academic teaching hospital jakarta - dhcprojects.com · appendix a list of medical facilities...

ACADEMIC TEACHING HOSPITAL JAKARTA

JAN S. VAN OS, MD, CARDIOLOGISTHENDRIK F. WIELAND, M.ARCH, MAA

ARESSTR. 38, 1363VJ ALMERE, THE NETHERLANDS, [email protected]

january 2018

mailto:J.S.VANOS%40GMAIL.COM?subject=

DHC, Aresstr 38. 1363 VJ Almere, The Netherlands. tel +31615431061

A. SUMMARY 1. Project description2. Project team3. Requirements4. Products 5. Parties6. Finances 7. Secondary benefits 8. Implementation plan

B . QUALITY, SAFETY AND CALAMITIES 1. Calamities2. Safety3. Quality

C. HEALTH CARE SITUATION INDONESIA 1. Introduction2. Health care summary (WHO) 3. Government requirements 4. Current health care situation 5. Health care vicious circle 6. Preliminary summary

D. PRODUCTS AND SERVICES 1. General medical services2. Emergency care 3. High end care4. Expats and foreigner care5. Insurance6. Pharmaceutical services 7. University affiliation8. Research facility9. Protected housing units 10. Medical tourism

E. MARKETING PLAN 1. General hospital2. Insurance3. Research4. Housing units5. Medicaltourism6. Recruitment

F. COMPETITION 1. Local2. International

G. LOCATION / BUILDING H. PERSONNEL

1. Recruitment and training ofstaff 2. Physicians, nurses and staff3. Training

I. PATIENT PROJECTION J. BUILDING COST K. MEDICAL INVESTMENTS L. COST PRICE CALCULATION

CONTENTS

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M. PROFITS FROM MARKETS

1. Hospital2. Appartments 3. Insurance4. Trials 5. University 6. Medical tourism

N. RETURN ON INVESTMENT O. ORGANIZATION / GOVERNANCE P. SWOT ANALYSIS

APPENDIX A LIST OF MEDICAL FACILITIES

APPENDIX B PUBLIC HOSPITAL GOVERNANCE

APPENDIX C ARCHITECTURAL DESIGN

APPENDIX D FULL SERVICE APPARTMENTS APPENDIX E TOTAL HIP COST PRICE

APPENDIX F FINANCIAL SUMMARY

APPENDIX G 10 YEAR BALANCE SHEAT

APPENDIX H CLINICAL WARD PROJECTION APPENDIX I RADIOLOGY DEPARTMENT

APPENDIX J SPECIAL DEPARTMENTS

APPENDIX K OTHER STAFF

APPENDIX L OPERATING THEATRE APPENDIX M PATIENT NUMBER PROJECTION

APPENDIX N POLYCLINIC

APPENDIX O STAFF TRAINING

APPENDIX P EXPAT INSURANCE

APPENDIX Q CONSTRUCTION COST

APPENDIX R DHC BUDGET

CONTENTS

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1. Project description

DHC (Dutch Hospital Consultants) has the intention to build an academic teaching hospital in Jakarta. The aim is to provide top level health care for a broad population (including those who are unfortunate) in an acedemic, teaching environment in close cooperation with Indonesian and international universities.A 400+ bed hospital with full emergency and outpatient facilities will be built. (A level hospital with JCI accreditation) A full rehabilitation center and protected housing plan for elderly will be incorporated. All medical specialities will be included in the hospital. A special focus will lie on child medical care and oncology. The ambition is to become the best and the most affordable hospital in Indonesia.During the last 15 years DHC has executed a comprehensive feasibility study on the development of healthcare in Indonesia. A thorough analysis of the health care situation and the opportunities in one of the largest and most rapidly growing economies led to the conclusion that Indonesia is missing an Academic Hospital that is for the people, affordable and up to the standard for international guests and expat’s. The current plan is the result of our former studies.

2. Project team

DHC is a collaboration of medical doctors, architects, bankers and economists. We use the concept of network teams, formed and customed to the needs of a particular project. We have been working formerly under the name AOW consultancy in the Netherlands, abroad as DHC and are active since the year 2000.

3. Requirements

To achieve our goals we need:1. A building site that we found in Jakarta close to the university,

a purchase option has been agreed upon.2. An in depth analysis of the health care situation in Indonesia3. A thorough business plan as has been written by DHC4. An architectural design, as has been provided by Wieland and

partners(attached tot as appendix).5. A project team that has been carefully selected by DHC for

this project.6. Financial sponsor of the project as we hope to find on the

international market.

4. Products

The following products will be implemented in the Jakarta Hospital:• primary health care• preventive health care• DHC insurance including expat insurance• full academic level health care program• training for students and specialists• research facilities• pharmaceutical care• protected living environment

5. Parties

Parties involved are:• DHC, the Netherlands• Wieland and partners IIHC B.V. , the Netherlands• AOW consultancy B.V., the Netherlands• Benzipluyk B.V., the Netherlands• George Yap Koi Ming

A. SUMMARY


6. Finances

A total investment from foreign sources of USD 750.000.000,- is currently under negotiation and may be available for the project.

Breakdown : (roughly)

Land purchase USD 200.000.000,- Building cost USD 250.000.000,- Medical equipment USD 150.000.000,- DHC USD 50.000.000,- First year start up USD 100.000.000,- Total USD 750.000.000,-

The finances can be provided at once as a total sum of USD 750.000.000,- or in tranches.The first Tranch will be needed to start up the activities of DHC, the architects, the marketing team, the health insurance acquisition team and the Land purchase.

Land purchase USD 200.000.000,- DHC team USD 15.000.000,- Architects USD 15.000.000,- CFO fee USD 1.500.000,- Prior investment USD 8.500.000,- Market/Insurance USD 10.000.000,- Total Initial Payment USD 250.000.000,-

Rest payments in quarterly tranches of 8 times USD 62.500.000,- = total of 500.000.000,-.

7. Secondary benefits

The development of a high standard hospital will have the following spin-off:• improved climate for foreign companies to send their employees

to Indonesia• employment for +5.000 Indonesians• magnet for foreign students• reduction on medical capital flight (currently over USD

10.000.000.000,- per annum out of Indonesia)• for Indonesian doctors to provide broad top of the bill health

care to their own people • good return on investment and profit for finance providers

8. Implementation plan

After receipt of the funding DHC will start he implementation of the project, The aim is to have the Hospital fully operational by the end of 2019.

A. SUMMARY


1. Calamities

In the basement of the hospital we will use a large space next to the emergency department in case of a calamity. The storage department for beds and the facilities for visiting guests will be transformed into an emergency hospital in a matter of minutes. The different rooms can be fully isolated from the outer world by a system of locks. The complete emergency hospital will have its own air supply and filter unit. This will provide a safe, isolated environment in case of an outbreak of a highly infectious disease or a chemical attack.

2. Safety

The location of the hospital will be isolated from the rest of the surroundings. A tight security corridor will protect the hospital from attackers. All cars are subject to state of the art of high security inspection and no car can approach the hospital without being searched of a bombs, explosives or weapons of mass destructions.The outer layer of the hospital will make it impossible, due to lack of line of sight for snipers. People outside will be unable to look into any room of the hospital.Pests and insects will be kept outside by using local air-conditioning systems and well filtered water supplies and sewage systems.The hospital constuction is fully earthquake resistant, as Java is on the ring of fire, up to an earthquake of 10.5 on the Richter scale.

3. Quality

All functions in the hospital and all processes will operate using all necessary ISO standardisation techniques and approvals, thus assuring the highest possible safety level for the patients. A large part of the initial work before opening the hospital will be defining all the protocols and ISO safety checklists. The medical processes will be JCI accredited.

B. QUALITY, SAFETY AND CALAMITIES


1. Introduction

During the last decades of the 20th century, health care changed from a skilled based profession (the doctor listens) to a more and more technical profession in which doctors highly depend on expensive medical equipment for their diagnostic skills and treatments. For a cardiologist the stethoscope of USD 50,- has been replaced by an echo-cardiography machine costing USD 250.000,-. Classical surgery has been replaced by less invasive endoscopic surgical techniques. The knife costing USD 1,- is replaced by equipment costing USD 400.000,-, and even more recently the DaVinci robot costing USD 5.000.000,-.

Not only in Indonesia but all over the world the growing material costs and the development of new (often very expensive) medicines have laid a huge burden on the budgets of the different countries. Many countries in the world are unable to follow the modern developments and many countries feel the heavy economic burdens of rising health care costs.

Indonesia failed to develop a new health care system during that period and relied too long on the Old Dutch Healthcare System. Government and local investors lost their grip on the patients and medical facilities resulting in the current situation. Foreign countries and private investors now start to see business opportunities in Indonesia and start to invest in mostly private initiatives focusing on easily cashable healthcare. Hospitals from Singapore invest in diagnostic centers with the sole purpose to lure patients to Singapore for their treatment. All these initiatives fail to improve the current health care system and benefit only those that already can afford their health care.

The spending of the government on health care is the lowest in Indonesia compared to other developed countries in Asia. In 2000 it was only USD 2,- per citizen. Although it has increased during the last years, it is still far away from being enough. When asking officials about the expenditures no exact answers are given and no one seems to know where the health care money is spent on.

Many hospitals have to struggle for survival and the salaries for the staff and doctors are low.

A hospital in Bandung, West Java, with almost 200 beds has an annual budget of less than USD 200.000,-. From that budget the investments and the staff have to be paid. They have to earn that money by treating uninsured patients and hardly get any support from the local and national government. A once very modern hospital has become now an old fashioned one with outdated equipment and standards. The director of that particular hospital stated that if he didn’t get more funds he would have to close the hospital soon.

The family doctors charge high prices and get paid by hospital organizations for referring patients to certain clinics, often abroad. This means that unfortunates and lower/middle classes are not given the health care they deserve in a modern economic society.As an example, it is striking that the No. 1 cause of death in Indonesia are still Infectiousness diseases with 44% of the total death toll. That are numbers one would expect from a poor third world country and not from an industrial modern Asian nation.

C. HEALTH CARE SITUATION INDONESIA


2. Health care summary (WHO)

For a full report on the health care situation and various policies see the link. The WHO has written a report in 2017 with a grant of the Bill and Melinda Gates foundation.

http://apps.who.int/iris/bitstream/10665/254716/1/9789290225164-eng.pdf

The republic of Indonesia Health system review:

Indonesia is the largest archipelago in the world with an estimatedtotal of 17 504 islands. The country is ranked fourth globally in terms of population, with a population of more than 240 million. This large population includes numerous ethnic, cultural and linguistic groups, speaking 724 distinct languages and dialects. The country is in the midst of a fundamental demographic shift as the working-age population increases relative to the rest of the population. Indonesia has also emerged as a middle-income economy, economically strong and politically stable. The political and social landscapes have also been evolving through transition from authoritarianism to democracy and decentralization reforms. These macro-transitions have concurrently influenced an epidemiologic transition in which noncommunicable diseases (NCDs) are increasingly important, while infectious diseases remain a significant part of the disease burden.

Indicators of overall health status in Indonesia have improved signi ficantly over the last two and half decades, with life expectancy rising from 63 years in 1990 to 71 years in 2012, under-five mortality falling from 52 deaths per 1000 live births in 2000 to 31 deaths in 2012, and infant mortality falling from 41 deaths per 1000 live births in 2000, to 26 deaths in 2012. However, progress on maternal mortality and communicable diseases has been slower, with maternal mortality remaining high (210 deaths per 100 000 live births in 2010), and continuing high incidences of tuberculosis (TB) and malaria. At the same time, risk factors for NCDs, such as high blood pressure, high cholesterol, overweight and smoking, are increasing.

Responding to this increasingly complex epidemiological pattern in the midst of multiple macro-transitions is one of the major challenges for the country’s health system. Indonesia has stepped up its leadership in global health; for example, the Minister of Health became Chair of the Board of the Global Fund in 2013, and the President was named by the United Nations Secretary-General to co-chair the high-level 27-person panel to draft the Sustainable Development Goals (SDGs). However, Indonesia remains the only country in Asia and one of 9 worldwide not to have signed the WHO Framework Convention on Tobacco Control.

The Indonesian health system has a mixture of public and privateproviders and financing. The public system is administered in linewith the decentralized government system in Indonesia, with central, provincial and district government responsibilities. The central Ministry of Health is responsible for management of some tertiary and specialist hospitals, provision of strategic direction, setting of standards, regulation, and ensuring availability of financial and human resources. Provincial governments are responsible for management of provincial-level hospitals, provide technical oversight and monitoring of district health services, and coordinate cross-district health issues within the province. District/municipal governments are responsible for management of district/city hospitals and the district public health network of community health centres (puskesmas) and associated subdistrict facilities. There are a range of private providers, including networks of hospitals andclinics managed by not-for-profit and charitable organizations, for-profit providers, and individual doctors and midwives who engage in dual practice (i.e. have a private clinic as well as a public facility role).

