Published on International Journal of Economics & Business
Publication Date: June, 2019
Nanang Priono, Bella Safitri, Nian Adi Perkasa & Nanik Puji Rahayu
Malang Indonesian College of Economics, Malang
Jaya Negara College of Economics, Malang
Kertanegara College of Economics, Malang
Caruban College of Economics, Madiun
Government Hospital is a business unit of Government Agencies that provide health services to the general public. The problem that always arises is the difficulty of predicting the needs of society and the services needed to support resource requirements.The problems that arise in the service of the hospital in Malang, hospitals have not received a payment claim from BPJS Health Branch of Malang for 4 months. As a result, hospitals Malang is threatened with bankruptcy, because of the lack of operational costs for medical services and the purchase of drugs, while the amount of funds that have not been in the pay of BPJS Rp. 7 billion, bringing the total for 4 months when reached Rp 28 billion “In addition to the main claim payment, BPJS must pay a penalty of 1 percent per month late payment. The research method in accordance with this research was qualitative research. The use of this method is based on the consideration that this method is intended to describe and assess qualitatively, how perception or view of the apparatus and the public on the implementation of Operational Services Cost Management Policy On Public Service Board Regional Hospital granted or implemented by policy makers BLUDs Malang City Hospital. The results of the study are; Good communication will be able to produce a good implementation anyway. Often there are problems in the distribution of communication that is the misunderstanding (miscommunication) due to the many levels of bureaucracy that must be passed in the communication process, so that what is expected is distorted in the implementation. There is thus a communication policy that will be implemented is determined by the extent to which the size and goals and objectives of the policy can be well understood. The main resource in the implementation of the policy is staff or employee (street – level – bureaucrats). Failure is often the case in the implementation of the policy, one of which is caused by the staff / employees who are not quite adequate. However, by looking at the number of employees based on the results of research conducted shows that the number of personnel in hospitals Malang is sufficient. Disposition aspect examined multiple dimensions which include support, attitudes and behavior of employees of Malang City Hospital in implementing policies BLUDs.
Keywords: Policy management of operational costs of services, bankruptcy, qualitative, implementation and Hospital.
Government Hospital is a business unit of Government Agencies that provide health services to the general public. The problem that always arises is the difficulty of predicting the needs of society and the services needed to support resource requirements.
Hospital side must be ready at any moment to facilities, infrastructure, medical personnel nor the funds needed to support these services. Besides Hospital as a social unit are faced with the increasing scarcity of resources to finance their needs, but on the other hand Hospitals are expected to work at the rates can be affordable by the public.
Based on Law No. 44 Year 2009 on Hospital said that one of the health care facility is a hospital for health service delivery are supported by diverse resources, therefore the hospital has the characteristics and complex organization.
The issues that arise in the service of the hospital in Malang Hospitals have not received a payment claim from BPJS Health Branch of Malang for 4 months. As a result, hospitals Malang is threatened with bankruptcy, because of the lack of operational costs for medical services and the purchase of drugs, while the amount of funds that have not been in the pay of BPJS Rp. 7 billion, bringing the total for 4 months when reached Rp 28 billion “In addition to the main claim payment, BPJS must pay a penalty of 1 percent per month late payment,” said Redi, cited expectations rakyat.com, Friday (14/9 / 2018).
Implementation is a set of activities in order to deliver to the public policy so that the policy can bring results, as expected. Policies for Indonesian dictionary is a series of concepts and principles that became the basis of an outline and in the implementation of a work plan to achieve goals or objectives.
Implementation of the policy in principle is a way for a policy to achieve its objectives, no more and less. To implement public policy, then there are two options available measures, which directly implemented in the form of programs or through policy formulation derivatives or derivatives of these policies.
Detailed Indonesian dictionary states that management is the process or how to act or process to manage certain activities by moving the power of others, a process that helps formulate a policy and objectives of the organization or process.
Mccording to Mulyadi (2002: 8) is: “Cost is the sacrifice of economic resources is measured in terms of money, which has occurred or is likely to occur for a particular purpose”.
In accordance with article 1 paragraph 23 of Law No. 1 of 2004 on State Treasury noted that the Public Service Board is an agency within the government that was formed to provide public services such as the supply of goods and / or services sold without prioritizing profit in conducting its activities based on the principles of efficiency and productivity.
MenurutUndang Law of the Republic of Indonesia No. 44 Year 2009 Article 1 About the Hospital, the Hospital is a health care institution held in the plenary of personal health services that provide inpatient, outpatient, and emergency services.
