CALCULATION OF UNIT COST ANALYSIS IN PHACOEMULSIFICATION

SERVICE WITH ACTIVITY BASED COSTING METHOD AT PKU

MUHAMMADIYAH YOGYAKARTA HOSPITAL
Windi Pertiwi 1, Firman Pribadi2, Triyani Marwati 2
1
Program Studi Magister Manajemen Rumah Sakit, Fakultas Kedokteran dan Ilmu
Kesehatan, Universitas Muhammadiyah Yogyakarta, 2Departemen Manajemen,
Fakultas Kedokteran dan Ilmu Kesehatan, Universitas Muhammadiyah Yogyakarta

Abstract

Background : Payment of claims Jamkesmas to the hospital based on INA CBGs

package, then the hospital as a patient care provider of Jamkesmas should conduct
efficiency in the management of these services. It is necessary for its analysis of the
cost of the service Phacoemulsification services so that hospitals do not get a loss.

Methods : This study is a qualitative study that calculate the unit cost (unit cost)
Phacoemulsification in INA CBGs services using Activity Based Costing (ABC) that
can occur based on the ABC method of cost comparison with INA CBG's claim.

Result : Based on the calculation, the unit cost of service Phacoemulsification with
activity-based costing method in CBG's is Rp. 3.152.637. With the difference
between the cost of the unit Phacoemulsification in CBG's and INA rates CBG's
Phacoemulsification is Rp. 413.155.

Conclusions : There is a negative difference between the unit cost of service

calculation Phacoemulsification with the ABC method with INA CBG's claim. So
that needs to do efficiency of the hospital.

Key Word : Phacoemulsification, INA CBG's, Activity Based Costing.

INTRODUCTION

Based on1 Ministry of Health has implemented guaranteeing health services

to the poor, the program through the Jaminan Kesehatan Masyarakat (Jamkesmas).
Jamkesmas is social assistance for health care for the poor and people who can not
afford the fee paid by the government and implemented since 2008.

Minister of Health Decree No. 989/Menkes/SK/IX/2007 on the application of

INA DRGs (Diagnosis Related Groups Indonesian) for participants of Community
Health Insurance program (Assurance) from 1 July 2008, the rate of health care
standards at the hospital is determined by classification of diseases and procedures act
of service in accordance with the type of hospital and hospital care class2.

In the aspect of services, in the year 2011 introduced a package of INA CBGs.
The application of packet-based packet way casemix payment system Cased Based
Group Indonesia (INA CBGs) in Jamkesmas program requires health providers to use
resources efficiently, including drugs and rational but effective. To achieve good
patient satisfaction and efficiency in terms of cost it is necessary to keep the
procedures that have been made by the hospital in the form of clinical pathways3.
In calculating unit costs that occur in the hospital service, with the
development of science, in the late 1800s and early 1900s was born of a system of
determining the cost of the activity-based products designed to overcome distortions
in traditional cost accounting. The accounting system is called Activit Based Costing.
Definition of Activity Based Costing (ABC) is a costing system that first trace costs
to activities and then to products4.

INA CBGs package rates are also included in the tariff applied to act as a case
Phacoemulsification surgery at the highest science of eye diseases which are handled
by the hospital. In 2012 there were 44 patients who underwent cataract
hospitalizations in RS PKU Muhammadiyah and get cataract surgery, 16 of whom is
a health patients who had cataract surgery with Phacoemulsification technique. With
the rate that has been applied then the hospital needs to make adjustments to the
tariff. It is necessary for its analysis of the cost of the service Phacoemulsification
actions that the hospital did not get the loss. From the above background, the
formulation of the problem can be formulated as follows:

1. How is the unit cost to Phacoemulsification with activity-based costing

method ?
2. How is the difference between the cost of the unit's Phacoemulsification and
Phacoemulsification INA CBG's claim?

