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
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
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 / 2017 2017, RSKD becomes Affiliated Education Hospital for Faculty of Medicine University of Indonesia by Decree of Minister of Health Number: HK 02.02 / I / 2733/2017 3
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: 800-900 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
and Social cooperation Support things to follow up Background (2) 5
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
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
and Social cooperation Support things to follow up in JKN (NHI) Financing (1) Cost of Cancer : 1.402.164 IDR per case FINANCING JKN* FOR CATASTROPHIC DISEASES *JKN = Jaminan Kesehatan Nasional = National Health Insurance (NHI) Source: BPJS Kesehatan
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 2006 2012 2016 Number of patient 315,000 600,000 800,000 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 Financial expenditure Indonesian society 12/13/2017
11 Tendention for Indonesian upper middle society NON BPJS Access Comfort Time Quality 12/13/2017
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, 2017 12
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
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
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
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
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
STACKING DIAGRAM DHARMAIS Profile, TOWER A LANTAI LUAS (M²) STACKING DIAGRAM REVIEW GEDUNG A and RS Social KANKER DHARMAIS cooperation FUNGSI Support KAPASITAS LANTAI 6 974 HOSPICE CARE 27 TT LANTAI 5 974 HOSPICE CARE 27 TT things to follow up LANTAI 4 974 HOSPICE CARE 27 TT LANTAI 3 974 LANTAI 2 974 LANTAI 1 974 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 8029 81 TT TOWER B 18
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
and Social cooperation Support REALIZATION OF NUMBER OF VISITORS IN DHARMAIS YEAR OF 2011-2016 things to follow up 350,000 300,000 250,000 200,000 150,000 100,000 50,000-114,468 127,425 152,523 165,535 233,670 219,607 284,704 299,019 301,938 314,031 294,354 12,957 13,012 14,063 14,315 12,093 12,930 2011 2012 2013 2014 2015 2016 307,284 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 (2014-2016) ranges between 54% to 66% Pengunjung Baru Pengunjung Lama Jumlah Description 2011 2012 2013 2014 2015 2016 Average Av (%) New Visitors 12,957 13,012 14,063 14,315 12,093 12,930 13,228 0.6% Established Visitors 114,468 152,523 219,607 284,704 301,938 294,354 227,932 12.5% Total 127,425 165,535 233,670 299,019 314,031 307,284 241,161 11.5%
and Social cooperation REALIZATION OF DHARMAIS REVENUES IN YEAR OF 2013-2016 Support things to follow up 800,000 734,727 700,000 600,000 601,945 500,000 421,564 448,443 435,357 400,000 378,336 300,000 266,525 288,150 285,508 200,000 100,000 103,856 121,181 135,687-2013 2014 2015 2016 PENDAPATAN USAHA (OPERASIONAL) JUMLAH PENDAPATAN APBN JUMLAH PENDAPATAN PENDAPATAN USAHA LAIN PENDAPATAN LAIN-LAIN DESCRIPTION 2013 2014 2015 2016 BUSINESS REVENUES (OPERATIONAL) IDR Million IDR Million IDR Million IDR Million Outpatient 142,021.59 170,118.29 242,434.05 261,214.03 Inpatient 266,382.56 287,980.10 206,009.14 174,142.69 NUMBER OF BUSINESS REVENUES 408,404.15 458,098.39 448,443.19 435,356.72
NO PROVINCE ALL DATA PBCR CASES EXPECTED DATA BELUM O/E REPORTED REPORTED (O) CASES DIVERIFIKASI 1 BALI 3,573 3,490 3,563 4,827 73.81 2 SOUTH SUMATERA 4,725 4,528 4,710 8,909 52.87 3,914 3 EAST JAVA 50,105 6,924 6,281 16,929 37.10 4 JOGJAKARTA 6,309 4,977 4,783 14,654 32.64 5 JAKARTA 78,953 23,291 17,923 58,819 30.47 11,171 6 SOUTH SULAWESI 908 538 604 2,513 24.04 7 CENTRAL JAVA 3,078 1,427 1,717 12,582 13.65 8 NORTH SULAWESI 2,224 1,020 1,070 8,195 13.06 9 WEST KALIMANTAN 962 262 426 3,396 12.54 10 EAST KALIMANTAN 8,755 246 531 4,453 11.92 8,423 11 WEST JAVA 23,036 1,639 4,566 50,089 9.12 17,113 12 PAPUA 112 100 199 2,256 8.82 13 WEST SUMATERA 764 309 235 5,103 4.61 577 14 NORTH SUMATERA 6,011 433 467 10,960 4.26 TOTAL MARKET SHARE OF DHARMAIS and Social cooperation Support 189,515 49,184 47,075 203,685 23.11 41,198 Expected Cases : Estimation for all cancer for all ages (Globocan 2012 ): 122,44/100.000 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)
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 (26.352 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
5 and Social 24
6 Study of Forms of Cooperation in Provision of Infrastructure 25
and Social cooperation Risk Assesment Support things to follow up SCOPE OF GOVERNMENT AUTHORITY AND BUSINESS AGENCY 26
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
7 Risk Assessment 28
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
Tower A Tower B THANK YOU