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Abstrak :
ABSTRAK Daerah Bekasi pusat pertanian tanaman pangan dan industri di Jawa Barat. Akan tetapi peran pertanian akan terganggu oleh kehadiran industri, yang mengakibatkan keseimbangan air untuk lahan terganggu. Oleh karena itu, faktor dampak industri yang berakibat pada kualitas irigasi akan diteliti, untuk dikelola bagi pertanian. Dalam rangka tersebut, pokok penelitian meliputi a) debit dan kualitas air sebagai variabel kualitas irigasi, kebutuhan air dan air limbah sebagai variabel dampak industri, serta dampak kualitas irigasi pada lahan sawah dan produksi sebagai variabel produktivitas lahan, b) korelasi antara kebutuhan air dan air limbah industri dengan kualitas irigasi, c) korelasi antara kualitas irigasi dengan pemberian air untuk lahan. Sehubungan dengan korelasi antara variabel diatas, dirumuskan dua hipotesis sebagai berikut : 1) Penurunan debit air dari sistem irigasi ada korelasinya dengan pemasokan air irigasi untuk industri, jika air limbahnya dibuang ke sistem drainasi. 2) Penurunan pemberian air untuk lahan tidak ada korelasinya dengan penurunan debit air irigasi dari sistem irigasi, jika kebutuhan air untuk industri dipenuhi dari air tanah. Dengan menggunakan data perkembangan industri, kualitas irigasi dan produktivitas lahan pada MT Gadu dalam kurun waktu 9 tahun (thn 1983-1991), diduga ada korelasi antara kebutuhanair dan air limbah industri dengan perubahan kualitas irigasi. Indikasinya, intensitas tanam 65,5 persen (38.313 ha), produktivitasnya 6,68 ton/ha, pemberian airnya 12,685 m3/det, lahan kurang air 17,2 persen karena debit air irigasi menurun 0,21 persen dari 44.940 m3/det, akibat air limbah industri 56,8 persen dari pemasokan airnya (0,167 m'}/det) dibuang ke sistem drainasi. Kualitas air irigasi khususnya S Bekasi meningkat sebagai dampak Prokasih. Data diungkapkan secara deskriptif dari hasil registrasi instansi terkait. Pengumpulan data dilakukan dengan pengambilan sampel air 10 titik sampling termasuk 2 titik sampling limbah industri, 25 unit industri untuk pemasokan airnya dan 21 responden untuk produktivitas lahan (metoda cluster). Pengujian hipotesis dengan analisis statistik, menggunakan variabel kebutuhan air dan air limbah industri, debit air irigasi dan pemberian air untuk lahan. Hasil analisis data memperlihatkan, 1) Dampak industri pada kualitas irigasi, adalah sebagai akibat pemasokan air untuk industri tersebut dari sistem irigasi yang lebih besar dari air limbah yang dialirkan ke sistem tersebut, sehingga debit air irigasi menurun (0,21 persen) dan kualitas air S Bekasi menurun (2,6 persen) (non significant); 2) Dampak kualitas irigasi pada produktivitas lahan, sebagai akibat penurunan debit air irigasi (1,51 persen) hingga pemberian air untuk lahan menurun (significant). Akibatnya, lahan kurang air (27,9 persen) dan produktivitas lahan menurun (12,3 persen). Air limbah sebagai faktor dampak industri diharapkan dapat dimanfaatkan lagi dan diprioritaskan untuk dikelola dengan baik agar memenuhi sebagai air irigasi namum pelaksanaannya relatif sulit. Dampak lebih jauh swasembada pangan dan kebutuhan air wilayah Barat akan terganggu, karena peruntukan air untuk industri meningkat menjadi 5,2 m3/det. Diversifikasi tanaman tahunan hemat air berpeluang, untuk mempertahankan kualitas irigasi dan swasembada pangan, tetapi timbal tantangan karena produknya berbeda dengan beras. Kesimpulan yang diberikan, akibat air limbah industri yang cenderung dibuang ke sistem drainase adalah terjadinya penurunan kualitas irigasi (debit dan kualitas airnya). Akibatnya pemberian air untuk lahan menurun, swasembada pangan dan kebutuhan air wilayah Barat terganggu. Diversifikasi tanaman tahunan hemat air berpeluang, untuk mengatasi masalah kualitas irigasi dan swasembada pangan, hanya kualitasproduknya perlu disesuaikan agar setara dengan beras.