MATERIALS AND METHODS

Types of Research
The study was conducted using qualitative descriptive method by conducting case
studies in PKU Muhammadiyah Hospital of Yogyakarta. The calculation is done
using the unit cost method of Activity Based Costing (ABC).
Location and Time Research
This study was conducted in May-December 2013 in the PKU Muhammadiyah
Hospital of Yogyakarta.
Subject and Object Research
In this study, the subject of his research is the Chief Financial Officer,
Ophthalmologist, Chief of the Central Surgical installation space, admissions clerk,
medical records, quality parts, marketing of PKU Muhammadiyah Hospital of
Yogyakarta. Meanwhile, the object of his research is the activity undertaken to
produce services in Phacoemulsification services at PKU Muhammadiyah Hospital of
Yogyakarta. Activity in question is all the activities that occur on Phacoemulsification
action either directly or supporting actions that support the activities of
Phacoemulsification.
Research Variables
In this research study is the variable unit cost of accommodation that occurs in
patients receiving Phacoemulsification actions and activities in the outpatient unit
Eyes, Inpatient Arafat, Installation Central Surgery, Nutrition, Installation
Laboratory, Radiology, Division of Finance and cashier.
1. Research Instruments
Guidelines for documentation of procedures that are associated with the
service Fakoemilsifikasi owned PKU Muhammadiyah Hospital of
Yogyakarta.
2. Interview guide
The interview is one method of data collection by asking directly or
communicating directly with respondents to obtain information on the issues
under study.
3. Observation using a checklist to guide clinical pathways such as direct
observation of the research object, the activities undertaken during the patients
treated.
4. Stopwatch is a measure of time used to measure the length of time of each
activity undertaken, ranging from patient registration to enroll in patients
discharged from the hospital.

Data analysis
This study collected data on primary and secondary data. From the results of the
primary and secondary data collection on top, the next step is processing the data of
direct and indirect costs on Phacoemulsification action that is cost allocation of units
(services, support and non-medical). The data obtained and analyzed by the method
of activity-based costing, the results of the analysis described later became:
1. Determine the activity centers on the unit.
2. Determine the the cost categories and cost of drivers of each cost category
3. Direct charge consumed in the act of Phacoemulsification action.
4. Determining the cost of direct and indirect resource overhead and total
overhead of resource overhead consumed each activity by using the
 proportion of time that is related to the outpatient unit Eyes, Installation
Central Surgery, inpatient ward Arofah.
5. Determine the activity centers terait Phacoemulsification actions contained in
Clinial Pathways.
6. Overhead charge into each activity centers in clinical pathways.
7. Summing the direct and overhead costs are included in clinical pathways.
8. Comparing the cost of CBG using ABC tally with INA CBGs set fee if the
government Determine the the cost categories of patients on clinical
pathways, namely the template group that raises the cost of the service charge
Phacoemulsification.

RESULTS
Picture of Research Subjects Based on the interview with the Head of Finance and
Head of the Unit of Ophthalmology Clinic at PKU Muhammadiyah Hospital of
Yogyakarta. Each study subject was given the opportunity to express opinions.
Cataract surgery services provided by RS PKU Muhammadiyah Yogyakarta
performed in patients with Phacoemulsification method. Regarding the calculation
system is applied in the hospital service PKU Muhammadiyah Yogyakarya for
Phacoemulsification is the conventional method which is based consumables and
labor costs.

1. Presentation of Data Measures Phacoemulsification

The process of calculating the unit cost (unit cost) for Phacoemulsification
action on JAMKESMAS program at PKU Muhammadiyah Hospital of
Yogyakarta performed using activity-based costing method is as follows:
Determine the activity centers on the unit in question.
Based on interviews and observations that have been made to the service at
PKU Muhammadiyah Hospital of Yogyakarta the activity center located at the
outpatient, inpatient and surgical central installation can be seen in Table 10.,
Table 11. and Table 12.
2. Direct charge consumed in the act of Phacoemulsification
Table 1. Direct costs Phacoemulsification action.

