| Summary: | Background: One objective of the fifth Millennium Development Goals is to
improve maternal health. Jembrana is a district at the Province of Bali that has
serious attention to maternal health through the program of Jembrana Health
Insurance (JHI). This scheme covers health service for mothers that comprises
normal delivery, antenatal care and family planning. The service that had
increasing claims every year is normal delivery service. Limited budget demands
efficiency of resources, thus it is necessary to study unit cost, identify the cost
needed particularly normal delivery service.
Objective: To identify the difference in resources used to produce normal
delivery service, calculate unit cost with Activity Based Costing (ABC) method,
specify the amount of tariff and descriptive the perception of stakeholders about
tariff of normal delivery JHI.
Method: The study used a case study design. Analysis unit are private practice
midwives and community health centers. Selection criteria of private practice
midwives based on the utilization of normal delivery and community health
centers based on category of health center, i.e. inpatient/primary health center.
Subject of the study were midwives, head of health centers, director JHI
management council and head of medical service department of Jembrana
District of Health Office.
Result: Differing activities in normal delivery affected the amount of cost that had
to be paid. Difference in the use of drugs, usable medical materials and medical
devices at the community health center was 143,868, at private practice
midwives was 147,136 whereas based on the standard of normal delivery was
136,983. The difference was caused by activities outside the standard, i.e.
activities of multiple palpation and use of drugs. Elimination of non value added
activity would save 9.8% from direct tracing. The amount of cost directly involved
and overhead would affect unit cost and amount of tariff.
Conclusion and Suggestion: Activitydifferences will affect the resources used
such as medical personnel, drugs, usable medical materials, accommodation and
overhead.
Unit cost at the community health center 259.341 and private practice midwives
210.346, which indicated that the higher unit cost in community health center.
Tariff proposition was still 500.000 both in community health center and private
practice midwives with the policy of improving the community health center
services. JHI program effectiveness is the role of various parties, both the local
government as policy makers in setting the of subsidy, JHI Management Council
to seek tariffs on basis of unit cost and health provider to provide good service
and cost efficiency. G9vernment allocated a budget to improve community health
center services that increase the utilization or reconsider use of normal
deliveries in community health centers.
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