2. RESEARCH METHODS
Based on the background of the problem and the purpose of this study, the research method in accordance with this research was qualitative research. The use of this method is based on the consideration that this method is intended to describe and assess qualitatively, how the perception or view of the apparatus and the public on the implementation ofServices Operational Cost Management Policy On Public Service Board Regional Hospital granted or implemented by policy makers BLUDs Malang City Hospital. All data obtained from informants by using observation and in-depth interviews.
Aspects that were examined in this study are the factors or variables Operational Cost Management Implementation Services In Public Service Board Malang City Hospital, Which consists of a bureaucratic structure, resources, communication and disposition.
Data collection techniques in this study using three ways, namely: non-participant observation, interview and documentation study.
3. RESULTS AND DISCUSSION
Analysis of Policy Implementation BLUDs in this study focused on aspects of policy implementation that consists of; communication, resources bureaucratic structure, and disposition. Description of the implementation of the policy as follows:
Good communication will be able to produce a good implementation anyway. Often there are problems in the distribution of communication that is the misunderstanding (miscommunication) due to the many levels of bureaucracy that must be passed in the communication process, so that what is expected is distorted in the middle of the road. There is thus a communication policy that will be implemented is determined by the extent to which the size and goals and objectives of the policy can be well understood.
Based on the results of interviews conducted to several informants related to communication that includes standards and goals and objectives can BLUDs policy is understood, implemented and achieved and it is known that an employee of Malang City Hospital not yet fully understand the standards and goals and objectives BLUDs policy.
Theoretically accordance with what is stated by Edward III, which confirms that the implementation will be effective if the measures and policy objectives understood by individuals who are responsible for the achievement of policy objectives through the transmission or distribution of clear communication.
Related to the understanding of the size and goals and objectives BLUDs policy, the informant did not understand it. Thus it can be argued that of the communication factor in policy implementation is not going according to what was confirmed by Edward III which states that if a policy that is implemented should be understood by individuals who are responsible for the achievement of policy objectives.
Regarding whether the size, goals and objectives BLUDs policies have been implemented, in general, have been implemented despite the informants say they are actually not fully understand what it is the size and the goals and objectives of the policy.
Understanding the informant to the size, goals and objectives into information that should be known is still very limited, because that is understood is what activities will be implemented and how much operating funds allocated. Meanwhile, if referring to the theory put forward by Winarno (2005: 128) who said that the factors that drive the confusion of information in public policy implementation is usually due to the complexity of the policy, the lack of consensus on the objectives of public policy, the problems in initiating policy the new as well as the tendency to avoid accountability policies. Thus it can be saidthat the size, goals and objectives of the policy has not been implemented properly.
comprehension and knowledge about the status of RSD Malang BLUDs full or staged under the terms of the formation of BLUDs still some individuals who know about it, and even then only the technical implementation and some other implementers. Lack of information and dissemination to the hospital’s staff and employees that lead to ignorance. tentang still or not given subsidy RS after switching status into BLUDs raises the opinions expressed are not healthy in the community and local media.
Based on the data and information that has been presented, the conclusion that can be drawn is that the communication aspect in the implementation of the Operational Fund Budget Management policy BLUDs Malang City Hospital has not been effective.
The main resource in the implementation of the policy is staff or employee (street – level – bureaucrats). Failure is often the case in the implementation of the policy, one of which is caused by the staff / employees who are not quite adequate. However, by looking at the number of employees based on the results of research conducted shows that the number of personnel in hospitals Malang is sufficient.
By looking at the number of employees actually Malang City Hospital is sufficient to implement policies BLUDs. This is consistent with the theory advanced by Edward III who assert that one can determine the success of the implementation of a policy are sufficient numbers of staff.
Furthermore, with regard to the capabilities and competence of personnel resources Malang City Hospital in implementing policies BLUDs, departing from the data and information obtained can be described by education level of each employee Malang City Hospital. The level of education does affect the person’s ability and competence in accordance with the educational background they have. However, in the implementation of the necessary policies are not only limited to the educational background of personnel who are in an organization, in the broader context of the necessary skills or skills that his approach through special education or courses followed.
In addition to the number, capacity and competence of personnel resources, other factors that can influence a policy implementation are the facilities and equipment.
Malang in hospitals, facilities and equipment factors which also influence policy implementation BLUDs. It can be seen from a number of facilities and equipment are adequate ckup in supporting the implementation of the policy.
Facilities and infrastructure for the benefit of service delivery in hospitals Malang, as well as with adequate facilities and equipment and the success of policies BLUDs.
