International Journal

MANAGEMENT REVIEW OF ENVIRONMENTAL COSTS IN HOSPITAL IN

MAKASSAR

Edited By

Tenriwaru, SE.,M.Si.,Ak.,CA
Students Program S3 Hasanuddin University
Phone Number; +6281354303130
Email: tenri3@yahoo.com

Dr. