DEVELOPMENT OF TOWER A AND TOWER B DHARMAIS INCC TOWARDS RECOGNIZED NATIONAL CANCER CENTER IN ASIA

Transcription

1 MINISTRY OF HEALTH REPUBLIC OF INDONESIA NATIONAL CANCER CENTER INDONESIA DHARMAIS CANCER HOSPITAL DEVELOPMENT OF TOWER A AND TOWER B DHARMAIS INCC TOWARDS RECOGNIZED NATIONAL CANCER CENTER IN ASIA Prof. dr. H. Abdul Kadir, PhD, SpTHT-KL(K), MARS President Director of Dharmais Cancer Hospital - National Cancer Center Indonesia

2 Answering people's need for an integrated cancer service center Development of executive services and hospice palliative center Reduce waiting time to improve the quality of life of cancer patients by providing effective services Solutions for meeting the needs of specialist doctors and subspecialty oncologists Increase the number of patients that can be handled by RSKD Achieving the vision as a National Referral Cancer Center is equivalent to Asian level

3 1 Profile, Background and PROFILE DHARMAIS CANCER HOSPITAL RSKD was inaugurated on October 30, 1993 by the President of the Republic of Indonesia HM. Soeharto Operational permit as Class A Special Hospital based on Decree of Investment Coordinating Board Number 12 / I / 10 / KES / PMDN / , RSKD becomes Affiliated Education Hospital for Faculty of Medicine University of Indonesia by Decree of Minister of Health Number: HK / I / 2733/2017 3

4 and Social cooperation Support things to follow up Background (1) In the world: The prevalence of cancer and death from cancer increases steadily from year to year In Indonesia: Cancer is a national health problem 01 The average number of outpatient visit: per day, 300 of which are radiotherapy service 02 Ability of radiotherapy equipment (LINAC): 75 patients per day on each equipment, causing 2-3 months waiting time and affecting service quality of patient 03 The condition of Dharmais Hospital to serve uppermiddle-class patients is currently limited Needs particular facilities and infrastructure. 4

5 and Social cooperation Support things to follow up Background (2) 5

6 Why PPP? Right time - Right cost (budget) Accuracy in planning (clinical and procurement) Long-term cost certainty Can drive innovation from the private sector Increase market capacity Value for money Source: Deloitte LLP Canada, 2017

7 Background (2) and Social cooperation Support PURPOSE OF CANCER CONTROL IN INDONESIA things to follow up 1. Increase screening, early detection, early cancer discovery and follow-up down staging cancer 3. Reduce death rates from cancer and reduce the cost of cancer treatment 2. Improve the quality of life of cancer patients

8 and Social cooperation Support things to follow up in JKN (NHI) Financing (1) Cost of Cancer : IDR per case FINANCING JKN* FOR CATASTROPHIC DISEASES *JKN = Jaminan Kesehatan Nasional = National Health Insurance (NHI) Source: BPJS Kesehatan

9 and Social cooperation Support things to follow up in Country Foreign Exchange (2) The number of patients treated abroad and the amount of expenditure Year Number of patient 315, , ,000 Expenditure (USD) 500 million 1.4 billion 1.53 billion Expenditure (IDR) 4.8 trillion 13.5 trillion 20 trillion Taking advantage of the wealthy patients who seek treatment abroad Co-branding with NCC overseas (Japan, Korea, etc), MD-Anderson, etc. The moment for service quality improvement

10 10 Financial expenditure Indonesian society 12/13/2017

11 11 Tendention for Indonesian upper middle society NON BPJS Access Comfort Time Quality 12/13/2017

12 and Social cooperation Increase in the Number of Patients (3) Support things to follow up Patients The increased number of JKN (UHC) BPJS patients makes wide-open access for patients to get treatment at hospital causing the need for medical service capacity increased The increasing prevalence of cancer and cancer mortality rates causing the need for an integrated cancer service center to increase Source: Academic Manuscript of Dharmais Cancer Hospital,

13 and Social cooperation Increase in the Number of Patients (3) Support things to follow up Source: Academic Manuscript of Dharmais Cancer Hospital, 2017 Attainment of Hospital BOR continues to increase causing the need to increase bed capacity (Inpatient) 13