In conclusion related to resources, Malang City Hospital has a number of resources are adequate and sufficient in terms of education, competence and ability to implement policies BLUDs. Similarly, in terms of facilities and equipment are adequate.
This is in accordance with the opinion of Edward III that the components of these resources include the number of staff, the expertise of the executive, the information is relevant and sufficient to implement policies and compliance related resources in the implementation of the program, the authority which ensures that the program can be directed to as expected, as well as their supporting facilities, such as facilities and infrastructure which can be used to implement the program of activities.
Disposition aspect examined multiple dimensions which include support, attitudes and behavior of employees of Malang City Hospital in implementing policies BLUDs.
With the involvement of all employees Malang City Hospital showed that support for the implementation of BLUDs walk. Hospital employees seemed enthusiastic of Malang in carrying out their duties and functions in support of the implementation of the BLUDs policy.
Successful implementation of a policy is determined by the extent of the involvement of all actors in supporting its implementation. If not all hospital employees involved, it indicates a lack of support for the implementation of the policy by staff involved.
Observing what was stated by Director of Hospital morally Malang that employees contribute to the implementation of policies BLUDs. According to Edward III in Winarno (2005: 142-143) suggests “the tendency or disposition is one factor that has important consequences for the implementation of effective policies”. If the executor has a tendency or a positive attitude or their support for the implementation of the policy, then there is high probability that the implementation of the policy will be implemented in accordance with the initial decision. And vice versa, if the executor to be negative or to refuse the implementation of the policy because of a conflict of interest, then the implementation of the policy will face serious obstacles.
In the opinion of Van Metter and Van Horn in Agustino (2006: 162) says that “the attitude of acceptance or rejection of the implementing agency policies greatly influence the success or failure of public policy implementation. It is very likely to occur because of the policies implemented is not the result of executing formulations that know very well the problems and issues that they feel. But public policy is usually top-down which is very likely the decision makers do not know can not even touch the needs, wishes or problems that must be resolved “.
Based on the results of interviews related to what was stated in the above theory is top down policy although it appears that there is a tendency alertness of the implementers to follow up the policy in relation to their roles, responsibilities and functions, so it can be said to occur attitude of acceptance. There is thus a kind of attitude can help meet the goals or in other words the success of the operational fund management policy BLUDs.
As a conclusion of indicators disposition / attitude can be argued that one of the indicators that affect the implementation of the policy is the attitude and behavior of the implementor. If the implementor agree with parts of the contents of the policy, then they will carry out happily, but if their views differ with policy makers, the implementation process will encounter many problems. Implementation of policies conducted associated with these factors can be concluded that the attitude and behavior of employees of Malang City Hospital as the implementor is enough support so that this aspect of influence on the success of policy implementation BLUDs Malang City Hospital.
d). Bureaucratic structure
The bureaucratic structure, as one of the aspects that affect the implementation of the policy, are factors that have an important role in determining the success or failure of policies to be implemented. Bureaucratic structures that are discussed in this study is that the mechanism. Program implementation mechanism is usually established through a standard operating procedure (SOP) were included in the program / policy.
Standard Operating Procedure (SOP) the development of internal demand will be the certainty of time, resources and the need for uniformity in the organization of complex and extensive work (Winarno, 2005: 150). The basic measure SOP or work procedure is commonly used to combat common conditions in various public sectors. By using SOP, the executor can optimize the time available and can serve to unify the actions of officials in the organization of complex and widespread, so it can cause great flexibility and a great similarity in the application of the rules.
In connection with the proposed in an interview conducted can be noted that with the establishment of SOP on the management of operational funds BLUDs services, the implementation of the policy has been effective because there is a standard that can be used by implementers.
Malang City Hospital has made the Standard Operations Procedure (SOP) on the management of operational funds BLUDs services. This SOP is already contained in the governance patterns BLUDs. Pattern BLUDs governance refers to the No. 23 Year 2005 concerning Financial Management BLU About Managed Services Operational Costs In Public Service Board,
Thus, based on interviews and data obtained in this study with respect to the Policy Implementation Operational Cost Management Services In Public Service Board Malang City Hospital can be concluded that the policy Operational Cost Management Services In Public Service Board Malang City Hospital can be properly implemented because work procedures carried out in accordance with the duties, responsibilities and functions of the employees of Malang City Hospital.
