Implications of Changes in Hospital Financial Performance

Assessment as Public Services

Nurhasanah

, Rosy Armaini

, Maria

, Yevi Dwitayanti

Department of Accounting, State Polytechnic of Sriwijaya, Palembang, Indonesia

Keywords: Public service agency, state budget, financial performance

Abstract: Assessment of the financial performance of the Public Service Agency (BLU) of the Hospital as an important

public service. The results of the study became a measure of hospital success in implementing BLU Financial

Management Patterns (PPK-BLU). The study was conducted at 31 hospitals using APBN 2013-2016. This

study examines the impact of policy change/performance appraisal regulations according to the Decision of

Minister of Health (Kemenkes) number 1981/MENKES/SK/XII/2010 and the Treasury Director General

Regulation number 34/2014 on the level of independence of Hospitals. Financial performance is measured

based on financial ratios which are the criteria in the two regulations. The results of this study are expected to

contribute to BLU/BLUD Hospital, especially Hospital BLU under the Ministry of Health in an effort to

achieve the level of independence from the use of APBN funds.

1 INTRODUCTION

Government-owned hospitals, whether central or

regional based on Law (UU) number 44/2009 must be

managed in the form of a Public Service Agency

(BLU). With the enactment of UU number 44/2009,

then in early 2012 hospitals were required to apply

the Public/Regional Service Agency Financial

Management Pattern (PPK-BLU/D). PPK-BLU/D

provides flexibility in the form of flexibility for

managers to implement sound business practices to

improve the quality of public services.

The implementation of PPK-BLU/D provides an

opportunity for hospitals to act more responsively and

aggressively in facing the demands of society and

rapid changes in the health sector by implementing

effective and efficient economic principles, but not

leaving the social mission to meet the needs of public

health services. For this reason it is necessary to pay

attention to the source of financing and the

availability of hospital funds. This indicates that

financial aspects are one measure of hospital success

in achieving its performance.

In 2010, since the government-owned hospital

turned into BLU, the government issued a Decree

(SK) through the minister of health, namely

Kepmenkes number 1981/MENKES/SK/XII/2010

concerning accounting guidelines for BLU hospitals

replacing the Kepmenkes number

156/Menkes/SK/I/2003.

Then in 2014 the Ministry of Finance of the

Republic of Indonesia issued Treasury Director

General Regulation number 34/2014 concerning

BLU performance assessment guidelines in the field

of health services so that BLU accounting policies

will be even better. Implication from PPK-BLU

makes BLU especially hospitals must pay attention to

their financial performance as an important part in

prioritizing excellent service.

This paper is to examine the financial

performance of BLU hospitals in Indonesia based on

financial ratios by comparing the assessment system

based on the Kepmenkes number

1981/MENKES/SK/XII/2010 with Treasury Director

General Regulation number 34/2014 on the level of

hospital BLU independence. The level of

independence of the hospital shows how well the

hospital can finance all expenditures from its

operating income, both operational expenditure and

capital expenditure. Findings of Madjid et al. (2009)

of 26 hospitals that use funds from the State Budget

(APBN) show that the level of hospital dependence

on the APBN is an average of 42%, and without

injections from the state budget some of the BLU is

unable to run its operations.

This research is important to see the level of

financial development of the hospital as a user of

104

Nurhasanah, ., Armaini, R., Maria, . and Dwitayanti, Y.

Implications of Changes in Hospital Financial Performance Assessment as Public Services.

DOI: 10.5220/0009153200002500

In Proceedings of the 2nd Forum in Research, Science, and Technology (FIRST 2018), pages 104-107

ISBN: 978-989-758-574-6; ISSN: 2461-0739

APBN funds, before and after the implementation of

changes in the regulation of the Treasury Director

General Regulation number 34/2014 on the level of

independence. This condition is also motivated by not

all hospital BLUs applying the regulation changes in

the same year.

Based on the description that has been explained,

the Problem Formulation in this study are: 1) How is

the financial performance of BLU-hospitals in

Indonesia towards the level of independence

measured by financial ratios based on Kepmenkes

number 1981/Menkes/SK/XII/2010; 2) How is the

financial performance of BLU-hospitals in Indonesia

to the level of independence measured by the ratio of

funds based on the regulation of Treasury Director

General Regulation number 34/2014; 3) How is the

comparison of BLU-hospital financial performance

in Indonesia measured by financial ratios based on

Kepmenkes number 1981/Menkes/SK/XII/2010 and

the Treasury Director General Regulation number

34/2014 on the level of independence of BLU-

hospitals in Indonesia.