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ABSTRACT Bekasi region is the center of food crops agriculture and industry in West-Java. The agriculture role will be disturbed with the presence of industry and which is also important for the regional economy, due to the disturbance of the water balance for land plots. Therefore, the factor of the industry impact on the quality of irrigation will be surveyed, in order to be able to be managed for irrigation (agriculture). In said frame, the priority of research shall cover : a) the discharge and quality of water as a variable of irrigation quality, the requirement of water and waste water as a variable industrial impact and the impact on the irrigation quality on rice fields and production as a variable of the land plot's productivity, b) the correlation between the requirement of water and industrial waste water with the irrigation quality, c) the correlation between the quality of irrigation with the discharge of water for land plots. In relation to the correlation between the variables above, two hypothesis are formulates as follows : 1) The declination of the water discharge of irrigation has its correlation with the supply of the water for the industry of the irrigation system, if its waste water to be disposed to the drainage system, 2) The decrease of the water supply for the land plots has no correlation with the decline of the irrigation water discharge of the irrigation system, if the need of water for the industry is fulfilled from ground water. By using the industrial development data, the irrigation quality and land productivity at MT Gadu in the duration of 9 (nine) years (year 1983-1991), at is guessed that there is a correlation between the need of water and industrial waste water and the change of the irrigation quality. Its indication comprises the intensity of planting 65.5 percent (38,313 ha), its productivity : 6.68 ton/ha, the discharge of its water : 12.685 m3/sec, land plots with insufficient water : 17.2 percent as the irrigation water discharge decreases with 0.21 percent of 44.940 m3/sec, consequence of industrial waste water : 56.8 percent of itswater supply (0.167 m3/sec) is disposed to the drainage system. The quality of the irrigation water particularly Bekasi river increases as the impact of Prokasih (Clean River Program). The data are revealed descriptively based on the results of registration of linked government agencies. The collection of data shall be conducted with the sampling of 10 points of water samplings including the 2 points of industrial waste samplings, 25 industrial units for the supply of its water and 21 respondents for the land productivity (cluster method). The testing of the hypothesis with the statistic analysis, uses variables on the requirement of water and industrial waste water, irrigation water discharge and the discharge of water for the land plots. The results on analysis of data shows, 1) The industrial impact on the irrigation quality is as the consequence of the water supply for said industry of the irrigation system which is larger than a waste water which is discharged to said system, so that the irrigation water discharge -decreases of (0.21 percent) and the quality of the water of Bekasi River declines (2.6 percent) (non significant) ; 2) The impact of the quality of irrigation on the productivity of land plots, as the consequence of the decrease of the water discharge of irrigation (1.51 percent) so that the discharge of water for land plots declines (significant). The consequence thereof is that the land plots with insufficient water (27.9 percent) and the productivity of land plots decreases (12.3 percent). Waste water as the factor of industrial impact is expected to be able to be made use of and priority is given to be managed well in order to fulfill the purpose as irrigation water butits implementation is relatively difficult. The further impact of self-supporting food and the need of water for the Western territory will be disturbed, because of the allocation of water for industry increases to 5.2 m3/sec. The diversification of annual plants which do not require much water shall have the opportunity to maintain the irrigation quality and self-supporting on food, but challenge will arise as its production differs from rice. The conclusion given, that the consequence of industrial waste water which has the tendency to be discharged into the drainage system shall be the decrease of the quality of irrigation (its water discharge and quality). The consequence thereof is that the discharge of water for land plots decreases, the self-supporting of food and the need of water for the Western territory becomes disturbed. The diversification of annual plants which do not need much water shall have the opportunity to overcome the problem of the quality of irrigation and the self-supporting of food, only the quality of its production should be adjusted in order that it is equal to rice.

Abstrak :