Cost category Cost

Registration 12.500
Spesialist of Eye consultation 22.500
Biometry Examination 150.000
Blood Test 14.400
Hbs Ag Test 40.000
Nutritions 22.500
Materai 6.000
Laundry 41.500
First Spesiailist of Eye Visite 35.000
Second Spesiailist of Eye Visite 35.000
Kasa lipat 5cm X 13 cm X 12 ply 2O Pcs 17.025
Handscoend ST 6,5 Gamex 1 Pcs 13.950
Handscoend ST 7 Gamex 1 Pcs 13.950
Spuit Inj 1 cc 80IU Terumo 2 Pcs 8.250
Spuit terumo 5cc 1 Pcs 3.300
Cendo Pantocain 0,5%# 0.5 Boyol 6.300
Aquadest Opls 25 cc, 2 4.125
IOL Simflex1 Pcs 77.400
Cendo Xitrol 21.325
Cendo Floxa 22.500
Cendo Noncort 32.500
Tripan blue 38.500
Miostat injection 38.500
Micro knife 15’ 118.000
Ciprofloxacin 500 mg tab, 10 2.700
Metilprednisolone 4 mg, 10 4.650
Administration of Arafah 58.500
Phaacoemulsifikation machine 795.454
Instruments Sterilisation 200.000
medical services phacoemulsification 1.050.000
Total 2.906.329
Source : Secondary Data
3. Determining the cost of overhead
Imposition of overhead costs to the activity through direct and indirect
resources resources. Steps to identify the overhead costs are as follows:
a. Determine the indirect cost of resources
 Indirect resources is an imposition of indirect costs to activities on the
basis of any nature or proportions. Non-functional unit includes non-
medical units such as the board of directors, administrative staff (training,
staffing, administration, logistics), and security.
Table 2. Indirect Resource Overhead Cost.

Indirect Resource Overhead Cost PKU

Muhammadiyah Hospital of Yogyakarta in 2012 Cost
Labour-related
Employee costs 8.318.871.403
Equipment-related
Cost Furniture and office equipment 293.911.128
The cost of depreciation of machinery and installations 108.085.548
Spaced-related
Maintenance and Repair Costs 395.923.835
Depreciation Cost of Non-Functional Building 53.181.580
Service-related
Cost of Goods Procurement 2.919.068.372
Office and subscriptions costs 4.697.790.343
Total 16.786.832.209
Source : Primary data

Indirect costs of resource overhead RS PKU Muhammadiyah Yogyakarta is Rp.

16,786,832,209 charges will be borne by the functional unit PKU Muhammadiyah
Hospital of Yogyakarta on the basis of the proportion of the number of employees in
each functional unit. This can be seen in Table 3.

Tabel 3. Imposition Basic Overhead Costs.

Fungsional Unit Total of Propotion Cost*

employee (persen)
Hospitalization unit 147 45% 7.554.074.494
Outpatient unit 28 9% 1.510.814.899
Surgery unit 20 6% 1.007.209.933
Emergency unit 20 6% 1.007.209.933
Supporting units 111 34% 5.707.522.951
Total 326 100% 16.786.832.209
*Cost : total of employee in unit / total of employee X total of cost

Source : Secondary data

After knowing the proportion of loading of each functional unit, then the next step
can be performed to calculate the imposition of any one patient who received
phacoemulsification action. In this stage will be divided by 3 units related to the
service are as follows Phacoemulsification.
1) Outpatient
Based on Table 3 . for indirect costs of resource overhead outpatient units get
a load of Rp . 1510814899 which will be charged to all outpatients . For that if
all patients during 2012 was 74 935 patients for loading the resource overhead
and indirect costs to any one action is Rp . 20 162 .
2) Hospitalization
Based on Table 3 . then for inpatient unit gets the biggest burden for indirect
costs Rp resource overhead . 7554074494 which will be charged to all
inpatient units . Based on the proportion based on the number of beds , the
inpatient unit Arafah that has 24 beds compared with the rest of the bed is 207
beds in the inpatient unit of the inpatient units Arafah got the imposition of
resource overhead and indirect cost of Rp . 875 834 724 . Indirect overhead
costs charged to the patient resource will be proportioned imposition of
resource overhead and indirect costs per patient per day . Arafat 's own
inpatient unit in 2012 the number of days of inpatient hospitalization 9,168
days , so that for each day of hospitalization , the patient will receive the
indirect imposition of resource overhead cost of Rp . 95 532 .
3) Installation of the Central Surgical
Based on Table 3. then for a surgical installation gets imposition central
resource for indirect overhead cost of Rp. 1007209933 which will be charged
 to all surgical patients central installation. Resource overhead indirect costs
charged to the installation will be borne by the central surgical patients by
charging base that has been done by RS PKU Muhammadiyah Yogyakarta,
which is based on the type of surgery. Loading large proportion and number
of patients can be seen in Table 4.
Table 4. Table burden surgery based on the type of operation.