Indonesia has a hierarchy of interrelated long-term, medium-term and annual plans, from central to provincial and district level. The planning process combines top-down direction, with bottom-up participation from communities and local agencies.


http://apps.who.int/iris/bitstream/10665/254716/1/9789290225164-eng.pdf


While Indonesia has established a national information system (SIKNAS) that links to district-level health information systems (SIKDA), communication between the systems has been weakened by decentralization, and by multiple separate reporting systems. Vital registration is not complete, and is supplemented by regular national sample surveys. The function of regulation is divided between central, provincial and district governments. Regulations are arranged in a hierarchy from laws to different levels of regulation at different levels of government. Regulation of providers includes requirements for individual providers to be registered and gain a licence to practise, while hospitals require a licence to operate and must participate in the hospital accreditation scheme. There is also a variety of regulations relating to the production of pharmaceutical products, their advertising, distribution and sale. However, there remains a high rate of illegal sale of pharmaceuticals by unlicensed drug vendors, and self-medication is common. Patient rights are guaranteed by several laws, including the right to confidentiality, to information about treatment and costs, to give consent to any procedures, and not to be treated negligently.

Indonesia faces the challenge of increasing health expenditures, as nominal health spending has been steadily increasing in the last eight years, by 222% overall. Although there has been a substantial increase in health spending at national level, health spending as a proportion of gross domestic product (GDP) remains below average among the low-to-middle-income countries (3.1% of GDP in 2012). The government share of total health expenditure also remains low, at only 39%, whereas private, primarily out-of-pocket (OOP) expenditure, is 60%.

In response to the high levels of OOP expenditure and its impact on access to health services by the poor, the Government of Indonesia has introduced various social insurance programmes for health, such as the Social Safety Net for Health-care, Askeskin, Jamkesmas and the most recent national health insurance scheme, the Jaminan Kesehatan Nasional ( JKN). This programme, which commenced in January 2014, pools contributions from members

and the government under a single health insurance implementing agency (BPJS Kesehatan). Population coverage is planned to expand progressively and the aim is to reach universal coverage by 2019, with a comprehensive benefit package and minimal user fees or co-payments. Payments to primary care providers are through capitations, and to hospital providers through DRG episodes of service payments (INA-CBGs). Salaries for public staff continue to be covered through budgetary allocations.

However, the focus of increased spending on health through the JKN is on curative care services and health infrastructure that supports medical care. Thus, the allocation for public health and prevention is relatively low, and the allocation for curative services is high. Challenges remain in the continuing high levels of OOP expenditure, the complex system of payments, expanding population coverage to include informal sector workers, and ensuring improvements in the supply of services to enable equitable access to services across regions of Indonesia.

Indonesia has experienced an increase in health infrastructure, including primary and referral health facilities, in the last two decades. Inpatient beds in both public and private hospitals and primary health centres have also increased. Puskesmas or primary health centres are important, particularly in the context of Indonesia’s Universal Health Coverage (UHC) or JKN programme, as the gatekeeper for medical cases as well as public health efforts. However, the ratios of both hospital beds and puskesmas to population remain below WHO standards and lag behind other Asia-Pacific countries. In addition, there are varying conditions and quality of the facilities, resulting in geographical disparities between Indonesian regions.

Capital investment is financed by the government budget from various institutions and different levels of government. At the hospital level, a hospital with Badan Layanan Umum (BLU) status can finance its own capital investment. Other sources of funds include cooperation with private institutions. Foreign investments



are welcomed, but limited to hospital-level investment only. There is wide use of mobile technology, with Indonesia currently the eighth-largest Internet user globally. The adoption and use of information technology in the health system is still limited and not well coordinated. This includes the limited growth in the use of electronic medical records.

Human resources for health have also grown in the last two decades, with increases in health worker to population ratios. However, the ratio of physician to population is still lower than the WHO-recommended figure, and ongoing geographical disparities exist. There is also a pronounced shortage of nurses and midwives at both hospital and puskesmas level, despite the increase in absolute numbers. Professional mobility of health workers has been modest, but with growing outmigration of nurses to the Middle East. Health training institutions have grown in number, with various changes in the curriculum aimed to improve the quality of the graduates; however, significant investment is needed to meet the population’s needs.

The Ministry is also responsible for management of programmes addressing public health issues, such as programmes to combat communicable disease, including TB, HIV/AIDS, malaria, dengue and avian influenza. These programmes are led by the Ministry of Health at national level, but are delivered by the network of public facilities at district level (hospitals and district health offices), and at community level (puskesmas and their networks). There is also an active surveillance and outbreak response system, and regular national surveys to measure and monitor key aspects of population health.

The puskesmas and their networks manage and deliver the basic immunization programme, although the programme can also be accessed through private providers. The immunization programme still faces significant challenges from both the supply and demand sides e.g. geographical disparity, topographical situation, limited availability of outreach activities and cold chain maintenance, due to the decentralization and availability of funding, negative perception

of immunization side-effects, and suspicion of haram ingredients, despite awareness campaigns.

The Ministry of Health also organizes and directs health promotion activities, which again are delivered through the network of facilities at district and community levels. Preventive efforts also focus on NCDs, including health promotion to raise public awareness, and community-based health awareness groups, early screening and early detection. For example, the Posbindu is a community engagement programme that addresses almost all NCD risk factors, and is integrated into other settings within the community, such as schools, workplaces and residences. Although Indonesia is not yet a party to the WHO FCTC, several policies on tobacco control have been implemented such as higher excise taxes on cigarettes, stricter regulation of tobacco advertising and of the promotion and sponsorship of tobacco products, introduction of smoke-free public places, and specific packaging and labelling of tobacco products.

The patient pathway commences from the primary care facilities, puskesmas and their networks, which act as gatekeepers for JKN patients before referral to hospitals for further treatment. Without a referral letter, a JKN patient is not allowed to seek treatment directly at a hospital or specialist clinic, except in an emergency situation. The puskesmas provides both curative and public health services, with a focus on six essential service areas: health promotion, communicable disease control, ambulatory care, maternal and child health, and family planning, community nutrition and environmental health including water and sanitation. Information and education on family planning is provided by the National Population and Family Planning Board (BKKBN) and its subnational-level agencies, while clinical family planning services are provided by Ministry of Health facilities.

Inpatient facilities include public hospitals at national, province and district levels, and a growing number of private hospitals, particularly in the central islands of Java–Bali. While patients attending hospital should be referred from primary health care



level, in fact many patients come directly to hospitals and pay OOP. As a result, patients accumulate at hospitals and face long queues. Emergency care is provided by all levels of services. Since 1970, pre-hospital care radically improved when the Indonesia Surgeons’ Association started to operate the 118 Emergency Ambulance Services in Jakarta with the support of the local government. The provision of pharmaceuticals, and oversight of the quality of pharmaceutical production is managed by the Ministry of Health Food and Drug Supervisory Board. In ensuring access to pharmaceuticals, the MoH ensures the availability of 484 essential drugs for primary care as listed in the National List of Essential Medicines (the national health programme-related drugs and vaccines). The government also monitors production capacity in the country and regulates drug prices by imposing price ceilings for several essential drugs.

Indonesia has also introduced a number of reforms to different aspects of the health system, while the health system has also been affected by reforms of government and public administration that are multisectoral. Key multisectoral reforms include the delegation of authority for certain government functions from central to local governments, including responsibility for the management and provision of public health services; and the progressive introduction of greater autonomy in the management of public service organizations, which include hospitals. Reforms that focus specifically on the health sector include reforms to improve the quality of medical education; and the introduction of a national health insurance scheme, the national health insurance programme ( JKN). Following its introduction, JKN has significantly influenced management and delivery of health services.

Potential future reforms are likely in the use of telemedicine to address issues of geographical coverage; more innovative ways of addressing the challenge of distribution of the health workforce, including contracting in by local governments; and dealing with the implications of removal of restrictions on free movement of the health workforce within the member countries of the Association of Southeast Asian Nations.

Health is clearly stated as one of the important objectives in the Indonesian constitution and is also welded in the Ministry of Health National Strategic Plan. In terms of financial protection and equity in health financing, Indonesia is still struggling. Even though JKN coverage is steadily increasing, OOP expenditure is above average. Catastrophic spending remains at a high level with many workers in the informal sector not yet insured. Implementation of the single risk pooling mechanism ( JKN) poses several risks to equity in health-care financing and service utilization. As all funds and risks are collected in a single pool, provinces or districts with limited health infrastructure and supply-side readiness, and lower health-care utilization, might receive less government subsidy compared to well-developed areas.

Information on user experience is limited in both the public and private sectors. Requirements for informed consent are regulated but there is no national charter to describe the rights of patients in choice of provider, privacy or information. The ratio of health workers to population has improved over time, but disparities between provinces remain large.

Both total and public spending on health as a proportion of GDP have been low and increasing only slowly, including for public health measures. There is a need to evaluate the current UHC program regulation on payment or claim cap at the hospital level. The health system in Indonesia needs to re-orient towards the changing epidemiological landscape. The increasing burden of noncommunicable diseases highlights the need to develop capacity to deliver care for chronic conditions, which require continuous long-term interactions between health providers and patients. The central government also needs to take into consideration the growing interregional disparities in terms of resources, services and health outcomes, and develop a comprehensive strategy to address these issues. With a large, widespread area and population, and with the commencement of a universal health coverage system, the need for a reliable and integrated information system to support planning and decision-making is becoming even more urgent.



With the existing limitations of the public sector supply side, JKN provides an opportunity for further collaboration with private health-care providers. However, there is a risk of fraud, and currently there is no system of prevention and prosecution of fraud. An accountable JKN system is required, as people need to see measures in place to ensure public reporting on performance and avoid corruption. In any case, given the complexity of health challenges in Indonesia, health nancing reform is not a panacea for its health system. Notwithstanding, JKN provides the momentum to move towards more coordinated policies and strategies to achieve national health system goals.

Table 1.3 Mortality and health indicators, selected years Source: World Bank (2015b). The Global Burden of Disease Study 2010 (GBD, 2010) quantified levels and trends of health loss due to diseases, injuries and risk factors in Indonesia. Stroke is the leading cause of death among Indonesians, causing 19.5% of all deaths in 2010. Common risk factors include hypertension, smoking and hypercholesterolemia (Kusuma et al., 2009).



3. GOVERNMENT REQUIREMENTS FOR A HOSPITAL ORGANISATION

see also APPENDIX B

The BLU/BLUD (Public service Agency owned by central and local government, Badan Layanan Uum Daerah) requires hospitals to meet six administrative requisites to ensure public service accountability.

These are: 1. a statement letter of ability to improve hospital performance, 2. a business plan document, 3. minimum service standards document, 4. a governance document, 5. a financial statement, and 6. a statement letter indicating that an external l auditor may

audit the hospital.

In short, greater flexibility means greater responsibility. This responsibility is reflected in the strategic planning process, where the onus is on hospitals to define their goals. Moreover, the implementation of more businesslike standards in hospital accounting and finance aims to make government-owned hospitals auditable by external auditors. In other words, the hospitals’ right to use public resources is followed by an obligation to become more accountable and transparent. Flexibility in managing financial and human resources are the biggest levers in improving the performance of the hospital. These changes improve the hospitals’ abilities to respond to patients’ needs as well as their competitiveness. Hospitals implementing BLU/BLUD may recruit NCS (non civil servant) staff as needed, whenever they can afford the human resources cost. Government institutions are not allowed to hire NCSs unless the regent or mayor has signed a technical regulation permitting this. The regent decree regulate s how a BLUD hospital recruits NCS, the salary, and other aspects of HR management.


This enables the hospital to select and recruit the most competent staff as needed. This is an opportunity to recruit more specialist physicians (when needed foreign). Other than to meet service standards, the additional staff are intended to offer more specialized services that should in turn increase the hospitals’ income.


4. Current Health Care Situation

WORLD HEALTH ORGANIZATION STATES:

There are hardly any modern health care and treatment facilities in Indonesia available for everyone.It is anticipated that over USD 10,000,000,000.00 in foreign currency savings and earning is lost as part of an none-taxable Organized Medical Care Export Plan from Indonesia to other regional countries caused by the negligence of the Indonesian Medical Board (Kollegium) along with a well structured undetectable opportunities for Indonesian Doctors to make quick earnings.

1. Not all diagnostics are available2. Not all treatments are available3. No oncology center4. Not sufficient invasive cardiology5. Not sufficient kidney dialysis6. No transplant center7. No healthcare for the unfortunates8. No complete health care insurance9. No modern children hospital10. Not sufficient cardiac surgery11. Not sufficient plastic surgery12. No burn center……… (This list can go on and on)

Although the above statements are hard and people can say we have an oncologist in Jakarta and we can treat cancer, the hard truth is that the type of care provided is poorly organized and relies on the hard work of often individual physicians. In the example of oncologic care, good treatment is performed by a team while keeping up with the modern treatment standards and continuously developing new treatment arms for different kind of tumors.