Biaya pelayanan kesehatan di Indonesia dari waktu ke waktu semakin meningkat akibat adanya krisis ekonomi yang terus berlanjut sehingga merupakan beban pembiayaan kesehatan bagi pemerintah daerah, hal ini berdampak pada puskesmas. Sementara itu belum diketahui biaya satuan pelayanan Balai Pengobatan di Puskesmas Lemah Abang II. Padahal ini perlu dilihat sebagai salah satu altenatif mobilisasi dana untuk mencukupi kebutuhan biaya operasional maupun pemeliharaannya dalam upaya memberikan pelayanan kesehatan yang lebih bermutu, Pemilihan Puskesmas Lemah Abang sebagai tempat penelitian karena merupakan salah satu dari 5 Puskesmas dengan kunjungan terbanyak di Kabupaten Bekasi, salah satu puskesmas yang berada antara wilayah industri dan pertanian. Sedangkan Pemilihan unit Balai Pengobatan adalah unit yang paling banyak kunjungannya. Penelitian ditakukan untuk mengetahui biaya total, biaya satuan aktual, dan normatif, CRR ATP/WTP dan tarif pesaing setara Metode penelitian yang digunakan studi kasus dengan pendekatan kuantitatif, sedangkan metode analisis biaya yang digunakan Activity Based Costing. Untuk survei ATP/WTP sampel yang digunakan sampel 66 orang pengunjung pelayanan Balai Pengobatan digunakan Activity Based Costing. Untuk survei ATP/WTP sampel yang digunakan sampel 66 orang pengunjung pelayanan Balai Pengobatan. Hasil Penelitian memperlihatkan bahwa biaya satuan aktual pelayanan pengobatan di BP di Puskesmas Lemah Abang II adalah Rp 16.175,5 Biaya satuan aktual pengobatan tanpa AIC Rp 15.032,3 Biaya satuan pengobatan tanpa AIC dan gaji Rp 7.912,6 Sedangkan biaya satuan normatif adalah Rp 15.633,4 Perhitungan dan tarif yang berlaku saat ini ternyata hanya mencapai 15,5 % Cost Recovery Rate (CRR) artinya yarif yang berlaku saat ini masih jauh dibawah total biaya Puskesmas. 'Dari berbagai penelitian sejenis di berbagai wilayah Jawa Barat terlihat Biaya yang paling besar adalah biaya operasional. Komponen biaya yang terbesar adalah gaji yang diikuti dengan biaya obat-obatan. Mengenai ATP/WTP didapatkan basil bahwa ATP pengunjung Balai Pengobatan di wilayah Puskesmas Lemah Abang II menyatakan 100 % mampu membayar sebesar Rp 5.000,- padahal tarif yang berlaku Rp 2.500,- Hal ini berarti bahwa ATP lebih besar dari WTP sehingga peluang untuk menaikkan tarif masih ada Sedangkan tarif pesaing setara semuanya berada diatas tarif pengobatan di BP Puskesmas Lemah Abang II. Dari hasil simulasi tarif berdasarkan biaya satuan aktual dan normatif, ATPIWT,.CRR dan tarif pesaing setara didapatkan usulan tarif pengobatan di Balai Pengobatan sebesar Rp 7,500 setiap kunjungan. Sedangkan CRR dapat ditingkatkan dari masyarakat yang mampu sedangkan bagi yang miskin ditanggung oleh pemerintah dalam bentuk kartu sehat. Dalam meningkatkan tarif harus diperhatikan tarif pesaing setara agar peningkatan tarif tidak mengganggu utilisasi dari PKM Lemah Abang II Dari basil tersebut disarankan bagi Puskesmas melakukan pengendalian biaya (cost containment) dan efisiensi biaya operasional, meningkatkan jangkauan pelayanan pengobatan di Balai Pengobatan dan mengoptimalkan penggunaan laboratorium. Untuk mendapatkan tarif pelayanan kesehatan secara menyeluruh perlu dilakukan analisis tarif pada unit pelayanan yang lain. ......Cost of health services in Indonesia is more increases time to time caused by economic crisis and still going up to now. The economic crisis is burdening the government for health financing. Meanwhile not knowing unit cost for health services this research is carried out in Public Health Center Lemah Abang II in Bekasi region. Bekasi Regional Government has to try alternative to mobilize the public funds to fulfilled operational and maintenance cost to give quality health services. This PHC which have been selected purposively and among five PHC who had been many patient. Selection sample this PHC Lemah Abang II because located between agricultural area and industrial area. Clinical treatment is area of this research. Moreover to find out total cost clinical treatment , actual unit cost and normative unit cost with tool coat analysis called Activity Based Costing. It is also aimed knowing the illustration of ability to pay (ATP) and willingness to pay (WTP) of patient PHC considering the competitors tariff as the basis of the suggest tariff. For survey ATPIWTP take proportional sample amount 66 persons who has take among the patient PHC Lemah Abang II Result of the research can figured that unit cost clinical treatment Rp 16,175,5 , unit cost without depreciation Rp 15.032,3 and unit cost without depreciation and salary Rp 7,912,6. Even though normative unit cost Rp 15.633,4 . The tariff and unit cost has been found only reached 15,5 % Cost Recovery Rate it means that tariff government rule is far below unit cost .From the other many researcher in West Java found that operational cost the biggest coat from total cost. Cost component who have biggest contribution was salary, behind that its cost of medicine. Based on ATP/WTP figured that patient on PHC Lemah Abang II declared 100 % able to pay health treatment Rp5.000; it means ATP patient more higher than tariff who had point out amount Rp 2.500, . This issue can give opportunity to increased tariff. On the other hand services from time to time undergo the increasing cost. In line with autonomy district make the Regional s, especially those who are dealing with the health service financing are bearing greater responsibilities. Bekasi Regional Government has to try mobilized the public funds for raising income collected from the society to cover their health service The tariff of Public Health Center Lemah Abang II should be viewed as one alternative to increase the income of PHC to cover operational and maintenance cost so that it can give more quality services. However in the welfare policy the public goods services should be finance collectively through the government subsidy collected from the society it self. From the tariff simulation on unit cost, ATPfWTP, CRR and considering the competitor tariff , the suggested tariff for clinical tariff is Rp 7.500,- per visit, With tariff 93,9 % of the society can afford it and 6,1 % cannot afford it so that they need to be subsidized. One way of giving the subsidy is providing them with the health cards. Tariffs other than the clinic production unit should refer to the unit cost which have been calculated in this research 2001 We suggested that the price charged by PHC Lemah Abang II must be based on unit cost health services and for more accurate the research from the other unit health services must be done. So that this research must be follow up with another research.