Based on observations and analysis of research data Operational Cost Management Implementation Services In Public Service Board Malang City Hospital it was concluded that:
a. Regional Public Service Hospital (BLUD RSD) Malang is a regional work units form the Regional Technical Institute under the Government of Malang City which is directly responsible to the Mayor through the Secretary of the area in charge of organizing pelayananan public health in the form of health care services, without prioritizing profit while still applying the principles of efficiency and productivity.
b. As SKPD shaped BLUDs, RSD Malang still require financial support and investment, both from the Central Government, Provincial Government and the Government of Malang. Support is needed to trigger the RSD in providing health services to the public more effectively and efficiently in accordance with sound business practices.
c. Regional Hospital Malang quite effectively implement BLUDs Policy Implementation. BLUDs Policy Implementation is a strategic policy to improve the efficiency and effectiveness of services at the hospital, because the hospital is required to run a healthy business. During RSD Malang status BLUDs run a healthy business and supported the Regional Government of Malang then, it is one of the success factors BLUDs Policy Implementation RSD Malang.
d. Results of the analysis are some picture of the state are still lacking that health services are not satisfactory, the state of health professionals, especially physicians, dentists, nurses, midwives, Analyst Health, Pharmacy (assistant pharmacists) and force academy elektromedik (Atem), Waste as well as supporting facilities services such as medical equipment / health services as well as building good conditions so that the necessary improvements. With the enactment Hospital into Public Service Agency (BLUD RSD) is expected to be more exist in improving the quality of hospital care, efficiency, effectiveness and productivity in the Hospital.
e. Based on the study through Performance Measurement Activities (KDP) and the Measurement Goal (PPS) overall performance BLUDs Malang after changing its status to BLUDs reached 88.30% with a predicate successfully.
f. Deployn Implementation RSD BLUDs Malang in general accordance with Regulation No 61 of 2007. Shows Pattern Governance, RSB and Financial Statements in accordance with the standards while the SPM, the Supervisory Board has not run optimally meets standards and criteria set.
g. Good or poor condition, RSD BLUDs Policy Implementation Malang walk quite well due to the availability of medical facilities and hospital equipment, adequate human resource quality, standard procedures for health care and treatment costs are affordable. However, the follow-up to the protests and ease of service are still many complaints of the patients, which is considered less swift in responding to protests.
h. similarityn perception between RSD elite and elite Malang Malang government positive effect on the delivery of public health services, especially from the aspect of equity, and affordability of health care.
i. Health service in RSD Malang perceived as fair and non-discriminatory for patients in all rooms and classrooms.
j. Prosedur service is still simple, easy and cost requirements of the service cost and affordable to the community. For indicator attendant capabilities despite improvements, still found those with less discipline, less fast in service and less friendly.
k. Supporting actor in policy implementation BLUDs RSD Malang include these factors: 1) The human resource development program and increased the number of employees, 2) System pattern of service carried out by the whole range of services can be improved, 3) RS has had protap diagnosis and action, 4) It has an integrated hospital information system although it still does not reach throughout the service unit, and 5) the existence of RSD near also facilitate public access.
l. Barriers / obstacles generally faced RSD Malang Operational Cost Management Implementation Services In Public Service Board Malang City Hospital, Based on medical services, organization and human resources, finance, facilities and infrastructure are reviewed by internal and external analysis has not met the minimum service standards.
Based on the research results suggested the following:
a. Once set into BLUDs the City RSD, RSD tried as much as possible to complete all administrative requirements in the management system of financial planning / budget and administrative documents required, including the preparation of the RBA.
b. RSD Malang basis for intensive enhancing coordination / consultation with consultants and Malang government ranks, especially the relevant technical agencies such as the Pembina Regional Secretary, Bappeda and others for the smooth implementation of the Policy Implementation BLUDs.
c. Importance capacity building, change of mindset (maindset), and entrepreneurship (entrepreneurship) to all employees and officials Hospital manager BLUDs RSD Malang.
d. Service and professionalism of the medical personnel and paramedics can be enhanced through education and training for workers who require special skills and career education to higher education.
e. Improving the welfare and the provision of benefits to employees RSD Malang as an attempt to reduce the concentration in the outbreak providing care for patients.
f. Existence of a system to monitor the implementation of sound business by RSD Malang.
g. There needs to be an empirical study to assess the effectiveness and efficiency of RSD Malang after switching status into BLUDs.
h. Equalize the perception of the leaders / managers of the entire staffing RSD BLUDs and Malang.
i. RSD Malang should expand cooperation with third parties or donors to support the hospital that has become a public service agency BLUDs area.
j. RSD Malang need to carry out re-deployment questionnaire to improve the quality of customer satisfaction.
k. Required intelligence proper execution strategy and wise to make the Public Policy Implementing a policy in a variety of conditions that occurred in RSD Malang.
l. Settling and the expansion of the parking lot layout Hospital to be more comfortable and safer.
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