The health care organization has not changed much since the Dutch left Indonesia. There are old hospitals with poor hygienic standards and very old equipment and poorly trained staff. A good medical

school and further specialization is not available for the young ambitious student. Although difficult to prove, many physicians have made statements such as “to become a doctor or a specialist, selection is not done on the merits of qualities but on the amount of money paid by the applicant”

There are generally five groups of people in Indonesia that use health care facilities: 1. The Rich Upper Ten, 2. The Foreigners, 3. The Middle Class, 4. The Lower Working Class, 5. The Lower Non-Working Class.

1. The Rich Upper TenThe rich can afford private clinics and healthcare in other countries at a huge cost for Indonesia.

They use the private clinics in Jakarta for diagnostics and treatment of simple diseases. For their surgery and more complex diagnostics they go to other countries in the region. Originally it was Singapore but Thailand, Malaysia and Australia are becoming more popular. The Chinese community also seeks their care in Hong Kong and China.

There are no exact economic data available for the loss of foreign currency savings and earnings caused by this type of Renegade Capital. However, low estimations indicate that it is exceeding the USD 10,000,000,000.00 level per year. A devastating amount of USD 40 per capita, being 20 times more than the current government spending on health care. This money is lost for the Indonesian economy but most important lost for the further development of the health care in Indonesia.

It is also bad for the rich people, as they have to travel in sick conditions to the health care destinations abroad, which is not




advisable but impossible in acute cases. This means that there is a high level of mortality in cardiac patients with acute coronary syndromes. Acute PCI techniques are unavailable in Indonesia and that means that those that survive their coronary event have poor chances for the future with a higher incidence of chronic heart failure and earlier death.

Although the rich think they are better off getting their health care abroad in the long run they and their children will suffer the same consequences as all the people of Indonesia.

The mission here should be to keep that money inside the country to be used for improvement of the health care system. It is a challenge for DHC to try to develop a health care system that uses this money and will eventually create a modern medical environment in Indonesia.

2. ForeignersForeigners seek their healthcare outside Indonesia.

The lack of good healthcare scares away investors and multinationals.Many expatriates, businessmen and tourists come every year to Indonesia. They rely on the health care as provided. Tourist experienced after the Bali bombing not only too many body bags but also a complete chaos in the local hospitals and the incompetence accordingly. The pictures on CNN and other broadcasting channels of the wounded were more traumatizing as the fact that the bombs went off. The bombings we regrettably get used to in our modern society, the poor health care was more of a trauma to many. One of the reasons that tourists evade Bali now is not only the chance for bombings but also the lack of health care.

Foreigners have high insurance policies for healthcare outside of Indonesia. For annual check-ups most of them go to Singapore and Kuala Lumpur. Pregnant ladies most of the time leave Indonesia while still allowed to fly to deliver their babies at home and not in Indonesia. The maternal care and pre-birth care is highly underdeveloped. Large amounts of possible health care fees are lost

for the Indonesian economy and health care system.

It is also a fact that many multinationals are fleeing to the so-called low-wage countries. Indonesia is such a country. Many companies decide not to come to Indonesia because of the lack of good health care for their employees. Resulting to high insurance costs for them. For Indonesia many billions of dollars are lost every year by losing the companies to start their business in Indonesia.

3. The Middle ClassThe middle class is the main consumer of the healthcare system and is often insured.

This is the group that can afford the healthcare in Indonesia. They are the consumers of the current health care system. Some of them can afford insurance while others can barely pay the bills and medicines. The group complains about the old fashion style of health care but have no choice and therefore no other place to go.

The average low cost insurance policy currently on the market for healthcare is USD 700.00 per person per annum, and for most of the average Indonesians a fortune. This insurance covers basic healthcare and doesn’t cover healthcare in other countries.

Insurances for high level care exceed western prices and can range up to USD 5,000.00 per person per annum.

4. The Lower Working ClassSparsely use of healthcare and no money for expensive treatment.

They cannot afford insurance and hardly ever go to hospitals for care. When ill they try to fix the problem with herbs and alternative so-called local black magic rituals. When a doctor is needed they go to the local kampong doctors and can hardly pay their bills. Often the doctor gets paid in chicken and rice. For expensive medicine as antibiotics and anti malaria drugs the people have no money. This is one of the main reasons why infectious disease is the number one



cause of death in Indonesia. There is no low cost insurance policy for the lower class on the market. Most of them rely on charity and religious organizations for their health care. Local hospitals often get needy patients that they cannot help because of lack of funds.

5. The Lower Non Working ClassNo money, no care and no long life.

These are the real victims. A social plan is non-existent and people are not able to survive on the streets. This particular group is even far too poor to go to the basic health care providers. They have barely enough money to keep themselves alive. If they encounter an accident or catch a disease they are literally in the hands of “the gods” and must struggle for survival.

This is in every country the most difficult group to provide healthcare. The first priority of man is survival by having to eat and to drink and be able to have a roof over its head. Health always comes at a high but second place. In modern societies there is a social plan for those people. In Indonesia such a broad social plan is impossible due to the unbalanced and non-equal distributed wealth caused by corrupted and struggling economic growth.

WHO statement on health care in Indonesia:

However, government investment in the health system has been limited, leading to insufficient facilities and workforce needed for public services, and encouraging the growth of private health facilities. Problems of maternal and child health, nutrition and communicable diseases persist, while noncommunicable and chronic diseases are emerging as new priorities. There are significant regional disparities in terms of health status and in the quality, availability and capacity of health services. Decentralization has affected the capacity of the central Ministry of Health to maintain integration and alignment across the different levels of the health system.



5. Health care vicious circle

During our studies of the Indonesian health care system we developed the above-mentioned vicious circle of health care in Indonesia.It’s a very simple economic principle combined with human characteristics. We are convinced that trying to solve one part of this circle will never lead to the full solution of the health care problem. Without investing in an integral solution it will be impossible to make a functional healthcare system and generate sufficient cash to care also for the financial and social unfortunate Indonesians who are in need of a real operating healthcare system.

No HospitalsThere are hospitals in Indonesia but as we mentioned before poorly staffed and equipped, resulting in incomplete healthcare. For physicians it is not attractive to work in a hospital where they cannot give better treatments to patients because of the lack of funds. It is not appealing to use a knife for surgery when you have learned all the minimal invasive endoscopic techniques. This leads to the outflow of doctors and doesn’t create an atmosphere for investments. The declining funds and reserves of the hospitals will create major health care problems in the next decennium. Already very poor international indices will probably get worse.The neonatal death rate at birth is among the highest in the world and totally not acceptable for a modern country that Indonesia is aiming to become sooner or later.

No DoctorsThe educational system for physicians is similar to other places in the world. First the student has to attend medical school to become a basic physician. After that it has to specialize to become either a family doctor or a specialist. In Indonesia many students have to work for 5 years in the kampong after their studies to pay for their government paid education. After that period they have to start their further training. They will learn their specialization in Indonesia in poorly equipped hospitals and often have to go to other countries to become a more experienced and modern specialist. Most of the time, they are not paid during the specialization period and even have to pay the specialist that trains them. At the end of their training they have to appear for a board called the “Collegiums” to do a final exam. After that they can call themselves a specialist in Indonesia and after that they will be allowed to treat Indonesian patients.Many students that go abroad don’t return to Indonesia. When they return they have to do the exam at the collegiums to be able to practice medicine in Indonesia. Some people doubt the objectivity of this exam at the collegiums. It is certainly only a knowledge and not skill based evaluation of the candidate.

No Hospitals

No Doctors

No Patients

No Money



No PatientsAs mentioned earlier, many Indonesian patients know of the poor quality of the hospitals and specialists that work there. So many people that can afford health care will seek it abroad. This leads to a negative cash flow.

No MoneyThe lack of funds leads to a climate where hospitals and other health care facilities barely have enough funds to survive and are not able to invest in modern equipment and education for their staff. This leads to a not to interesting environment for physicians to work in.



6. Preliminary Summary

The Indonesian health care system allows large amounts of healthcare expenditures to leave the country. These funds are needed to make the current hospital situation better leading to a new trust among physicians and their patients.

Education is expensive and for specialists not suitable and sufficient. There is a large outflow of physicians to other countries.

Patients cannot afford their healthcare and most cannot afford a very expensive health care insurance.

Breaking the vicious circle on all fronts is the only way to radically meet the Peoples Need that will change the health care system and provide Indonesia with a healthier fuure.

The challenge for DHC and this project is to provide a new concept that is economically sound for the investors and gives hope for all Indonesians that in the future their health care is secured and affordable within the budget of every Indonesian citizen.


D PRODUCTS AND SERVICES

1. General medical services2. Emergency care3. High end care (oncology, minimal invasive surgery, children

hospital, ICU etc)4. Expat/foreigners medical care5. Insurance company6. Pharmaceutical services7. University affiliation8. Research facility9. Protected housing units10. Medical tourism

1. General Medical ServicesAll basic health care will be provided . To be eligible to become an academic teaching hospital one of the requirements is to have at least 17 specialities represented within the hospital with at least 400 beds. This will grant the hospital the A status.

• Cardiology• Internal Medicine• Surgery• Pneumatology• Neurology• Rheumatology• Dermatology• Allergology• Orthopedics• Psychology• Plastic Surgery• Eye care• Nose, Throat and Ear• Urology• Gynecology• Gastroenterology• Heart Surgery• Pediatrics• Geriatrics• Pathology

• Dentistry• Neurosurgery• Rehabiitation• Nuclear medicine

As a support for all these specialties the hospital will also provide Intensive Care medicine and Coronary Care facilities.

2. Emergency careA complete emergency care unit will be incorporated in the hospital. Annex to it the only quick readiness calamity hospital will be available in case of needed medical care for large groups due to calamities, terrorism or natural disasters.One floor of the parking garage can be transformed into a full service hospital facility.

3. High end careIn order to perform Heart-, Neuro- or Transplant-surgery a high level Intensive Care unit is mandatory. The units will be all constructed as isolation chambers with enough space around the beds for intense treatment using artificial heart pumps or dialysis.

4. Expats and foreigner careCurrently still most of the foreigners and expats seek their health care in their native country or in Singapore. There is still a lack of trust regarding the quality of the Indonesian Health Care system. The recent accreditation of the Siloam group has set the trend of improvement. As will be outlined later, the expats pay heavily for their insurance, mounting up to USD 40.000,- per annum. Companies pay most of it and there certainly is a market with the expat community for the Jakarta Hospital. The collaboration with renowned medical centers and the Western athmosphere will create a safe environment for this group.



5. insuranceIn Indonesia several health care insurance policies are sold. They do not provide all the possible care, most of them only provide very basic health care. The price varies from 25.000 IDR to 80.000 IDR per month (USD 2 to USD 6). To be eligible for better health care most of the time 5% of the montly income is used. Government workers get an automatic deduction of that amount. It is clear that this insurance is very basic and this leads to situations where the patient or his family have to pay still to get good treatments. At this time more than 55% of all care given is paid OOP (out of the pocket).

DHC will implement a hospital coupled insurance scheme with several levels of insurance. Obviously only basic health care will be provided to the lowest level.The highest level will be for expats and VIP’s. The full scope of medical care will be available for them within a luxury environment.

6. Pharmaceutical servicesThe international costs for pharmaceuticals vary extremely by region. Generics are readily available on the market and a production facility in the hospital organization to produce ,within the group of most used medicines, our own will lower the medication costs. It will also provide a secondary source of income. The hospital pharmacist will sell the drugs to the general public at competitive prices.

7. University affiliationTo become a teaching hospital the Jakarta Hospital has to affiliate with a university. Several universities are interested and there are mutual benefits for both parties. Universities are quality ranked and the medical students need to receive co-ships at the end of their studies. This to learn the profession directly with patients at a hospital. When they are able to do that in an A-hospital with International accreditation it will be of benefit fopr their further career. Each student has to pay for their co-ship and the amount starts at USD 10.000,-.The universities also receive foreign students that pay for their education.

For them a cooperation with an academic hospital with international contacts is a plus. Therefore the university will become more attractive for foreign students.

8. Research facilityThere is an international market for medical research. Mostly granted by Pharmaceutical industries. A large hospital with a large general population of patients can recruit large numbers of patients into trials. Often the patients will receive treatments that they otherwise could not afford to pay. The studies will be performed by the specialists with the aid of assistants and medical students.With an international standard of hospital care and a huge number of patients the DHC Jakarta Hospital will be also competitive in the international research market. Currently this is a multi billion USD market.

Pharmaceutical companies face a growing competition in the fast development of medicines. Countries develop complicated rules for medical research that make it impossible for industries to develop a compound into a medicine in a relative short time. As it took an average 4 years to put a patented compound on the market 25 years ago, it now takes at least 8 years. This results in higher risks for the developing company and a shorter period to make a profit from the compound. It directly results in higher drug prices.

The Jakarta Hospital will negociate an exclusive contract with several pharmaceutical companies (Pfizer, Aventis and Novartis) to set up a joint research center resulting in significantly reducing the development time for a drug.



