Berapa % Penunjang? Bagaimana Mengelola Tarif Paket?

24 Kolaborasi Manajemen dan Staf Medis Jasa Medis Konsep : Fee For Services Konsultasi : Rp Visite : Rp (kelas 3,2,1 sama) Kebijakan pemakaian obat dan pemeriksaan penunjang Pasien yang butuh banyak diberikan banyak, yang butuh sedikit diberikan sedikit.

25 GROWING COMPLEXITY (EKSTERNAL) Rumah Sakit Pasien Kem Kes BPJS Tarif INA-CBG Verifikasi Claim Rujukan Berjenjang

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28 Kompleksitas Memiliki keterkaitan dan saling berhubungan antara satu pihak dengan pihak lainnya. (tidak bisa hidup sendiri)

29 3. Leadership & Change Management

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34 LEADERSHIP: Transforming your Organisation

35 4. Cost Control & Quality Control

36 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.

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39 (GRANT, 2013)

40 Fixed cost ($) Cost per unit of output ($) Total Fixed Costs Curve Output (in unit) Total fixed costs remain constant as activity increases Output (in unit) Cost per unit declines as activity increases.

41 Total Cost ($) Cost per unit ($) Variable Costs Curve Output (in Unit) Total variable costs increase as activity increases Output (in Unit) Cost per unit is constant as activity increases.

42 Costs and Revenue in Dollars Cost-Volume-Profit Break-even Point Profit Loss Volume in Units

43 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

44 POLIKLINIK ANAK No Jam 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

45 5. Information Technology

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47 Momentum / Energi Contoh Dengan Bantuan Information Technology pekerjaan diselesaikan 2 kali cepat. Rumus : E = m.v 100 = = 100.2

48 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

49 TERIMA KASIH