14 and Social cooperation Increase in the Number of Patients (3) Support things to follow up The existence of chances / opportunities to establish the Executive Outpatient Service for the community is possible with the Minister of Health Regulation (PERMENKES) No. 11 of the year of 2016 Executive Outpatient Service is the provision of non-regular outpatient health services in hospitals conducted through specialist-subspecialist services in one integrated room exclusively without staying in hospitals with above standard facilities and infrastructure. 14

15 and Social cooperation Support things to follow up PIC OF COOPERATION AGREEMENT Ministry of Health Based on Presidential Regulation 38/2015 basically the Minister acts as PJPK BLU (Public Service Agency) Dharmais Delegates The Minister may delegate the authority to represent the Ministry to those whose scope, duties and responsibilities cover the infrastructure sector. Team PPP PPP knot Procurement Committee BLU operates as a working unit of country ministries / agencies / local governments for the purpose of providing public services whose management is based on the authority delegated by the respective agency Establishment and instruction Coordination Minister of Health acts as PJPK. The Minister may delegate the authority to an officer whose scope, duties and responsibilities cover the infrastructure sector. Provision of authority to the Dharmais BLU in the management of revenues from PPP objects and AP payments is required 15

16 3 Tower A (Service and Hospice Building) and Tower B (Integrated Executive Service) is an integrated part of Dharmais Cancer Hospital The development of Tower A and Tower B planning refers to Regulation of the Minister of Health No. 24 of 2016 on Requirements for Building and Infrastructure of Hospitals and Guidelines of Class B Hospital 16

17 and Social cooperation Support things to follow up Tower A (6 floors) is a service and hospice palliative building. The building s ground floor area is ± 1050 m², Total building area ± 8,029 m². Tower A Tower B Tower B (12 floors) is an Operational Building with Executive Services. The ground floor area is 1,940 m² with a total floor area of 26,352 m². 17

18 STACKING DIAGRAM DHARMAIS Profile, TOWER A LANTAI LUAS (M²) STACKING DIAGRAM REVIEW GEDUNG A and RS Social KANKER DHARMAIS cooperation FUNGSI Support KAPASITAS LANTAI HOSPICE CARE 27 TT LANTAI HOSPICE CARE 27 TT things to follow up LANTAI HOSPICE CARE 27 TT LANTAI LANTAI LANTAI LAUNDRY WORKSHOP, GUDANG IPSRS KANTIN UMUM, MINIMARKET LANTAI DASAR 974 GENSET, TRAFO, R. POMPA, BOILER LOBBY UTAMA LT.SEMI-BASEMENT 1211 PARKIR, GUDANG UMUM, KANTIN KARYAWAN LUAS TOTAL TT TOWER B 18

19 4 Background Idea / Concept on Development of Dharmais NCC Aspect of Regulation Needs Aspect (Market) Service & Technology Plan Fulfillment of Dharmais & Reference Standard Service (NCC) Organization Aspect Aspects of facilities and infrastructure and Medical Devices PPP approach Aspects Feasibility Analysis Overview Financial Aspect PPP Procurement System Document FBC OBC Financial Modelling of PPP 19

20 and Social cooperation Support REALIZATION OF NUMBER OF VISITORS IN DHARMAIS YEAR OF things to follow up 350, , , , , ,000 50, , , , , , , , , , , ,354 12,957 13,012 14,063 14,315 12,093 12, ,284 Note: 1. In 2014, the JKN (NHI) program was started, resulting in a significant increase in patient visits; 2. In 2016, there is number of Room and Bed capacity improvement, which significantly affects the number of patients. 3. The average number of JKN (NHI) patients ( ) ranges between 54% to 66% Pengunjung Baru Pengunjung Lama Jumlah Description Average Av (%) New Visitors 12,957 13,012 14,063 14,315 12,093 12,930 13, % Established Visitors 114, , , , , , , % Total 127, , , , , , , %