A typical registration of a drug consists of 4 phases:

Phase 1Basic research on healthy volunteers during 2-3 weeks. The revenues per volunteer are USD 10,000,-. In this phase (depending on the type of drug) between 100 and 500 volunteers are needed. There are no exact figures of the number of phase 1 studies performed every year. The top 5 pharmaceutical industries however perform around 100 of those studies every year. The economic value is over 1 billion USD every year.The recruitment of volunteers and the completion of the study now takes over one year. It is mostly done in special facilitated centers with an insufficient capacity. The Jakarta Hospital in close cooperation with DHC will establish a highly computerized and efficient research center dedicated to phase 1 studies with the full back-up of the hospital. The volunteer generally receives 10 % of the revenues.

Phase 2Basic research on the effect of the drug and dose finding in patients. The revenues per patient are lower but still USD 5,000,- per patient. In this phase (depending on the type of drug) between 100 and 500 volunteers are needed. There are no exact figures of the number of phase 1 studies performed every year. The top 5 pharmaceutical industries however perform around 50 of those studies every year. The economic value is over 1 billion USD every year.The recruitment of patients is the work of doctors. The patient population must be large enough to provide for a fast recruitment. The Jakarta Hospital in cooperation with DHC will set up a phase 2 and 3 research facility that will generate revenues for the hospital and a high quality and fast research report for the pharmaceutical company.

Phase 3In phase 3 the medical effect of the drug is tested. This is the largest and most lucrative research available on the market. More than 500 studies are performed every year with an average of 3.000 patients in every study and a general revenue of USD 3,000,- per patient. This clearly is a multi billion dollar market.

Phase 4Experience trials after registration of the drug.

9. Protected housing unitsThere are elderly people or partly disabled people who need more care than can be given at home. The hospital will provide 320 housing units where people can take their own furniture and live within the community. They will have full service regarding meals, laundry and medical care. A nurse is on watch 24 hours per day. This kind of service is not yet available in Indonesia.

10. Medical tourismDHC has performed an extensive study on medical tourism in the world. As treatments in Western countries are very expensive and sometimes not insured people started to look for other locations to get good quality medical treatments. India, Thailand and Singapore are frontrunners in this market. In 2012 India had revenues of USD 2.2 billion solely from this market. The Jakarta Hospital can be competitive in pricing and quality as we will show later with the example of a total hip replacement.


E. MARKETING PLAN

1. General hospital2. Insurence3. Research4. Housing units5. Medical tourism6. Recruitment

1. General hospitalIt is important to spread the news on the high level of hospital organization that will be coming to Jakarta. A broad public must be reached in order to reach a high operational percentage quickly after opening.DHC will appoint a team to develop a full marketing plan and to implement it. This will start directly after DHC established its base. This will give the team a span of more than eighteen months to promote the hospital and insurance plan.The team will focus on advertising in local newspapers, online, magazines, expat forums. Starting a medical column in magazines. Advertising on television. Opening small stands in several big shopping malls, combining hospital information with insurance recruitment

2. InsuranceThe insurance policies will mainly be sold through agents and through local advertising. Contracts will government agencies will be sought. Currently 5% of the salaries of government workers goes into Health Care Insurance. AHC will offer a competitive price for the insurance with a higher scala and quality of service.The expat insurance will take an additional approach. There will be active recruitment with companies in and around Jakarta that employ foreign workers. An expat insurance can be as high as USD 40.000,- a year. DHC will offer them with a viable and cheaper alternative.

3. ResearchA research facility will be formed with close collaboration of Pharmaceutical industries. Thus reducing the research time and increasing the design to market time of a drug. Specific know how of this market will be sought for.

4. Housing unitsThe marketing of this product will be similar as the hospital. In the malls there will also be a stand with information on this specific sort of housing.

5. Medical tourismWhen the hospital is fully operational the marketing team will focus on this market. There are international brokers and they will be sought to cooperate with the Jakarta hospital. Individual and independent campaigns can be started in the USA where medical costs are enormous in comparison with the costs at the Jakarta Hospital. Profits from this market can be an important factor in the hospital finances.

6. RecruitmentIn the beginnignfocus will also be on trying to recruit the needed staff and to prepare them with training for the jobs at hand. Coopertion with international medical head hunters will be sought. Especially to find specialists that are willing to work at the hospital.


F. COMPETITION

1. LocalThere are in the Greater Jakarta Area currently 8 major hospitals. Of those four are cited by the global insurer Allianz, Graha Medika Hospital, Mayapada Hospital, Pondok Indah Hospital and Siloam Hospitals. Currently the largest competitor is the Siloam Group. (APPENDIX A)

About Siloam International Hospitals

Siloam Hospitals, which was founded in 1996, is Indonesia’s most progressive and innovative healthcare provider, and has set the benchmark for high quality healthcare services in Indonesia. Siloam’s medical team of 400 general practitioners, 1,500 specialized doctors, 7,200 nurses, and allied health, technician and support staff, provides healthcare to nearly two million patients annually. In 2007, Siloam Hospitals Lippo Village became the first hospital in Indonesia to receive international accreditation from the USA-based Joint Commission International ( JCI), with re-accreditation in 2010. Sister hospitals Siloam Hospitals Kebun Jeruk and Siloam Hospitals Denpasar have recently been accredited to JCI as well.

Royal Siloam Hospitals, which was founded in 1996, is Indonesia’s most progressive and innovative healthcare provider, and has set the benchmark for high quality healthcare services in Indonesia. Siloam’s medical team of 400 general practitioners, 1,500 specialized doctors, 7,200 nurses, and allied health, technician and support staff, provides healthcare to nearly more than two million patients annually. In 2007, Siloam Hospitals Lippo Village became the first hospital in Indonesia to receive international accreditation from the USA-based Joint Commission International ( JCI), with re-accreditation in 2010. Sister hospitals Siloam Hospitals Kebun Jeruk and Siloam Hospitals Denpasar have recently been accredited to JCI as well.

With equal access to medical care in Indonesia still a challenge, Siloam’s business strategy allows its hospitals to operate on a lower cost based on economic of scale. Hence, Siloam is able to increase affordability from all socio-economic backgrounds and provide access to quality and affordable healthcare all over Indonesia. The company’s vision of International

quality, reach, scale, and godly compassion establishes the platform for Siloam to respond to the dynamic social transformation in Indonesia.

2. InternationalSingapore hospitals are the main competition from abroad (Gleneagles Hospital and Mount Elizabeth Hospital). They have set up diagnostic centers in and nearby main shopping centers. Small treatments are given at those locations but for most treatments patients will have to travel to Singapore. Most expats currently use those services. It is even said that local physicians receive large referral bonuses when the patient actually receives a treatment in Singapore.

The Subjects on which the Jakarta Hospital will be competitive on are:

• Easy accessibility for all patient type groups• Full scope of services• Modern, fully digital environment• Competitive pricing of treatments• Lean and Mean(ingfull) organization• Highest possible medical quality of care ( JCI accreditation)• Relying on multiple business sources• Patient driven, not doctor driven• International cooperation


G. LOCATION / BUILDING

The land for the Hospital is located in central Jakarta, close to the major highway at an intersection. The University is closeby as many international hotels and businesses. The design of the hospital is inspired by the lucky four leaf clover, the symbol of Ireland. This provides on each floor four distinct wards with a maximum of outside windows. The building will have a helipad for quick transfer of patients. Doctor and student facilities will be located on the top floors. A full restaurant and clean food processing facility will be located on the lower floors. Visitors,

patients and staff will receive their meals in separate rooms. To use as much of the terrain as possible for the building (there are restrictions due to water management) there will be no parking lot but a modern fully automated parking garage system.A building impression is given in APPENDIX C

Click on the map for the link toward Google Maps.

https://www.google.com/maps/place/Jakarta,+Indonesi%C3%AB/@-6.2374586,106.8253219,2310m/data=!3m1!1e3!4m5!3m4!1s0x2e69f3e945e34b9d:0x100c5e82dd4b820!8m2!3d-6.17511!4d106.8650395


H. PERSONNEL

1. Recruitment and training of staffThe quality of staff needed for our modern hospital is currently barely available in Indonesia, mostly due to the low level of experience and training at the current Indonesian hospitals. It is therefore imminent that the key positions in the hospital will be taken by foreigners or Indonesians currently working abroad.Close cooperation with highly established health care partners will be sought. A collaboration with , the Mayo clinic, Rochester clinic, Dubai Health care City and the University of Leiden will be established.

2. Physicians, nurses and staffAs stated before, there are many high quality Indonesian doctors working in many countries abroad. A group of 25-150 non Indonesian specialists will fill the highly specialized positions.Currently there is a law in Indonesia that excludes foreign doctors from treating Indonesians without an Indonesian doctor being responsible for the work that the foreign doctor is doing. We have an agreement with the government that there will be an exception on this law only and exclusively for the Bali Medical Center under the condition that we will also treat financially less fortunate people.Recruitment will be done by an International experienced and specialized head hunting team from The Netherlands in close cooperation with the DHC group. Primarily recruitment will be done from the USA, Australia and Western Europe. Knowledge of the Indonesian language or the willingness to master is eminent. Recruitment must start at least one year before the opening of the hospital, although this will cost the organization substantially. It is very important that the specialist has something to say about the recruitment and training of the lower staff and the selection of materials and equipment he is going to work with.

3. TrainingTraining of nurses and assistants will be done in Indonesia in cooperation with the University in Jakarta, the local training facilities and the local hospitals. There will be for every member of the staff a training period of at least 3 months in a hospital in the USA, Dubai or in The Netherlands. The staff members will take a final exam at the end of their training period, upon failure they will not be allowed to work in the hospital.After the initial trained group, the new staff will be trained by local staff and trainers in the Jakarta University Hospital.Due to the high initial training costs we have decided to start up the hospital not at full capacity. In house training during a period of 1 to 2 years will finally get the hospital running at its full capacity.


I. PATIENT PROJECTION

For the development of the hospital it was necessary to make a judgment on the number of patients that would be treated and the kind of specialities they needed for their care. As hospital data from Indonesia are not readily available we analysed data from The Netherlands, Malaysia and Singapore. Estimates on the number of patients to be treated were made from a population of 100.000 and 500.000. The average pathology was calculated and the time for treatments , hospital stay and investigations. This led to the number of beds needed, equipment needed, number of treatment rooms and number of polyclinic rooms. All investments, and costs are based on these assumptions.See APPENDIX M

J. BUILDING COST

In APPENDIX Q an overview is given of the total building costs including advisor and architect fees.Land purchase estimated at USD 200.000.000,-Building costs estimated at USD 250.000.000,-

K. MEDICAL INVESTMENTS

In APPENDIX, H,I,J,K,L and N the needed medical investments are projected in detail.The final pricing will be dependent on current market pricing and the level of deduction that will be negotiated due to a bulk contract. Wether a tender will be used is subject to negotiation as many companies that deliver medical equipments are also situated in Indonesia.


L. COST PRICE CALCULATION

To calculate the cost price we calculated the actual price of each aspect of a product and added a flat profit margin on each product. Thereafter we calculated using an example (Hip Replacement) wether the calculated final price would be comparable and competitive to the regional market. We could establish that the final cost price was well within the regional limit.See APPENDIX E

The price was USD 5.730,- in the Jakarta Hospital comparable to the USD 6.000,- in Singapore. Calculations that led to the individual cost price calculation are given in APPENDIX H,I,J,K,L and N

Comparision of treatment pricesThe Jakarta Hospital will be able to provide very low prices for their activities, roughly 75% of the regional international prices. The Jakarta Hospital will never be able to compete with the local third class prices, often € 2 - € 3 per day. In Jakarta however a visit to a specialist costs € 6,- and a night in a hospital bed € 25,-.A well differentiated daily bed price has been set to keep the hospital competitive.The general rule in Indonesia is the lower the daily bed price, the lower the health care provided. There are not many well developed countries in which the daily bed prices vary as much as in Indonesia. A night stay in a puskesmas can sometimes cost only € 5,- while a stay in a private clinic in Jakarta could cost as much as € 1.000,- per day. This huge variation in prices is typical for a market that struggles to provide health care at an acceptable cost for a large as possible population. In the international and regional health care market other prices are used. Not only for the cost of hospital admission but also for the cost of treatment.

To give two examples:

1. Price of a one day stay in a hospital bed

The Jakarta Hospital can be very competitive towards the European and American health care markets. This will be one of the main strategies of the Jakarta Hospital. With low competitive international hospital prices we aim to attract a significant segment of the yearly growing medical tourism market. Not only generating funds for the hospital but also generating a capital for the Indonesian economy directly and indirectly.


L. COST PRICE CALCULATION

2. Cost price for a total hip replacement.

The price of a total hip replacement includes the very expensive prosthesis. The quality of this artificial hip, and the quality, is often compromised to provide for lower cost prices. The DHC Jakarta Hospital will only use the high quality hips for their replacement surgery. We will never abandon our quality concept with the only goal to lower prices. An exception will be made in the treatment of the unfortunates. The budget for this patient group is much lower and will never be able to give treatment to all. Lower cost prices for this group means that more patients can be treated with the same budget.In both examples the DHC Jakarta Hospital price is the lowest and world-wide very competitive. In negotiations with foreign insurance companies we will be able to provide services at 80% World Market Price Level. This will include travel and rehabilitation costs in local hotels.



