Pernbentukan kawasan perdagangan bebas oleh banyak negara, termasuk Indonesia, membuat pexsaingan makin ketat, termasuk induslri rumah sakit. Agar dapat bcrtahan, rumah sakit diharapkan dapat mcningkatkan pendapatan dan menekan biaya. Pendapatan lnstaiasi Farmasi RSAB HK hanya mempunyai ratio pcndapatun sebesar 28 - 29 % giari total pendapatan rumah sakit, sedangkan litcmtur menyatakan sekitar 40-50 %. Dineksi rumah sakit mengharapkan pcndapatan ditingkatkan menjadi 40 %.Dilakukan penelitian kualitatif selama 2 bulan pada bulan April dan Mei 2007 di Rumah Sakit Anak dan Bunda I-Iarapan Kita untuk mengctahui mengapa banyak resep keluar. Jumlah informan sebanyak 21 orang. Kesesuaian infonnasi didapatkan dari informan petugas Instalasi Farmasi dan petugas lain yang mcngetahui/berhubungan dengan aktivitas instalasi. Kecukupan informasi/inf`o|'man clilakukan dengan snow balling efécr. Metode pengumpulan informasi dilakukan dengan wawancara, observasi, dan pemeriksaan data/dokumen. Validitas data dijaga dcngan lriangulasi sumber, metode, dan data/analisis.Hasil penelitian menunjukkan harga obat mahal, obat tidak lengkap, dan waktu tunggu lama berhubungan dengan rendahnyn pcmanfaatan lnstalasi Farmasi RSAB HK. Peneiusuran lebih lanjut, empat faktor diatas disebabkan:

1. Forrnularium yang out of date dan tidak ditaati;
2. Pembayaran vendor dan petty cash yang terlambat,
3. Kurangnya insentif untuk memotivasi pasien rnembeli opal di RS;
4. Pengenaan Pajak Pertambahan Nilai yang kurang tepat;
5. Pengelolaan dan monitoring stok kurang optimum;
6. SIRS yang tidak dapat digunakan memonitor stok;
7. Skedul kerja petugas tanpa pcnjadwalan scsuai beban kcrjajam sibuk.

Beberapa hal disarankan untuk mengatasi hal ini berdasarkan kemudahan melakukan, lama waktu pelaksanaan, penggunaan sumbcr daya, dan efektivitas:

1. Koreksi hai-ga jual obat rajal scsuai aturan PPN;
2. Mempcrccpal pembayaran vendor dan penggantian petty cash gudang farmasi;
3. Menerapkan metode stok minimum dan maksimum pada pengelolaan persediaan;
4. Sosialisasi peian lnstalasi Farmasi dalam memmjang aktivitas RS;
5. Perbaikan SIRS schingga mampu mcmonitor stok dan melatih petugas menggunakan dengan benar;
6. Mengatur jadwal masuk petugas sesuai jam sibuk;
7. Membatalkan rencana penambahan depo ranap;
8. Penentuan strategi harga dengan super value strategy (kualitas tinggi dan harga murah) untuk jangka pendek (misalnya 1 tahun) dan dilanjutkan dcngan high value strategy (kuaiilus tinggi dengan harga sedang) atau good value strategy (kualitas sedang harga dengan rendah) ditambah pengenaan margin lebih besar untuk obat pasien ranap kelas yang lebih linggi dan obat slow moving, serta perlakuan pembelian obat pasien rawat inap kelas 3 dan intensif sebagai pasien rawat map.

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Free trade zone among countries, including Indonesia, create tight competitions in hospital industry. To survive, hospital has to increase revenues and decrease costs. As a government hospital, the ratio of pharmacy installation revenues compared to total revenues is 28 - 29 %. Some literatures indicate higher number reaching 40-50 % for industry average. The management of the hospital is targeting and demanding increased ratio to 40 %.

A qualitative research was conducted in April and May 2007 at the Children and Women Hospital Harapan Kita to detemtine why many prescriptions failed to be used inside and were outside. 21 persons were used as informants. Informations appropriateness was got by using employees of Instalation and other persons who knew lnstalation activity. Snow balling effect in deciding the adequacy of the informants and information was used. Information and data collection was conducted using interviews, observation, and documents/data study. Triangulation of sources, methods and data/analysis were used to maintain the validity of data.

The results of the study show that high price ofthe drugs/medicines, unavailability of some arrays of the medicines, and long queues are the prominent causes of internal prescription leakage. Further investigation reveal above problems were caused by:

1. Outdated formularium;
2. Dcllaycd payment lo vendor and reimbursement of the petty cash;
3. Not enough incentives to motivate patient to buy inside;
4. In-appropriate application of value added tax;
5. Not optimized inventory management;
6. Hospital Information system is unable to monitored drugs stocks;
7. Evenly distributed staffs allocation, without considering the needs to assign more people at busy hours.

Seven issues are suggested to solve the problems based on feasibility, effcetivity, duration of the afford, and usages of the resources:

1. Price correction due to in-appropriate of value added tax;
2. Expedite faster payment to vendors, and expedite reimbursement petty cash;
3. Apply minimum and maximum stock system to inventory management;
4. Sosialize the iinance role of thc instalation to Hospital activity;
5. Upgrade computer program systems and train staffs in better using it;
6. Reschedule work force so that more staffs are on duty at peak hours;
7. Abort the plan to establish second In-patient depo;
8. Rocalculating thc selling price in terms super value strategy (high quality low price) for I year, then to high value strategy (high quality normal price) for good value strategy (normal quality low price), higher margin for higher class of in-patient and slow moving drug, and sell medicine without VA tax to class 3 and intensive in-patient.