21 and Social cooperation REALIZATION OF DHARMAIS REVENUES IN YEAR OF Support things to follow up 800, , , , , , , , , , , , , , , , , , , , PENDAPATAN USAHA (OPERASIONAL) JUMLAH PENDAPATAN APBN JUMLAH PENDAPATAN PENDAPATAN USAHA LAIN PENDAPATAN LAIN-LAIN DESCRIPTION BUSINESS REVENUES (OPERATIONAL) IDR Million IDR Million IDR Million IDR Million Outpatient 142, , , , Inpatient 266, , , , NUMBER OF BUSINESS REVENUES 408, , , ,356.72

22 NO PROVINCE ALL DATA PBCR CASES EXPECTED DATA BELUM O/E REPORTED REPORTED (O) CASES DIVERIFIKASI 1 BALI 3,573 3,490 3,563 4, SOUTH SUMATERA 4,725 4,528 4,710 8, ,914 3 EAST JAVA 50,105 6,924 6,281 16, JOGJAKARTA 6,309 4,977 4,783 14, JAKARTA 78,953 23,291 17,923 58, ,171 6 SOUTH SULAWESI , CENTRAL JAVA 3,078 1,427 1,717 12, NORTH SULAWESI 2,224 1,020 1,070 8, WEST KALIMANTAN , EAST KALIMANTAN 8, , , WEST JAVA 23,036 1,639 4,566 50, , PAPUA , WEST SUMATERA , NORTH SUMATERA 6, , TOTAL MARKET SHARE OF DHARMAIS and Social cooperation Support 189,515 49,184 47, , ,198 Expected Cases : Estimation for all cancer for all ages (Globocan 2012 ): 122,44/ pop. Note: In the case of Jakarta ranks highest with 17,923 cases or about 38.07%, and 12,097 *) cases or 25.7% of which are handled by Dharmais things to follow up *) Data in 2016, per 30 Juni 2017 Source: INDONESIAN CANCER DATA QUALITY By DHARMAIS NCC (Per 31 Juli 2017)

23 Estimated Project Value and Social cooperation Support things to follow up DEVELOPMENT COSTS TOWER A & B FINANCIAL COSTS Tower A 6 floors (8.029 m²) : Rp. 61 M Health equipment and nonhealth equipt Tower A : Rp. 19 M Tower B 12 floors ( m²) : Rp. 315 M Health equipment and nonhealth equipt Tower B : Rp. 128 M Demolition & transfer : Rp. 8 M Total Development costs : Rp. 531 M Contigencies & PPN : Rp. 40 M IDC & Financial costs : Rp. 86 M TOTAL CAPEX : Rp. 657 M Availability Payment (AP) scheme Return on investment : 14% Term of cooperation : 20 years 23

24 5 and Social 24

25 6 Study of Forms of Cooperation in Provision of Infrastructure 25

26 and Social cooperation Risk Assesment Support things to follow up SCOPE OF GOVERNMENT AUTHORITY AND BUSINESS AGENCY 26

27 and Social cooperation Risk Assesment Support DEVELOPMENT OF TOWER A AND TOWER B DHARMAIS things to follow up PJPK = Penanggung Jawab Proyek KPBU = PiC of cooperation project PSA Dharmais AP payments Minister of Health Delegation of Authority PJPK Directorate General of Health Services PPP Agreement Regres Agreement Guarantee Agreement PT. PII (If needed) Payment Services Health services Development & Maintenance SPV Equity financing EQUITY (Own Capital) Patient BLU = Badan Layanan Umum = PSA = Public Service Agency Design Consultant Construction Contractor Medical Equipment Laundry, Parking, Restaurant etc. Loan Financing Financial institutions Financing BUP = Badan Usaha Pelaksana = SPV = Special Purpose Vehicle

28 7 Risk Assessment 28

29 Preface Financial Cooperation Issues & Action Plan Schedule and Plan of Action Activities Year 1st Year 2nd 1. Preparation and making Final Business Case (FBC) 2. Transaction process (PQ, RFP, signing contract, Financial Close) 3. Demolition parking lots, Canteen, etc Year 3th 4. Construction and development Tower A 5. Facilities transfer 6. Construction and development Tower B 7. Employee recruitment 29

30 Tower A Tower B THANK YOU