It is assumed, should the results be based on the maximum possibilities, the revenues will be enormous. It is however very unlikely that all mentioned activities will be equally successful. The strength of the DHC concept however is not to focus on one potential market but to broaden its activities on all possible medical fields. The most vital and crucial part of this proposed plan is the insurance company, the international contacts that need to be established. Sound contracts must be drawn up with existing insurance companies and a thorough field study must be done to be sure that the insurance company will get enough insured people to provide the financial back-bone of the proposed plan.A hospital driven medical tourism office in Europe, Australia and the USA will be set up to facilitate the patients. This organisation will seek contact with local insurance companies to provide a steady flow of international patients to the Jakarta Hospital.A training program must be written and recruitment of staff must follow in close co-operation with the universities.

1. HospitalIt is prognosed that the hospital will run at 30 % capacity during the first year slowly growing to a 60-100 % capacity.For calculating the profit margin for medical activities a 60 % occupancy is used. The average occupancy of hospitals in Indonesia is around 70 %, in Western Europe 85%.Each part of the organization contributes to the profit margin while keeping costs low. An annual profit of USD 207.000.000,- is feasible and covers the initial payments of interest and loan return. Depending on the success of secondary activities, the profit will increase.

2. AppartmentsAPPENDIX D shows a summary of all the costs and revenues from the rent and service in the 320 appartments that are going to be incorporated within the hospital. Yearly rent is expected to be USD 18.432.000,- while costs are USD 8.734.944,- This leaves a sound profit margin of USD 9.697.056,-Increasing the number of appartments is still under consideration and is dependable on the building permit regarding height and square footage of the building.

3. InsuranceInitially the full capacity of the hospital organization can accommodate at least the medical services for 500.000 people. We aim to provide the health care service through our insurance system to 150.000 people, thus leaving enough room for the other activities of the hospital.There are generally 4 main parties for the insurance with of course a different kind of palette of services. The cheapest will provide very basic health care including simple medicines.



Additional insurance to protect for the costs of Diabetes will be offered.

The most expensive insurance schema will give entry to all treatments in the hospital.We aim for a small percentage of the population that could afford the insurance, this makes the plan viable. The TOP policy with almost a complete service palette will be the most profitable. This will be our main focus.

When all insurance goals are reached there will be an income of USD 180.000.000 with a cost of 50% for the rendered medical services. This leaves a 50% profit margin. The costs are roughly 1/3 of the total hospital costs, meaning revenues lost due to treating insured people.

4. TrialsFor patients the participation in trials can have huge financial benefits. Not only will there treatment and medicine be free of charge, they will also receive 5-10% of the revenues after deduction of trial costs. Out of the USD 5.000,- trial fee there will be a profit of USD 3.000,-. The patient will receive USD 300,-. For many indonesian this amount can make a difference in life.

As the trials will be performed by students and trainees at the hospital the costs will be relatively low.Aim is to participate in at least 30 studies with 100 included patients. Cardiovascular management, diabetes and hypertension are the main sources of pathology oin Indonesia and will provide

the most patients.A low projection of USD 12.000.000,- is included in the income and cost summary

5. UniversityAffiliation with the University of Jakarta, medical school, means that we will provide training for the students and young doctors that want to become specialists.This will also grant the A status of the hospital. Co-operation with other Universities in Indonesia and regional countries (Vietnam is eager to send students) will provide a steady flow of paying students. There is room for 800 students peryear. Half of it is included in the income summary. This means that 400 students that pay each USD 10.000 will provide an income source of USD 4.000.000,-. They will also reduce the operational cost of the hospital as they will perform functions that otherwise would have been done by paid staff members.

6. Medical tourismThere is a growing medical tourism market, due to several reasons; long waiting lists for specific types of surgery, high prices and poor health care quality.These are the largest competitors for our Jakarta Hospital for the European and American markets:Bumrungrad hospital in Bangkok(Large hospital with more than 200 surgeons who are board-certified in the United States)Beautiful Holidays in Penang(Touroperator that supplies two hospitals in Penang of medical and cosmetical tourists)The medical market in India is currently expanding on a rapid scale. The government aims for a yearly revenue of 2,2 billion USD per year by the year 2020.



No profits regarding the medical tourism industry are included in the prognosis yet. They are regular patients going through the hospital system paying the cost prices for their treatment thus occupying space where other patients could be treated, It is therefore a market but not a separate source of income. They will however be a solid base for the hospital when the companies that sell the treatments have found their way to the Jakarta Hospital.

The Jakarta Hospital aims on a low estimate of 5% and a high estimate of 20% of this current market. Not taking in account the rapid annual growth of this market. It will not only provide revenues for the hospital but will also generate local and national revenues.

Although the ambition is high we think it to be achievable. One of the main reasons to build the medical center in Jakarta is this yearly growing market. Indonesia, as a major tourist attraction is despite the recent bombings still appealing for many. It also has a good infra-structure and has an international airport at 20 minutes driving from the Jakarta Hospital. Many airlines from Australia, Asia, Europe and Singapore have daily flights to Jakarta.As most of the care that patients seek abroad is an expensive form of surgery, the revenues will be high but the costs will also be higher as average for a small group of patients.

1995: 250.000 patients per year were visiting Singapore for a medical treatment.2002: 150.000 patients per year were visiting India for a medical treatment.

2005: 500.000 patients per year were visiting India for a medical treatment.2020: Experts estimate that medical tourism could bring India alone as much as $2.2 billion per year.

Estimated revenueWith this level of revenue, it will be easy to negotiate with the foreign insurance companies to send patients to Jakarta mainly for their elective surgical treatments.


N. RETURN ON INVESTMENT

After the initial grace period of two years a yearly interest and repayment scheme will result in a 10-year period in which the total loan will be paid off. When the profits are fully used for repayment of the loan this will lead to a significant reduction in interest payment thus resulting in a return of investment after 6 operational years. This is however highly dependable on the grace of the shareholders of the hospital. This will be part of negotiation.


O. ORGANIZATION / GOVERNANCE

DHC will be the initial party that will set up the hospital until opening. Independent management will take over the hospital with participation of DHC and a party to be appointed by the investors. For the management participation DHC will receive an annual fee of USD 2.500.000,-.When the investors seek it, we will provide a substantial part of the shares to the investors, giving them a prominent place in decisions regarding policies of the hospital.

There will be an independent governance committee. It has to approve main investments, pricing and future plans for the hospital. There will be auditing by the International accreditation board, the Indonesian accreditation board, the regional boards. Financial support and auditing will be performed by an international accountancy firm, also with approval of the investors.There will be full transparency in the book keeping that will be available for the investors at all time.The CEO of the hospital will have support of the president of the medical staff, COO, CFO and sector managers (mother and child, surgical, internal, intensive care and head). Each will have support from a different number of assistant-managers.


P. SWOT ANALYSIS

DHC is certain that the strengths and opportunities weigh above the weaknesses and threats. By going for high quality, we can bend the weaknesses into strengths. It is a challenge, but we will prevail.


APPENDIX A

JAKARTA Clinics

International SOSJl Puri Sakti 10CipeteSouth Jakarta Emergency: 7506001 (24 hour)Fax: 7506002 https://www.internationalsos.com/locations/asia-pacific/indonesia24 hour service, emergency evacuation service.

Global Doctor Jakarta Int’l Medical CenterJl Kemang Raya No 87Jakarta Selatan 12730Tel: 719 4565 (24 hour medical advice, house & hotel calls).Fax: 719 8969 24 hour service, English-speaking doctors, medical insurance, emergency evacuation service.

Emergency Medical Services

Medic OneJl. Benda Alam I no.73,Cilandak Timur,Jakarta 12560.Emergencies: 7259111, 72159100 (24 hour)Fax: 7399303http://www.medic-one.org/24 hour service, emergency evacuation service.

Global Assistance & HealthcareJl Cilandak KKO Raya, Building 111-GCSouth JakartaEmergencies: 299 78 997 (24 hour)Fax: 299 78 955http://www.global-assistance.net/24 hour service, emergency evacuation service.

Hospitals

Brawijaya Women & Children HospitalJl. Taman Brawijaya, No.1 Cipete UtaraJakarta Selatan - Indonesia 12150Tel: 7211337, 72799533Fax: 721-1364Customer Service : [email protected] Website : www.brawijayahospital.com

Metropolitan Medical Centre (MMC) Jl Rasuna Said Kav C21Kuningan,South JakartaTel: 5203435, 5205201-04Fax: 5203417

Klinik MedikalokaIndorama BuildingJl H R Rasuna Said Block X 1 Kav 1-2KuninganSouth JakartaTel: 5261118 (24 hrs)Fax: 5261119

The Jakarta Women & Children ClinicJl. Prapanca Raya No. 32,South JakartaTel: 72799911 (Office hours 8 a.m – 8 p.m)

Pondok Indah HospitalJl Metro Duta Kav UEPondok IndahSouth JakartaTel: 7657525, 7692252, 7651883Emergency: 7502322Fax: 7502324

Pertamina Hospital Jl Kyai Maja No 43Kebayoran BaruSouth JakartaTel: 7219400 (hunting)Emergency: 7219365Fax: 7203540

Mayapada Hospital Jl Honoris Raya Kav 6,Kota Modern/Kodya Dati II,Tangerang 15117BantenTel: 5529035 (hunting)Fax: 5529036

Siloam Hospitals Lippo Village Jl Siloam No 6Lippo Karawaci 1600,Tangerang 15811BantenTel: 5460 055Fax: 5460921

Siloam Hospitals Kebon Jeruk Jl. Raya Perjuangan Kav 8,Kebun Jeruk,Jakarta 11530Tel: 2567 7888 Fax: 5369 5666

List of Medical Facilities in IndonesiaThis list is provided for the information of Australian travelers. While every care has been taken in preparing the list, the Austral-ian Embassy cannot accept liability for any injury, loss or damage arising in respect of the information provided. Medical costs can be substantial - having appropriate travel insurance is strongly recommended.


APPENDIX A

Siloam Hospitals Lippo Cikarang Jl. M.H Thamrin Kav 105Lippo Cikarang, Bekasi 17550Tel: 2963 6900 (hunting)Fax: 2963 6911

Rumah Sakit Anak dan Bunda Harapan KitaJl Let.Jen. S Parman Kav 87Jakarta Barat 11420 Tel: 5668284Fax: 5601816Email : [email protected] ServiceEmergency : 567 2472 / 5668284 ext. 6107, 6108Pharmacy : 5668284 ext. 1103, 1102Laboratory : 5668284 ext. 1216, 1220Radiology : 5668284 ext. 1150, 1149Blood bank : 5668284 ext. 1218Ambulance : 5668284 ext. 3128

24-hour Cardiovascular Clinic, Cinere HospitalJl. Maribaya No. 1 Puri CinereJakarta 16514Tel: 7545499Fax : 7536965

X-Ray/Ultrasound Physiotherapy

Medistra Hospital Jl Gatot Subroto Kav 59South Jakarta 12950Tel: 5210200 (appointments)Emergency: 5210201Fax : 5210184Email: [email protected]

Rumah Sakit Mata AINI Jl H.R. Rasuna SaidSouth JakartaTel: 5256228 (hunting)Fax: 5224288

Dental

Melati ClinicWisma 46 Kota BNI3rd Fl, Suite 303Jl Jend Sudirman Kav 1JakartaTel: 5702526/5702527 (appointment 9a.m. - 6p.m)Fax: 5731537

Stephanie Dental ClinicMenara duta lt 2Jl HR Rasuna Said Kav B9South JakartaTel: 5252579 / 5252596 (until 6 p.m.)Fax: 5252595* We suggest that you obtain a quotation for likely fees prior to commencing dental treatment.

