Analisis Efisiensi Rumah Sakit Badan Layanan Umum Daerah (Studi Kasus: Provinsi Sulawesi Selatan Tahun 2014-2017)
| Main Authors: | Irwandy/ Promotor: Sjaaf, Amal Chalik/ Kopromotor: Achadi, Anhari, Mardiati Nadjib/ Penguji: Ayuningtyas, Dumilah, Purnawan Junadi, Besral, Abdul Kadir, Supriyantoro, Harimat Hendrawan |
|---|---|
| Format: | Doctoral |
| Terbitan: |
Depok: FKMUI, 2019
|
| Subjects: | |
| Online Access: |
http://lib.fkm.ui.ac.id/file?file=digital/2019-4/131208-Irwandy-Naskah Ringkas-FKM-2019.docx http://lib.fkm.ui.ac.id/file?file=digital/2019-4/131208-Irwandy-Disertasi-Fulltext-FKM-2019.pdf |
Daftar Isi:
- ABSTRAK Pengelolaan rumah sakit yang efisien dengan tetap memperhatikan kendali mutu dan biaya menjadi kunci agar mampu bertahan di era Jaminan Kesehatan Nasional saat ini khususnya bagi RS yang berstatus BLUD yang dituntut untuk dapat mengelola operasional rumah sakit dengan prinsip efisiensi dan produktifitas. Tujuan penelitian ini adalah untuk menganalisis tingkat efisiensi rumah sakit BLUD di Provinsi Sulawesi Selatan tahun 2014-2017. Penelitian ini menggunakan desain cross sectional dengan pendekatan kuantitatif dan kualitatif. Populasi penelitian adalah seluruh RS Pemerintah yang telah berstatus BLUD di Provinsi Sulawesi Selatan. Sampel RS penelitian sebanyak 25 RS. Unit analisis adalah kinerja tahunan RS selama 4 tahun (2014-2107). Untuk mengembangkan indikator efisiensi RS digunakan metode wawancara Delphi dan Uji Stabilitas dan Sensititifitas Indikator dengan stepwise modelling melalui pendekatan backward menggunakan metode Data Envelopment Analysis (DEA). Penilaian Efisiensi dan Produktifitas RS dianalisis dengan menggunakan metode DEA dan Malmquist Productivity Index. Dalam menilai faktor yang berpengaruh terhadap tingkat efisiensi RS digunakan Regresi Tobit. Selanjutnya potensi pengembangan efisiensi RS dianalisis dengan menganalisis total potential Improvement RS, wawancara mendalam dan Matriks Analisis SWOT. Hasil penelitian menunjukkan indikator input dan output yang dapat digunakan untuk mengukur efisiensi RS BLUD di Provinsi Sulawesi Selatan terdiri atas indikator input yakni luas bangunan, Total Asset, Total Biaya Operasional dan Total Biaya Farmasi sedangkan indikator output terdiri atas jumlah pasien, jumlah pemeriksaan laboratorium, tindakan operasi, total pendapatan operasional, Av-LOS dan TOI. Skor efisiensi RS selama periode penelitian (2014-2017) sebesar 1,023 (2.3%) dan produktifitas rumah sakit tumbuh sebanyak 4% namun hasil penelitian menunjukkan dari tahun ketahun tingkat efisiensi dan produktifitas RS cenderung terus menurun. Selanjutnya ditemukan bahwa terdapat pengaruh antara tingkat efisiensi rumah sakit dengan kelas RS, status BLUD, Akreditasi rumah sakit, jumlah RS sekitar dan jumlah penduduk. Untuk mencapai tingkat efisiensi yang optimal RS perlu mengoptimalisasikan penggunaan input RS seperti asset, bangunan, biaya operasional dan biaya farmasi rumah sakit. Selanjutnya RS masih harus meningkatkan kapasitas outputnya agar optimal yakni untuk jumlah pasien sebesar 10,05%, pemeriksaaan laboratorium sebesar 18,2%, tindakan operasi sebesar 11,73%, pendapatan operasional RS sebesar 8,45% serta menjaga tingkat Av-LOS RS agar tidak terjadi peningkatan melebihi 20,39% dari ratarata saat ini dan 21,59% untuk TOI. Kata Kunci: Efisiensi, RS, BLUD, DEA, Indonesia, Sulawesi Selatan ABSTRACT Managing the hospital with concern to quality control and costs is the key to survive in the current era of National Health Insurance, especially for hospitals with BLUD status that are required to be able to manage with the principle of efficiency and productivity. The purpose of this study was to analyze the level of efficiency of BLUD hospitals in South Sulawesi Province in 2014-2017. This study used a cross sectional design with quantitative and qualitative approaches. The study population was all government hospitals that had BLUD status in South Sulawesi Province. The samples were 25 hospitals. The unit of analysis were the annual performance of hospitals (years 2014-2107). To develop hospital efficiency indicators, we used the Delphi interview method and Stability and Sensitivity Test with stepwise modeling through a backward approach using the Data Envelopment Analysis (DEA). The hospital efficiency and productivity assessment were analyzed using the DEA and the Malmquist Productivity Index. In assessing the factors that influence the level of efficiency of the hospital, tobit regression is used. Furthermore, the strategy to improve the efficiency of hospitals was analyzed with DEA, in-depth interviews with hospital managers and SWOT Analysis Matrix. The results showed that the indicators that can be used to measure the efficiency of the BLUD Hospital in South Sulawesi Province consisted building area, Total Assets, Total Operating Costs and Total Pharmaceutical Costs as input indicators, while the output indicator consisted of the number of patients, number of laboratory examinations, number of operations procedures, total income of hospital, Av-LOS and TOI. Hospital efficiency scores during the study period (2014-2017) were 1.023 (2.3%) and hospital productivity grew by 4% but the results of the study showed that from year to year the level of efficiency and productivity of hospitals tended to decline. Furthermore, it was found that there was an influence between the level of efficiency of the hospital and the hospital class, BLUD status, hospital accreditation, number of hospitals around and population density. To achieve the optimal level of efficiency, the hospital needs to optimize the use of hospital inputs such as assets, buildings, operational costs and hospital pharmacy costs. Furthermore, the hospital still has to increase the output capacity to be optimal, by improve the number of patients at 10.05%, laboratory examination by 18.2%, operating procedure by 11.73%, hospitals income at 8.45% and maintaining the level of Av-LOS should be not increase more than 20.39% of the current average and 21.59% for TOI. Keywords: Efficiency, Hospital, BLUD, DEA, Indonesia, South Sulawesi Province