2 LITERATURE REVIEW

2.1 Understanding of BLU

Public Service Agency (BLU) in the attachment of

Permenkeu RI number 217/MK.05/2015 concerning

Statement of Accrual Based Government Accounting

Standards (PSAP) number 13 (PSAP 13), stated as

follows: Public Service Agency, hereinafter referred

to as BLU, is an agency within the central/regional

government and which is established to provide

services to the public in the form of the provision of

goods and/or services sold without prioritizing profit

seeking and in carrying out its activities based on the

principles of efficiency and productivity.

2.2 Financial Performance

This study uses financial ratios referring to

Kepmenkes number 1981/Menkes/SK/XII/2010 and

the Treasury Director General Regulation number 34

of 2014. Financial ratios based on Kepmenkes

number 1981/Menkes/SK/XII/2010 concerning

Agency Accounting Guidelines General Hospital

Services (BLU), contains four financial ratios,

namely:

1. Liquidity Ratio

2. Activity Ratio

3. Solvency Ratio

4. Profitability Ratio

Based on the Treasury Director General

Regulation number 34/2014 Regarding Guidelines

for Assessing the Performance of Public Service

Agencies in Health Services, there are several

financial ratio techniques:

1. Cash ratio

2. Current ratio

3. Receivables collection period

4. Fixed asset turnover

5. Rewards for fixed assets

6. Equity payments

7. Inventory turnover

8. Ratio of PNBP income to operational costs

9. Patient cost subsidy ratio

2.3 Level of Independence

The level of independence is measured by a ratio that

shows how well the hospital can finance all

expenditure from its income. BLU's operating income

is the income earned (in this study, the hospital) from

the operational activities carried out. Based on

Kepmenkes number 1164/Menkes/SK/X/2007

concerning Guidelines for Preparing Business Plans

and Hospital Budgets for Public Service Agencies.

The role of the research model plays a very

important role in analyzing how BLU Hospital

Financial Performance in Indonesia is based on

Kepmenkes number 1981/Menkes/SK/XII/2010 and

the Treasury Director General Regulation number

34/2014 and its comparison to the Level of

Independence of Hospital BLU based on Kepmenkes

number 1164/Menkes/SK/X/2007.

3 RESEARCH METHODOLOGY

3.1 Objects and Types of Research

The object of this research is BLU-hospital's financial

performance and the level of BLU-hospital

independence measured by financial ratios that use

two different rules while the level of independence is

measured by the criteria of Kepmenkes number

1164/Menkes/SK/X/2007 (very good, good, not

good).

This study was included in a comparative

descriptive study. is intended to obtain a description

of the financial performance of BLU-hospitals by

using the assessment system of Kepmenkes number

1981/Menkes/SK/XII/2010 and the Regulation of

Implications of Changes in Hospital Financial Performance Assessment as Public Services

105

Treasury Director General Regulation number

34/2014 on the level of BLU-hospital independence

and findings of assessment rules/systems which is

more contributing and meaningful to the level of

independence.

3.2 Population and Research Sample

The research population is a hospital in Indonesia

using APBN funds that apply PPK-BLU. Sampling

techniques with saturated sampling techniques. Thus

the total population is the same as the number of

samples studied, namely as many as 31 BLU hospitals

in Indonesia. Unit of observation is an overview of

BLU-hospital financial statements for the period

2013-2016 (audited).

4 RESULTS AND DISCUSSION

4.1 The Financial Performance of BLU

Hospitals in Indonesia towards the

Level of Independence based on

Kepmenkes Number

1981/Menkes/SK/XII/2010

Based on Kepmenkes number

1981/Menkes/SK/XII/2010 stipulates that the

assessment of Hospital BLU's financial performance

is done through liquidity, activity, solvability and

profitability ratios.

Based on the results of data processing seen in the

unstandardized coefficients column, the obtained

multiple linear regression equation model as follows:

Y = 2,982 + 0,302X1 + 0,263X2 + 0,367X3

+ 0,104X4 + e ....... (1)

Based on the conclusion knows that the ratio of

liquidity, activity, solvency and rentability has a

relatively strong relationship of 55.3% and shows the

effect of 30.6% contribution to the variable BLU-

Hospital Self-Reliance in Indonesia in 2013-2016.