Blood Bank

Lembaga Transfusi DarahPalang Merah Indonesia (Red Cross)Jl Kramat Raya 47Jakarta PusatTel: 3906666, 3908422Fax: 3144884

EASTWEST Physiotherapy & RehabilitationDarmawangsa Square City Walk Unit 52-53, 2nd FloorJl. Darmawangsa VI, Kebayoran Baru, Jakarta 12160, IndonesiaTel: +62-21-7278 8361Fax: +62-21-7278 0712www.eastwest.co.id

Psychiatric Care

Sanatorium Dharmawangsa (Mental Health Clinic)Jl Dharmawangsa Raya No 13Block P/II, Kebayoran BaruSouth JakartaTel: 7394484Fax: 7394162

Omni Medical Center(Psychiatric Ward)Jl Pulo Mas Barat VI No. 20 Jakarta 13210Tel: 4723332, 2977 9999Emergency: 471 8080Fax: 4718081

Ophthalmology

Jakarta Eye Centre (Klinik Mata Jakarta)Jl. Terusan Arjuna Utara No.1,Kedoya,Jakarta, IndonesiaTel: 29221000

WEST JAVABANDUNG

Advent Hospital Jl Cihampelas 161BandungTel: 022-2034386Emergency: 022-2038008Fax: 022-2043167

EAST JAVA

Dr Soetomo Hospital Karang Menjangan Jl Mayor Jenderal Prof Dr Moestopo No. 6-8SurabayaTel: 031-5020079, 5024091Emergency: 031-5501298Fax: 031-5028735

Darmo Hospital Jl Raya Darmo No. 90SurabayaTel: 031-5676253, 5614135Emergency: ext. 128Fax: 031-5620690

Siloam Gleneagles Hospital Surabaya Jl. Raya Gubeg 70Surabaya 60281Tel: 031-5031333Fax: 031-5030221, 5031533


APPENDIX A

CENTRAL JAVA

Panti Rapih Hospital Jl. Cik Ditiro No.30YogyakartaTel: 0274-514014, 514845, 563333 (hunting)Emergency: 0274-552118Fax: 0274-564583

Bethesda HospitalJl Sudirman No. 70YogjakartaTel: 0274-586688Emergency: 0274-562246Fax: 0274-563312

St Elizabeth HospitalJl Tegalsari IX No 1 Candisari Semarang 47056Tel: 024-8310076

RS. Telogo Rejo Jl. K.H. Ahmad Dahlan No.1SemarangTel: 024-844 6000

Hermina Hospital (Mother and Children Hospital)Jl. Pandanaran No. 24 SemarangTel: 024-841 1112

KASIH IBU Hospital SurakartaJl Brig Slamet Riyadi 404Solo 57142Tel: 0271-71442Fax: 0271-717722

KUSTATIJl Kapten Mulyadi 249Solo 57118Tel: 0271-643013Fax: 0271-634823

BRAYAT MINULYAJl Dr Setiabudi 106Solo 57139Tel: 0271-716646Fax: 0271-727309

ORTOPEDI Dr R SUHARSO, SURAKARTA Jl Jend A Y Yani, PabelanSurakartaTel: 0271-714458Fax: 0271-714058

WEST SUMATERA

M. Djamil Hospital (General Hospital) Jl Perintis KemerdekaanPadangTel: 0751-32373Fax: 0751-32371

Bhayangkara Hospital (Police Hospital) Jl Jati No 1 Jati Baru PadangTel: 0751-22397

SOLO

Muhammadiyah Kartasura HospitalJL Slamet Riyadi No. 06SoloPh: 0271-780156

PKU Muhammadiyah SoloJl Ronggo Warsito No. 130SurakartaPh: 0271-714578Fax: 0271-719745

Dr OEN Surakarta HospitalJl Brig Katamso No 55SoloPh: 0271-663663Fax: 0271-642026

Dr OEN SOLO BARUKomp Perumahan Solo Baru,Kec Grogol, Kab. SukuharjoTel: 0271-620220Fax:0 271-622555

PANTI WALUYOJl A. Yani No. 1SoloTel/Fax: 0271-712077

TNI-AU ADISUMARMOJl Tentara PelajarSolomaduTel: 0271-780535, 784665

NORTH SUMATERA

Columbia Asia Hospital Jl Listrik No. 2AMedanTel: 061-4566368Emergency: 061-4533636Fax: 061-4566585

SOUTH SUMATERA

RSB YK MadiraJl Jend Sudirman 1051 C-DPalembangTel: 0711-364954Fax: 0711-812102

KALIMANTAN

St Antonius Hospital Jl KH Wahid Hasyim No 249 PontianakWest KalimantanTel: 0561-732101Fax: 0561-733623

Suaka Insan HospitalJl Jafri Zamzam no. 60BanjarmasinSouth KalimantanTel: 0511-54654, 3353335Emergency: 0511-364035Fax: 0511-55121


APPENDIX A

Restu Ibu HospitalJl Ahmad Yani No 83BalikpapanEast KalimantanTel: 0542-734181, 423110, 427342Emeregency: 0542-422706Fax: 0542-422304

SULAWESI

Siloam Hospital MakasarJl Metro Tanjung Bunga Kav 9 Tanjung MerdekaMakassarSouth SulawesiTel: 0411-3662900

BATAM

Rumah Sakit Awal BrosJl. Gajah Mada Kav IBatamTel: 0778-431 777 Hunting ext 1900Fax: 0778-430 777

PEKANBARU

Rumah Sakit Awal BrosJl. Jenderal Sudirman No. 117 PekanbaruTel: 0761-47028, 47333Operator: 0761-47210

Rumah Sakit Tabrani RAB Jalan Jenderal Sudirman No. 140PekanbaruTel: 0761-35464, 35467, 26421

BANDA ACEH

Rumah Sakit Umum Zainoel AbidinJl. Tgk H.M Daud Beureueh No. 108Lampriet, Banda AcehTel: 0651-22077

Rumah Sakit Teungku FakinahJl. Jend. Sudirman No. 29Banda AcehTel: 0651-47646 / 41454

Rumah Sakit Harapan BundaJl. Teuku Umar No. 131-A, SeutuiBanda AcehTel: 0651-48114

UN Clinic UN Compound, Jl Jend. Sudirman No. 15Banda AcehTel: 0651-41899


APPENDIX B

Case Studies:

A. Public hospital governance in Indonesia

A case study on public hospitals designated as

“Local Public Service Agencies”

Ni Luh Putu Eka Putri Andayani,Tiara Marthias, Likke Prawidya Putri, Armiatin

Abstract Since 2009, all public hospitals in Indonesia have been managed according to the 2007 Ministerial Decree on Financial Management Patern of Public Service Agencies (Badan Layanan Umum Daerah, BLUD). The reform grants all public hospitals greater fexibilities in operational management and allows them to apply not-for-proft-business principles, e.g . hospitals may use their operating revenue directly to buy medical supplies, involving far less bureaucratic processes, thus increasing efciency. This case study describes and assesses these important policy developments and practice in public hospital governance and performance in Indonesia after these reforms.

The study was conducted in fve BLUD district hospitals owned by district/municipal governments in Indonesia: Panembahan Senopati Hospital (PSH), Kota Yogyakarta Hospital (KYH) and Sleman Hospital (SH) in the Special Region of Yogyakarta; Tidar Hospital (TH) in central Java; and Meuraxa Hospital (MH) in Banda Aceh. Data were collected from interviews with hospital managers and some external key stakeho lders, such as the Head of the Organization and Governance Bureau, Financial and Asset Management Ofcer, District Secretary, and Head of the Local Stafng Agency, as well as from a review of documents.The fve hospitals involved in the study were designated as BLUD and therefore permited to develop their fve-year business plans. These hospitals use their operational revenue to directly fund their operating costs. For example, PSH used its previous years’ savings

to develop new buildings. They also have full authority to contract more staf to meet B-class hospital requirements2 (PSH, KYH and TH), contract retired specialists (MH), or build cooperation with other medical facul ties (SH) to suit their needs. This means that hospitals can expand their se rvices and 2 According to Health Ministry Re gulation No. 340/2010, B-class hospitals have higher competencies than C-class hospitals, including: the presence of a full-time Medical Rehabilitation Specialist; 1–12 kinds of specialist medical services other than the core types (paediatric, internal medicine, general surgeon and obstetrics-gynecology); 1– 4 kinds of subspecialist medical services; more than nine general practitioners; more than two dentists. capabilities, improve revenue allocation to increase stafng levels, and upgrade medical equipment. They also apply a Minimum Service St andard that includes clinical, managerial and customer satisfaction in dicators to improve quality control and management. The presence of an internal auditor (in PSH, KYH and SH) and an external auditor from the c entral

Government appears to have improved the hospitals’ accountability. All hospitals except MH have Supervisory Boards which act as owner (local government) representatives. Overall, these public hospitals have shown improvement in capacity as well as accountability following the implementation of BLUD, which has enabled them to meet patient needs beter. Nonetheless, there are still challenges for public hospitals to deal with concerning s ubsidies and politics. In every election (local or national level), health care always becomes a “sexy” political commodity to win votes. Politicians promise to make health services free for the poor, but after election, most political leaders are unwilling to allocate enough budget to subsidise pu blic health care facilities.


APPENDIX C

ARCHITECTURAL DESIGN

AERIAL VIEW STREET VIEW


APPENDIX D


APPENDIX E

Cost price calculation

Total hip replacement


APPENDIX F

Summary of cost price, actual hospital costs and specialist fee.


APPENDIX G

10 Year Balance sheat, projected ROI

BALANCE

Hospital building cost 250,000,000$ Training costs 20,000,000$ Investment inventory 40,000,000$ Investment medical 140,000,000$ First year operational 100,000,000$ Fees 50,000,000$

Rest 600,000,000$ 540,000,000$ 480,000,000$ 420,000,000$ 360,000,000$ 300,000,000$ 240,000,000$ 180,000,000$ 120,000,000$ 60,000,000$ 600,000,000$ Annual return 60,000,000$ 60,000,000$ 60,000,000$ 60,000,000$ 60,000,000$ 60,000,000$ 60,000,000$ 60,000,000$ 60,000,000$ 60,000,000$ 60,000,000$

Interest 5% 30,000,000$ 30,000,000$ 27,000,000$ 24,000,000$ 21,000,000$ 18,000,000$ 15,000,000$ 12,000,000$ 9,000,000$ 6,000,000$ 3,000,000$

90,000,000$

HOSPITAL BALANCEyear 1 year 2 year 3 year 4 year 5 year 6 year 7 year 8 year 9 year 10

COSTS oprational 30% 50% 60% 60% 70% 70% 70% 80% 80% 80%

Annual return plus interest 90,000,000$ 96 90,000,000$ 87,000,000$ 84,000,000$ 81,000,000$ 78,000,000$ 75,000,000$ 72,000,000$ 69,000,000$ 66,000,000$ 63,000,000$ Investment 18,154,571$ 17 18,154,571$ 18,154,571$ 18,154,571$ 18,154,571$ 18,154,571$ 18,154,571$ 18,154,571$ 18,154,571$ 18,154,571$ 18,154,571$ Operational patient 63,406,141$ 70 31,703,071$ 52,838,451$ 63,406,141$ 63,406,141$ 73,973,832$ 73,973,832$ 73,973,832$ 84,541,522$ 84,541,522$ 84,541,522$ Specialist 57,024,216$ 60 28,512,108$ 47,520,180$ 57,024,216$ 57,024,216$ 66,528,252$ 66,528,252$ 66,528,252$ 76,032,289$ 76,032,289$ 76,032,289$ Reservation 18,154,571$ 17 18,154,571$ 18,154,571$ 18,154,571$ 18,154,571$ 18,154,571$ 18,154,571$ 18,154,571$ 18,154,571$ 18,154,571$ 18,154,571$ Salaries 33,352,207$ 35 16,676,104$ 27,793,506$ 33,352,207$ 33,352,207$ 38,910,908$ 38,910,908$ 38,910,908$ 44,469,609$ 44,469,609$ 44,469,609$ Maintenance 25,000,000$ 25,000,000$ 25,000,000$ 25,000,000$ 25,000,000$ 25,000,000$ 25,000,000$ 25,000,000$ 25,000,000$ 25,000,000$ 25,000,000$

295

305,091,708$ 228,200,425$ 276,461,280$ 299,091,708$ 296,091,708$ 318,722,135$ 315,722,135$ 312,722,135$ 335,352,563$ 332,352,563$ 329,352,563$

INCOME

Total hospital 469,634,684$ 240,890,405$ 281,780,810$ 375,707,747$ 375,707,747$ 422,671,216$ 469,634,684$ 469,634,684$ 469,634,684$ 469,634,684$ 469,634,684$

POTENTIAL PROFITat 60 % occupation 164,542,976$ 12,689,980$ 5,319,530$ 76,616,040$ 79,616,040$ 103,949,081$ 153,912,549$ 156,912,549$ 134,282,121$ 137,282,121$ 140,282,121$

Total 10 year profit 1,000,862,132$

ROI 600,000,000$ 527,310,020$ 521,355,991$ 446,807,751$ 368,532,099$ 265,009,623$ 109,347,555$ -54,097,616 $ -200,084,618 $ 26,365,501$ 26,067,800$ 22,340,388$ 18,426,605$ 13,250,481$ 5,467,378$ -2,704,881 $ -10,004,231 $

7 yearsInterest reduction 634,499$ -2,067,800 $ -1,340,388 $ -426,605 $ 1,749,519$ 6,532,622$ 11,704,881$ 16,004,231$


APPENDIX H


APPENDIX H

WARD COST SPECIALIST

Hospital Total Avg profit per bed Hospital Total Avg profit per bedProfit day year day year cost day year day year

20% 13,850$ 5,055,250$ 32$ 11,729$ 20% 38,555$ 14,072,575$ 89$ 32,651$ 40% 19,375$ 7,071,875$ 45$ 16,408$ 40% 52,569$ 19,187,685$ 122$ 44,519$ 60% 28,800$ 10,512,000$ 67$ 24,390$ 60% 78,187$ 28,538,255$ 181$ 66,214$ 80% 34,325$ 12,528,625$ 80$ 29,069$ 80% 92,201$ 33,653,365$ 214$ 78,082$

100% 39,850$ 14,545,250$ 92$ 33,748$ 100% 106,215$ 38,768,475$ 246$ 89,950$

Specialist Total Avg profit per bedProfit day year day year

20% 10,500$ 3,832,500$ 24$ 8,892$ 40% 12,500$ 4,562,500$ 29$ 10,586$ 60% 17,500$ 6,387,500$ 41$ 14,820$ 80% 19,500$ 7,117,500$ 45$ 16,514$