No Type of surgery service Total of Service Burden

1. Small Surgery 306 0.5
2. Medium Surgery 1451 1
3. Big Surgery 1438 1.5
4. Special Surgery 1275 2
5. Advanced Surgery 144 2.5
Total 4614 7.5
Source : Primary Data
Based on Table 4. then for special operations will get charging indirect costs
amounted Rp.74.220.064 resource overhead. Phacoemulsification surgery is
one that is performed by RS PKU Muhammadiyah Yogyakarta included in
special operations. If the action is based on the number of special operations
for the particular surgery will get charging indirect costs Rp resource
overhead. 58 212.
b. Determining the direct cost of resources
Direct loading of resources is an indirect cost to the activity through a
causal link between the resources consumed by the activity generated.
1) Outpatient
Table 6. Direct Resource Overhead cost outpatient unit.

Direct Resource Overhead cost of outpatient unit at

PKU Muhammadiyah Hospital of Yogyakarta in 2012 Cost
Labour-related 6.811
Equipment-related 81
Service-related 1.721
Total 8.613
Source : Primary Data
 2) Arafah Unit

Table 7. Direct Resource Overhead cost of Arafah unit.

Direct Resource Overhead cost of Arafah unit PKU

Muhammadiyah hospital of Yogyakarta in 2012 Cost
Labour-related 5.482
Equipment-related 80
Service-related 3.856
Total 9148
Source : Secondary Data

3) Surgery unit

Table. 8. Direct Resource Overhead cost of surgery unit.

Direct Resource Overhead cost of surgery PKU

Muhammadiyah Hospital of Yogyakarta in 2012 Cost
Labour-related 57.540
Equipment-related 4.329
Service-related 5742
Total 67.611
Source : Secondary Data

c. Total of overhead cost

Table 9. Total of overhead cost.

Type of unit Overhead cost Total of

Indirect Direct overhead
resource resource cost
Outpatient unit 20.162 8.613 28.927
Arafah unit 95.532 9.418 104.950
Surgery unit 58.212 67.611 125.823
Source : Primary Data
d. Overhead charge into each activity centers.
1) Burden of overhead costs to the activity at the outpatient unit.

Tabel 10. Burden of overhead cost in activity of outpatient unit.

Activity center Time Burden of
(minute) overhead costs
Patient acceptance 3 933
Vital sign examinations 5 1.555
Anamnesis, physical examination, diagnosis, 30
medical explanation, doctor instructions 9.331
Doctor prescription 5 1.555
Charging administration hospitalized patients 15
who will be hospitalization 4.666
Consultations to other part spesialist 15 4.666
Escort patient undergoing inpatient 20 6.221
Total 93 28.927
Burden of overhead cost = time of activity / total of activity time X total of costs

Source : Primary Data

2) Burden of overhead cost of activity in Arafah unit.

Table 11. Burden of overhead cost of activity in Arafah unit.

Activity in Arafah unit Time Burden of

overhead cost
Preparation room 15 6.478
Patient Acceptance 5 2.159
Handover medica record 3 1.296
Room orientation 15 6.478
Mounting identity bracelet 5 2.159
Vital sign examination 5 2.159
Assesment of patient history of pain score, 15 6.478
risk of fall, and allergy
Pemasangan intra vena line 15 6.478
Filling medical record (nursing care) 5 2.159
Pre operation preparation 20 8.638
Preparation and administration of drugs 15 6.478
Bleeding observation 5 2.159
Wound care 15 6.478
Fluid Balance 5 2.159
Assesment of patient history of pain score 5 2.159
Assesment of gastrointestinal function 5 2.159
Personal hygiene 15 6.478
Remove the identity bracelet and intravena 20 8.638
line
Return the excess drug to the pharmaceutical 5 2.159
Preraration of patient to go home 5 2.159
Providing cover letter administrative 15 6.478
settlement
Delivering patient 10 4.319
Assesment of gastrointestinal function 5 2.159
Personal hygiene 15 6.478
Total 243 104.950
Burden of overhead cost = time of activity / total of activity time X total of costs

Source : Primary Data

3) Burden of overhead cost of surgery unit.

Tabel 12. Burden of overhead cost of surgery unit.