4.2 The Financial Performance of BLU

Hospitals in Indonesia towards the

Level of Independence based on

Treasury Director General

Regulation Number 34/2014

Treasury Director General Regulation number

34/2014 stipulates an assessment of BLU Hospital's

financial performance through the cash ratio, current

ratio, receivable collection period, inventory

turnover, fixed asset turnover, fixed asset benefits,

equity benefits, PNBP revenue against operating

costs and patient cost subsidy ratios. In this study

researchers only used 6 ratios of financial

performance appraisal ratios, namely the cash ratio,

current ratio, fixed asset turnover, fixed asset

benefits, equity rewards and PNBP revenue against

operating costs.

The beta section of the unstandardized

coefficients column, the multiple linear regression

equation model is obtained as follows:

Y = 57,067 + 0,608X1 + 0,608X2 + 0,400X3

+ 0,679X4 + 0,556X5 + 0,438X6 + e

……(2)

Based on the results of the regression analysis as

a whole shows that between the cash ratio, current

ratio, fixed asset turnover, fixed asset benefits, equity

rewards and PNBP revenue against operating costs

has a relatively strong relationship of 51.6% and

shows a contribution effect of 27.3% on the variable

level of BLU-Hospital Self-Reliance in Indonesia in

2013-2016.

4.3 Comparison of BLU Hospital

Financial Performance in Indonesia

Correlation value on paired samples correlation test

shows a value of 0.328 which states that there is a not

too strong relationship between before and after the

change in regulatory policy guidelines for preparation

of BLU-Hospital financial statements in Indonesia

and these changes also have no significant impact

because of the significance value obtained that is

0.072 or more than 0.05.

T count value in paired samples T test is seen that

t count 2.991 is greater than t table 2.042 which states

that there is a difference in the level of independence

between before and after the change in regulatory

policy guidelines for BLU hospital financial report

preparation, with a significant level of 0.006 less than

0.05.

5 CONCLUSION

The financial performance of BLU-hospitals in

Indonesia towards the level of independence is

measured by the Financial Ratio based on Kepmenkes

number 1981/Menkes/SK/XII/2010, namely the

liquidity, activity, solvability and profitability ratios

FIRST 2018 - 2nd Forum in Research, Science, and Technology (FIRST) – International Conference

106

have a relatively strong relationship of 55.3% and

shows the effect of contribution of 30.6%.

The financial performance of BLU-hospitals in

Indonesia towards the level of independence is

measured by the financial ratio based on the

Regulation of the Director General of Treasury

number 34/2014 namely cash ratio, current ratio,

fixed asset turnover, fixed asset benefits, equity

benefits and PNBP revenues against operating costs

have a relatively strong relationship of 51.6% and

show a contribution effect of 27.3%.

Comparison of BLU-hospital financial

performance in Indonesia is measured by the financial

ratio based on Kepmenkes number

1981/Menkes/SK/XII/2010 and Regulation of the

Director General of Treasury number 34/2014 on the

BLU-Hospital Self-Reliance Level in Indonesia,

which has a difference, but the value of the

relationship is not too strong or only 32.8% between

before and after the change in regulatory policy

guidelines for BLU-Hospital financial report

preparation in Indonesia.

ACKNOWLEDGEMENTS

This research is based on work supported by State

Polytechnic of Sriwijaya, Indonesia. The author

thankfully acknowledges scientific discussion with

our colleagues from State Polytechnic of Sriwijaya,

Indonesia. The authors would like to acknowledge the

anonymous reviewers at the IC FIRST 2018 for their

feedback on an earlier version of the paper, and also

thank to the two anonymous reviewers who provided

feedback as part of this journal's review process.

REFERENCES

Keputusan Menteri Kesehatan RI

No.156/MENKES/SK/I/2003 tentang Pedoman

akuntansi rumah sakit.

Peraturan Direktur Jenderal (Dirjen) Perbendaharaan No.

34/2014 tentang Pedoman penilaian kinerja BLU

bidang layanan kesehatan.

Peraturan Menteri Keuangan RI No. No.217/PMK.05/2015

tentang Pernyataan Standar Akuntansi Pemerintahan

(PSAP) Berbasis Akrual No. 13 tentang Penyajian

Laporan Keuangan Badan Layanan Umum.

Undang-undang RI nomor 44 Tahun 2009 tentang Rumah

Sakit.

Implications of Changes in Hospital Financial Performance Assessment as Public Services

107