100% 21,500$ 7,847,500$ 50$ 18,208$

Specialist staff and physician assistantWards open

per year Specialist Assistant Assist Occ 20% Occ 40 % Occ 60 % Occ 80 % Occ 100 %salary

Class 3 1 2 60000 60000 120000 180000 240000 300000Class 2 1 2 60000 60000 120000 180000 240000 300000Class 1 1 2 60000 60000 60000 120000 120000 120000Pediatric 1 2 60000 60000 60000 120000 120000 120000maternity 2 2 60000 60000 60000 60000 60000 60000ICU 6 6 180000 180000 180000 180000 180000 180000traditional 2 2 60000 60000 60000 60000 60000 60000

540000 660000 900000 1020000 1140000

Specialist profit 3,832,500$ 4,562,500$ 6,387,500$ 7,117,500$ 7,847,500$

Specialist salary 3,292,500$ 3,902,500$ 5,487,500$ 6,097,500$ 6,707,500$

Specialist needed

Class 3 1 2 3 4 5Class 2 1 2 3 4 5Class 1 1 1 2 2 2Pediatric 1 1 2 2 2maternity 2 2 2 2 2ICU 6 6 6 6 6traditional 2 2 2 2 2

Total specialist 14 16 20 22 24

Salary/specialist 235,179$ 243,906$ 274,375$ 277,159$ 279,479$


APPENDIX I

Radiology Department / Investments / Operational Costs / Cost Price

RADIOLOGY DEPARTMENT

Equipment Production daytime Exam Costs Staff EQUIP SPECIALIST Fixed hospital cost / profit Exam cost price Total profit Total cost Radiologist time IndiaLOCATION/DEVICE Number Cost Total exam capacity hours/ exams/ usage days/wk exams/ exams/ fixed Staff shift total sal sal sal/ per per hospital hospital LOCATION/DEVICE

time day day percent week year material total staff cat total exam exam exam cost profit per hour hosp hosp spec hosp Exams time TotalEmergency Room (hr) (hr) (N) (N) (%) (N) (N) (N) (N) (N) (N) ($) Emergency Room cost (N) (min) (Hr)

Bucky 2 150,000$ 300,000$ 0.15 13 24 320 60% 7 1344 69888 -$ 2 3 12 rad 1 6,000$ 72,000$ 1$ 1$ 6$ 5$ 349,440$ 60$ 400$ Bucky 73$ 7$ 4,193,280$ 419,328$ 505,440$ 69888 3 3494CT 1 1,500,000$ 1,500,000$ 0.3 3 24 80 10% 7 56 2912 60$ 174,720$ 2 3 12 rad 2 8,500$ 102,000$ 35$ 144$ 25$ 50$ 145,600$ 75$ 250$ CT 389$ 289$ 218,400$ 72,800$ 842,320$ 2912 15 728Echo 1 200,000$ 200,000$ 0.4 3 24 60 10% 7 42 2184 -$ 1 3 6 rad 1 6,000$ 36,000$ 16$ 26$ 10$ 10$ 21,840$ 100$ 250$ Echo 162$ 52$ 218,400$ 21,840$ 113,840$ 2184 5 182

Radiology Radiology

PACS 12,000,000$ PACS

Bucky 5 150,000$ 750,000$ 0.1 50 12 600 60% 6 2160 112320 -$ 5 2 12 rad 1 6,000$ 72,000$ 1$ 2$ 6$ 5$ 561,600$ 50$ 500$ Bucky 64$ 8$ 5,616,000$ 673,920$ 843,600$ 112320 3 5616 673,920$ MRI 2 2,000,000$ 4,000,000$ 0.5 4 12 48 60% 6 173 8986 60$ 539,136$ 2 2 4.8 rad 2 8,500$ 40,800$ 5$ 125$ 30$ 50$ 449,280$ 125$ 250$ MRI 394$ 239$ 1,123,200$ 269,568$ 2,149,216$ 8986 20 2995 269,568$ CT 1 1,500,000$ 1,500,000$ 0.3 3 12 40 60% 6 144 7488 60$ 449,280$ 2 2 4.8 rad 2 8,500$ 40,800$ 5$ 56$ 25$ 50$ 374,400$ 75$ 250$ CT 272$ 172$ 561,600$ 187,200$ 1,284,480$ 7488 15 1872 187,200$ Echo cardio 2 300,000$ 600,000$ 0.4 5 12 60 60% 6 216 11232 -$ 2 2 4.8 rad 2 8,500$ 40,800$ 4$ 15$ 6$ 10$ 112,320$ 80$ 200$ Echo cardio 115$ 29$ 898,560$ 67,392$ 321,120$ 11232 3 562 67,392$ Echo VIP 1 200,000$ 200,000$ 1 1 12 12 60% 7 50 2621 -$ 1 2 2.4 rad 2 8,500$ 20,400$ 8$ 21$ 50$ 20$ 52,416$ 250$ 250$ Echo VIP 349$ 49$ 655,200$ 131,040$ 128,816$ 2621 10 437Bucky VIP 1 150,000$ 150,000$ 0.4 3 12 30 60% 7 126 6552 -$ 2 2 4.8 rad 2 8,500$ 40,800$ 6$ 6$ 25$ 10$ 65,520$ 200$ 500$ Bucky VIP 248$ 23$ 1,310,400$ 163,800$ 148,320$ 6552 10 1092Angiography 2 1,500,000$ 3,000,000$ 1 2 12 24 60% 6 86 4493 400$ 1,797,120$ 6 2 14.4 rad 3 11,000$ 158,400$ 35$ 187$ 150$ 100$ 449,280$ 300$ 300$ Angiography 1,172$ 722$ 1,347,840$ 673,920$ 3,244,800$ 4493 60 4493Echo 3 200,000$ 600,000$ 0.3 10 12 120 60% 6 432 22464 -$ 3 2 7.2 rad 1 6,000$ 43,200$ 2$ 7$ 10$ 10$ 224,640$ 60$ 200$ Echo 89$ 19$ 1,347,840$ 224,640$ 435,840$ 22464 3 1123 224,640$ Mammography 1 150,000$ 150,000$ 0.2 5 12 60 60% 6 216 11232 -$ 1 2 2.4 rad 1 6,000$ 14,400$ 1$ 4$ 6$ 5$ 56,160$ 100$ 500$ Mammography 116$ 10$ 1,123,200$ 67,392$ 112,560$ 11232 3 562 67,392$ Lithotrypsy 1 1,000,000$ 1,000,000$ 1 1 12 12 60% 6 43 2246 250$ 561,600$ 2 2 4.8 rad 2 8,500$ 40,800$ 18$ 125$ 6$ 100$ 224,640$ 400$ 400$ Lithotrypsy 899$ 493$ 898,560$ 13,478$ 1,107,040$ 2246 5 187Nuclear medicine 2 1,500,000$ 3,000,000$ 1 2 12 24 60% 6 86 4493 800$ 3,594,240$ 4 2 9.6 rad 3 11,000$ 105,600$ 24$ 187$ 150$ 100$ 449,280$ 250$ 250$ Nuclear medicine 1,510$ 1,110$ 1,123,200$ 673,920$ 4,989,120$ 4493 15 1123OPG 1 150,000$ 150,000$ 0.1 10 12 120 60% 6 432 22464 -$ 1 2 2.4 rad 1 6,000$ 14,400$ 1$ 2$ 6$ 5$ 112,320$ 20$ 200$ OPG 34$ 8$ 449,280$ 134,784$ 168,720$ 22464 3 1123 134,784$ OR radioscopy 6 200,000$ 1,200,000$ 1 6 10 60 40% 7 168 8736 -$ 6 2 9.6 rad 1 6,000$ 57,600$ 7$ 38$ 6$ 10$ 87,360$ 400$ 400$ OR radioscopy 461$ 55$ 3,494,400$ 52,416$ 480,960$ 8736 3 437OR angio 1 1,500,000$ 1,500,000$ 2 1 10 5 20% 7 7 364 400$ 145,600$ 4 2 3.2 rad 3 11,000$ 35,200$ 97$ 1,154$ 150$ 125$ 45,500$ 1,000$ 500$ OR angio 2,926$ 1,776$ 364,000$ 54,600$ 646,300$ 364 60 364OR Bucky 1 150,000$ 150,000$ 0.3 3 10 33 20% 7 47 2427 -$ 1 2 0.8 rad 1 6,000$ 4,800$ 2$ 17$ 6$ 10$ 24,267$ 120$ 400$ OR Bucky 155$ 29$ 291,200$ 14,560$ 71,067$ 2427 3 121ICU radioscopy 1 200,000$ 200,000$ 1 1 24 24 10% 7 17 874 -$ 1 2 0.4 rad 1 6,000$ 2,400$ 3$ 64$ 6$ 5$ 4,368$ 250$ 250$ ICU radioscopy 328$ 72$ 218,400$ 5,242$ 62,768$ 874 1 15ICU mobile bucky 1 200,000$ 200,000$ 0.2 5 24 120 30% 7 252 13104 10$ 131,040$ 1 2 1.2 rad 1 6,000$ 7,200$ 1$ 4$ 6$ 5$ 65,520$ 80$ 400$ ICU mobile bucky 106$ 20$ 1,048,320$ 78,624$ 259,760$ 13104 3 655ICU echo 1 200,000$ 200,000$ 0.3 3 24 80 10% 7 56 2912 -$ 1 2 0.4 rad 2 8,500$ 3,400$ 1$ 19$ 30$ 10$ 29,120$ 75$ 250$ ICU echo 135$ 30$ 218,400$ 87,360$ 88,520$ 2912 3 146ICU echo cardio 1 300,000$ 300,000$ 0.4 3 24 60 10% 7 42 2184 -$ 1 2 0.4 rad 2 8,500$ 3,400$ 2$ 38$ 50$ 10$ 21,840$ 100$ 250$ ICU echo cardio 200$ 50$ 218,400$ 109,200$ 109,240$ 2184 3 109OR echo 1 200,000$ 200,000$ 0.3 3 10 33 20% 7 47 2427 -$ 1 2 0.8 rad 2 8,500$ 6,800$ 3$ 23$ 30$ 10$ 24,267$ 75$ 250$ OR echo 141$ 36$ 182,000$ 72,800$ 87,067$ 2427 3 121OR echo cardio 1 300,000$ 300,000$ 0.4 3 10 25 20% 7 35 1820 -$ 1 2 0.8 rad 2 8,500$ 6,800$ 4$ 46$ 50$ 10$ 18,200$ 100$ 250$ OR echo cardio 210$ 60$ 182,000$ 91,000$ 109,000$ 1820 3 91GYN echo 6 200,000$ 1,200,000$ 0.2 30 12 360 60% 6 1296 67392 -$ 6 2 14.4 rad 2 8,500$ 122,400$ 2$ 5$ 6$ 5$ 336,960$ 40$ 200$ GYN echo 58$ 12$ 2,695,680$ 404,352$ 795,360$ 67392 3 3370 404,352$ Ward Mobile bucky 3 200,000$ 600,000$ 0.2 15 12 180 20% 7 252 13104 10$ 131,040$ 3 2 2.4 rad 1 6,000$ 14,400$ 1$ 13$ 6$ 10$ 131,040$ 80$ 400$ Ward Mobile bucky 120$ 34$ 1,048,320$ 78,624$ 444,480$ 13104 3 655

TOTAL 35,150,000$ 406917 7,523,776$ 138.8 1,106,800$ 4,437,177$ 31,046,080$ 4,843,800$ 19,549,753$ 31673 2,029,248$

TOTAL RADIOLOGYUSAGE PERCENTAGE RADIOLOGY

Hospital incomeOR 20%ICU 10% profit 31,046,080$ EMERGENCY 10% cost 19,549,753$ RADIOLOGY 60%GYN 60% Total 50,595,833$ WARD 20%ICU MOB BUCK 30% Specialist incomeOR MOB BUCK 40%EMERG BUCK 60% salary 4,843,800$ (possibility digital processing India)

2,029,248$ hours total 31673 hr

per hour income 153$


APPENDIX I


APPENDIX J

Special Department / Investments / Operational Costs / Cost Price

SPECIAL DEPARTMENTS

Equipment Production daytime Exam Costs Staff EQUIP SPECIALIST Fixed hospital cost / profit Prod cost price Total profit Total cost SPECIALIST TIMENumber Cost Total exam capacity hours/ exams/ usage days/wk exams/ exams/ fixed Staff shift total sal sal sal/ per per hospital hospital LOCATION/DEVICE

time day day percent week year material staff cat total prod prod prod cost profit hosp hosp spec hosp Exams time Total(hr) (hr) (N) (N) (%) (N) (N) (N) (N) (N) (N) ($) cost (N) (min) (Hr)