Activity in surgery unit Time Burden of

overhead cost
Patient identification 5 4.339
Medical record handover 5 4.339
Checks surgery tools and materials 5 4.339
Pre operation check 3 2.603
Checks anesthesia equipment and materials 15 13.016
Do time in,durante, time out 15 13.016
Implement anesthetic by a specialist 15
anesthetist 13.016
Carry out operations 30 26.032
Write operation report 5 4.339
Writing instruction postoperative 5 4.339
Monitoring patients after surgery 30 26.032
Decision permission to get out of recovery 5
room by anesthesia specialists 4.339
To call into the inpatient room to pick up 2
patient 1.735
Medical record handover 5 4.339
Total 145 125.823
Burden of overhead cost = time of activity / total of activity time X total of costs
 Source : Primary Data

e. Determine the activity centers associated actions contained in Clinial

Phacoemulsification Pathways and overhead charge into each activity
centers in clinical pathways
1) Outpatient unit

Table 13. overhead cost Phacoemulsification service in outpatirnt unit.

Activity Total of overhead of Total of

transaction activity cost

Patient acceptance 1 patient 933 933

Vital sign examinations 1 activity 1.555 1.555
Anamnesis, physical 1 activity
examination, diagnosis, medical
explanation, doctor instructions 9.331 9.331
Doctor prescription 1 activity 1.555 1.555
Charging administration 1 activity
hospitalized patients who will be
hospitalization 4.666 4.666
Escort patient undergoing 1 patient
inpatient 6.221 6.221
Total of overhead cost 24.261
Source : primary data
2) Arafah unit

Table 14. Overhead cost Phacoemulsification service unit in Arafah unit.

Activity in Arafah unit Total of overhead Cost Total of cost

transaction of activity
Preparation room 1 activity 6.478 6.478
Patient Acceptance 1 activity 2.159 2.159
Handover medica record 1 activity 1.296 1.296
Room orientation 1 activity 6.478 6.478
Mounting identity bracelet 1 activity 2.159 2.159
Vital sign examination 4 activity 2.159 8.636
Assesment of patient history of 1 activity
pain score, risk of fall, and
allergy 6.478 6.478
Filling medical record (nursing 4 activity
care) 2.159 8.636
Pre operation preparation 1 activity 8.638 8.638
Preparation and administration 2 activity
of drugs 6.478 12.956
Assesment of patient history of 1 activity
pain score 2.159 2.159
Preparation and administration 1 activity
of drugs 6.478 6.478
Personal Higiene 2 activity 8.638 17.276
Filling medical record (nursing 1 activity
care) 2.159 2.159
Remove the identity bracelet 1 activity
and intravena line 2.159 2.159
Return the excess drug to the 1 activity
pharmaceutical 6.478 6.478
Preraration of patient to go 1 activity
home 4.319 4.319
Providing cover letter 1 activity
administrative settlement 2.159 2.159
Delivering patient 1 activity 6.478 6.478
Total of Overhead cost 113.579
Source : Primary Data
3) Surgery Unit

Table 15. overhead cost Phacoemulsification service unit in Surgery unit.

Activity ini surgery unit Total of overhead cost Total of cost

Transaction of activity
Patient identification 1 activity 4.339 4.339
Medical record handover 1 activity 4.339 4.339
Checks surgery tools and 1 activity
materials 4.339 4.339
Pre operation check 1 activity 2.603 2.603
Checks anesthesia equipment 1 activity
and materials 13.016 13.016
Do time in,durante, time out 1 activity 13.016 13.016
Carry out operations 1 activity 26.032 26.032
Write operation report 1 activity 4.339 4.339
Writing instruction 1 activity
postoperative 4.339 4.339
Monitoring patients after 1 activity
surgery 26.032 26.032
Decision permission to get out 1 activity
of recovery room by anesthesia
specialists 1.735 1.735
To call into the inpatient room 1 activity
to pick up patient 4.339 4.339
Total of cost 108.468
Source : Primary Data
f. Summing the direct and overhead costs are included in clinical pathways
Table. 16. Unit cost of Phacoemulsification service.

No Type of cost Cost

1. Direct cost Phacoemulsification service Rp. 2.906.329
2. overhead cost Phacoemulsification service in Rp. 24.261
outpatient unit
3. Biaya overhead Phacoemulsification service in Rp. 113.579
Arafah unit
4. Biaya overhead Phacoemulsification service in Rp. 108.468
surgery unit
Total of cost Rp. 3.152.367
Sumber : Primary Data

From the above calculation to obtain the unit cost Phacoemulsification action by the
ABC method on CBG's system is Rp. 3,152,367.