LAB LAB

Haematology 8 350,000$ 2,800,000$ 3211028 0$ 321,103$ 36 2 144 2 8,500$ 1,224,000$ 0.38$ 0.24$ 0.16$ 0.10$ 321,103$ 0.25$ Haematology 1.24$ 0.83$ 802,757$ 513,764$ 2,650,206$ 3211028 0.05 2676Chemical 12 300,000$ 3,600,000$ 5351713 0$ 535,171$ 36 2 144 2 8,500$ 1,224,000$ 0.23$ 0.19$ 0.16$ 0.10$ 535,171$ 0.25$ Chemical 1.03$ 0.62$ 1,337,928$ 856,274$ 3,302,343$ 5351713 0.05 4460Hormones 6 300,000$ 1,800,000$ 2140685 0$ 642,206$ 36 2 144 2 8,500$ 1,224,000$ 0.57$ 0.24$ 0.16$ 0.10$ 214,069$ 0.25$ Hormones 1.62$ 1.21$ 535,171$ 342,510$ 2,584,274$ 2140685 0.05 1784Special 2 750,000$ 1,500,000$ 1070343 0$ 321,103$ 12 2 48 2 8,500$ 408,000$ 0.38$ 0.39$ 0.16$ 0.10$ 107,034$ 0.25$ Special 1.58$ 1.17$ 267,586$ 171,255$ 1,256,137$ 1070343 0.05 892

PATHOLOGY PATHOLOGY

Microbiology 250,000$ 47635 15$ 714,529$ 16 2 64 2 8,500$ 544,000$ 11.42$ 1.47$ 0.16$ 0.10$ 4,764$ 10.00$ Microbiology 38.15$ 27.99$ 476,353$ 7,622$ 1,333,293$ 47635 2 1588Virology 500,000$ 9880 25$ 246,992$ 8 2 32 2 8,500$ 272,000$ 27.53$ 14.17$ 0.16$ 0.10$ 988$ 10.00$ Virology 76.96$ 66.80$ 98,797$ 1,581$ 659,980$ 9880 2 329Serology 800,000$ 72395 25$ 1,809,873$ 6 2 24 2 8,500$ 204,000$ 2.82$ 3.09$ 0.16$ 0.10$ 7,239$ 0.25$ Serology 31.42$ 31.01$ 18,099$ 11,583$ 2,245,113$ 72395 0.05 60

PHARMACY PHARMACY

Pharmacy PharmacyProduction 10,000,000$ 6,000,000$ 1825455 10$ 18,254,545$ 30 2 120 2 8,500$ 1,020,000$ 0.56$ 0.92$ 0.16$ 0.10$ 182,545$ 5.00$ Production 16.74$ 11.58$ 9,127,273$ 292,073$ 21,137,091$ 1825455 0.1 3042

17,250,000$ 13729132 22,845,522$ 720 6,120,000$ 1,372,913$ 12,663,963$ 2,196,661$ 35,168,435$ 14,831$

TOTAL SPECIAL DEPARTMENTS

Hospital income

profit 12,663,963$ cost 35,168,435$

Total 47,832,398$

Specialist income

salary 2,196,661$

hours total 14831 hr



APPENDIX K

Other Staff / Investments / Operational Costs / Cost Price


APPENDIX L

Operating Theatre/ Investments / Operational Costs / Cost Price

OR

Equipment Production daytime Exam Costs Staff EQUIP SPECIALIST Fixed hospital cost / profit OR cost price Total profit Total cost Specialist timeNumber Cost Total OR capacity hours/ OR/ usage days/wk OR/ OR/ fixed Staff shift total sal sal sal/ per per hospital hospital LOCATION/DEVICE

time day day percent week year material staff cat total OR OR OR cost profit per hour hosp hosp spec hosp Exams time Total(hr) (hr) (N) (N) (%) (N) (N) (N) (N) (N) (N) ($) cost (N) (min) (Hr)

General 8 2,000,000$ 16,000,000$ 1.5 5.3 16 85 70% 6 358 18637 200$ 3,727,360$ 3.5 2 112 OR 1 12,000$ 1,344,000$ 72$ 240$ 225$ 150$ 2,795,520$ 750$ 500$ General 1,638$ 663$ 13,977,600$ 4,193,280$ 12,346,880$ 18637 90 27955Vascular 2 3,000,000$ 6,000,000$ 3 0.7 12 8 100% 6 48 2496 2,000$ 4,992,000$ 5.5 2 44 OR 2 14,000$ 616,000$ 247$ 673$ 450$ 150$ 374,400$ 1,500$ 500$ Vascular 5,020$ 3,070$ 3,744,000$ 1,123,200$ 7,662,400$ 2496 180 7488Neuro 1 4,000,000$ 4,000,000$ 5 0.2 10 2 100% 6 12 624 2,000$ 1,248,000$ 3.5 2 14 OR 2 14,000$ 196,000$ 314$ 1,795$ 750$ 150$ 93,600$ 2,500$ 500$ Neuro 7,509$ 4,259$ 1,560,000$ 468,000$ 2,657,600$ 624 300 3120Robot 2 5,000,000$ 10,000,000$ 1.5 1.3 12 16 70% 6 67 3494 400$ 1,397,760$ 3.5 2 28 OR 2 14,000$ 392,000$ 112$ 801$ 225$ 150$ 524,160$ 750$ 500$ Robot 2,438$ 1,463$ 2,620,800$ 786,240$ 5,113,920$ 3494 90 5242Management 1 1 2 14,000$ 28,000$

13 36,000,000$ 25251 11,365,120$ 200 2,576,000$ 3,787,680$ 21,902,400$ 6,570,720$ 28,473,120$ 43805

TOTAL POLICLINIC

Hospital income

profit 21,902,400$ cost 28,473,120$

Total 50,375,520$

Specialist income

salary 6,570,720$




APPENDIX M

Patient Number Projection


APPENDIX N

Polyclinic

POLICLINIC EMERGENCY FUNCTION

Equipment Production daytime Exam Costs Staff EQUIP SPECIALIST Fixed hospital cost / profit Exam cost price Total profit Total cost Specialist timeNumber Cost Total exam capacity hours/ exams/ usage days/wk exams/ exams/ fixed Staff shift total sal sal sal/ per per hospital hospital LOCATION/DEVICE

time day day percent week year material staff cat total exam exam exam cost profit per hour hosp hosp spec hosp Exams time Total(hr) (hr) (N) (N) (%) (N) (N) (N) (N) (N) (N) ($) cost (N) (min) (Hr)

Pediatric 4 5,000$ 20,000$ 0.33 12 10 121 50% 6 364 18909 1$ 18,909$ 1.5 2 24 poli 1 6,000$ 144,000$ 8$ 0$ 60$ 5$ 94,545$ 41$ 125$ Pediatric 115$ 14$ 780,000$ 1,134,545$ 263,055$ 18909 20 6240Gynaecologist 4 10,000$ 40,000$ 0.33 12 10 121 50% 6 364 18909 25$ 472,727$ 2 2 32 poli 1 6,000$ 192,000$ 10$ 1$ 60$ 25$ 472,727$ 41$ 125$ Gynaecologist 162$ 61$ 780,000$ 1,134,545$ 1,148,655$ 18909 20 6240Dermatologist 9 5,000$ 45,000$ 0.2 45 10 450 50% 6 1350 70200 30$ 2,106,000$ 2.5 2 90 poli 1 6,000$ 540,000$ 8$ 0$ 60$ 25$ 1,755,000$ 25$ 125$ Dermatologist 148$ 63$ 1,755,000$ 4,212,000$ 4,413,600$ 70200 12 14040Dentist 9 60,000$ 540,000$ 0.4 23 10 225 50% 6 675 35100 50$ 1,755,000$ 2 2 72 Poli 2 8,500$ 612,000$ 17$ 4$ 60$ 50$ 1,755,000$ 50$ 125$ Dentist 232$ 122$ 1,755,000$ 2,106,000$ 4,273,200$ 35100 24 14040Geriatrics 5 5,000$ 25,000$ 3 2 9 15 50% 6 45 2340 10$ 23,400$ 1 2 20 poli 1 6,000$ 120,000$ 51$ 3$ 450$ 5$ 11,700$ 75$ 25$ Geriatrics 594$ 69$ 175,500$ 1,053,000$ 162,100$ 2340 180 7020KNO/EYE 11 250,000$ 2,750,000$ 0.33 33 10 333 50% 6 1000 52000 20$ 1,040,000$ 2 2 88 Poli 2 8,500$ 748,000$ 14$ 15$ 60$ 10$ 520,000$ 41$ 125$ KNO/EYE 160$ 59$ 2,145,000$ 3,120,000$ 3,078,000$ 52000 20 17160Traditional 2 5,000$ 10,000$ 1 2 10 20 50% 6 60 3120 10$ 31,200$ 1 2 8 poli 1 6,000$ 48,000$ 15$ 1$ 150$ 5$ 15,600$ 50$ 50$ Traditional 231$ 31$ 156,000$ 468,000$ 97,600$ 3120 60 3120VIP 2 20,000$ 40,000$ 2 1 10 10 50% 6 30 1560 100$ 156,000$ 3 2 24 Poli 3 11,000$ 264,000$ 169$ 7$ 300$ 50$ 78,000$ 350$ 175$ VIP 976$ 326$ 546,000$ 468,000$ 509,200$ 1560 120 3120General 23 5,000$ 115,000$ 0.33 70 10 697 50% 6 2091 108727 1$ 108,727$ 1.5 2 138 poli 1 6,000$ 828,000$ 8$ 0$ 60$ 5$ 543,636$ 41$ 125$ General 115$ 14$ 4,485,000$ 6,523,636$ 1,512,564$ 108727 20 35880Surgery 10 25,000$ 250,000$ 0.5 20 10 200 50% 6 600 31200 125$ 3,900,000$ 3 2 120 poli 2 8,500$ 1,020,000$ 33$ 2$ 75$ 150$ 4,680,000$ 95$ 190$ Surgery 480$ 310$ 2,964,000$ 2,340,000$ 9,670,000$ 31200 30 15600Scopist 6 600,000$ 3,600,000$ 1 6 10 60 50% 6 180 9360 50$ 468,000$ 2 2 48 poli 3 11,000$ 528,000$ 56$ 108$ 175$ 25$ 234,000$ 125$ 125$ Scopist 539$ 239$ 1,170,000$ 1,638,000$ 2,238,000$ 9360 60 9360KNO treatment 2 250,000$ 500,000$ 1 2 10 20 50% 6 60 3120 50$ 156,000$ 2 2 16 poli 2 8,500$ 136,000$ 44$ 45$ 175$ 50$ 156,000$ 125$ 125$ KNO treatment 488$ 188$ 390,000$ 546,000$ 588,000$ 3120 60 3120EYE treatment 2 250,000$ 500,000$ 1 2 10 20 50% 6 60 3120 250$ 780,000$ 2 2 16 poli2 8,500$ 136,000$ 44$ 45$ 175$ 50$ 156,000$ 125$ 125$ EYE treatment 688$ 388$ 390,000$ 546,000$ 1,212,000$ 3120 60 3120Dentalsurgery 2 200,000$ 400,000$ 0.5 4 10 40 50% 6 120 6240 200$ 1,248,000$ 2 2 16 poli 2 8,500$ 136,000$ 22$ 18$ 75$ 50$ 312,000$ 63$ 125$ Dentalsurgery 427$ 290$ 390,000$ 468,000$ 1,808,000$ 6240 30 3120Function 9 400,000$ 3,600,000$ 0.5 18 10 180 50% 6 540 28080 20$ 561,600$ 1.5 2 54 poli 3 11,000$ 594,000$ 21$ 36$ 75$ 10$ 280,800$ 63$ 125$ Function 225$ 87$ 1,755,000$ 2,106,000$ 2,444,400$ 28080 30 14040EYE/KNO function 5 200,000$ 1,000,000$ 0.5 10 10 100 50% 6 300 15600 20$ 312,000$ 1.5 2 30 poli 3 11,000$ 330,000$ 21$ 18$ 75$ 10$ 156,000$ 63$ 125$ EYE/KNO function 207$ 69$ 975,000$ 1,170,000$ 1,078,000$ 15600 30 7800ER 19 25,000$ 475,000$ 2 10 24 228 40% 7 638 33197 75$ 2,489,760$ 1 2 76 poli 3 11,000$ 836,000$ 25$ 4$ 60$ 50$ 1,659,840$ 100$ 50$ ER 314$ 154$ 3,319,680$ 1,991,808$ 5,118,600$ 33197 120 66394Floor management 16 16 1 16 poli 4 12,500$ 200,000$ Floor management

23,931,180$ 31,025,535$ 39,614,973$ 22941413,910,000$ 440782 15,627,324$ 888 7,412,000$ 12,880,849$

TOTAL POLICLINIC

Hospital income

profit 23,931,180$ cost 39,614,973$

Total 63,546,153$

Specialist income

salary 31,025,535$




APPENDIX O

Staff Training


APPENDIX P

Expat Insurence Plan


APPENDIX Q

Building Constriction Costs


APPENDIX R

DHC Budget

academic teaching hospital jakarta - dhcprojects.com · appendix a list of medical facilities...

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