DISCUSSION

Jamkesmas bill payments to hospitals based on INA CBG 's package , which
is based on the diagnosis or the type of disease in which a specified rate of each
diagnosis of the disease , the patient's hospital as a waitress Jamkesmas need to make
efficiencies in the management of these services . Packages here have been included
in the administration of drugs to patients Jamkesmas , both outpatient and inpatient5 .
Phacoemulsification included in a health service in the system CBG 's INA in 2011
with the code H26.9 rate of Rp.2.739.482 for hospital type B as RS PKU
Muhammadiyah Yogyakarta . But if you use action fare Phacoemulsification in a
health action on the INA CBG 's 2014 with its tariff H.130.2 code is Rp.4.225.236 for
hospital type B as RS PKU Muhammadiyah Yogyakarta . While the results that
emerged from the calculation of the action Phacoemulsification with Activity Based
Costing method is Rp.3.152.367. This shows the difference between the negative
charges Phacoemulsification rates CBG 's INA in 2011 which has been adopted by
the government on a health service with a unit cost incurred by RS PKU
Muhammadiyah Yogyakarta at Rp.413.155 . It is also consistent with previously
studies conducted by6, it is concluded that the cost of medical services operative
measures undertaken in Mohammad Hussein Hospital Palembang 98.6 % do not fit
and greater than the rate INA DRG.

Under these conditions, it is necessary to efficiency costs. Under these

conditions, the RS PKU Muhammadiyah need to know what the cost structure is not
efficiency so as to reduce their costs. Calculation Phacoemulsification action on
Jamkesmas services for early stage is to determine the activity obtained through
clinical pathways . Phacoemulsification service at PKU Muhammadiyah Hospital of
Yogyakarta involves 3 units of service , ie outpatient unit , inpatient units Arafah and
central surgical unit installation . The cost of the first-ever direct cost is the cost , for
actions on services Jamkesmas Phacoemulsification is Rp.2.906.329 . For the cost of
direct cost which appears in the action Phacoemulsification Jamkesmas services that
emerged was the largest structure of medical services physician. Based on case
studies conducted by the3 care facilities at primary, secondary and tertiary, which has
reasonable rates will apply supply gets more funds if the community has followed the
national security system of tariffs applied in the national security system. Fee for
service payments that have been run so far, both for services and the services of
medical doctors still assumed to follow a more favorable medical perpetrator
financially , because a specialist before the era of Social Security earning 80-90 % of
private patients ( general ), while in - era Social Security will be reversed ie 80-90 %
of their income BPJS and only 10-20 % of patients who pay themselves rich .
 In addition to the cost of medical services other costs that also arises is the
cost of drugs and medical consumable materials, in this case the use drug
Phacoemulsification service are in accordance with formulary Jamkesmas namely the
use of generic drugs, but there beberpa action of drugs used in the formulary
Phacoemulsification outside medical treatment. Physicians in providing medication
compliance in accordance with formulary JAMKESNAS influence on service quality
and cost efficiency in hospitals5.

Physicians have an important role in improving the efficiency of hospital

services. Doctors were able to reduce their costs on treatment of patients with
appropriate treatment standards agreed, choosing drugs rationally considering the
price and effectiveness of the drug as well as comply with formulary specified, select
the necessary investigations, conduct rational methods of treatment and return
patients as soon as possible7.

By speeding up or shortening the treatment time would be nice hospitalization

of patients and their families, as well as savings for the hospital8. Standard shorten
hospitalization time was faster when discharged from the standard medical treatment.
According to a health service package with a standard time code H26.9 have 3 days
of hospitalization and untu RS PKU Muhammadiyah Yogyakarta, hospitalization time
in accordance with existing clinical pathways is 2 days so have dlakukan cost
efficiency in terms of hospitalization time.

The second cost structure that emerges is overhead. Overhead costs are
divided into two general categories: direct and indirect resource overhead and
resource overhead9. Within overhead cost structure that appears like-functional
payroll payroll costs in the eye outpatient unit, inpatient surgical Arafat and
installation of central if based on the number of existing nursing workforce , ie 215
nurses, then this has been in accordance with10.
CONCLUSION
Based on research conducted Phacoemulsification action unit costs obtained by the
method of activity-based costing is Rp.3.152.637 and the difference between unit cost
and rates INA Phacoemulsification Phacoemulsification CBG's is Rp. 413 155.

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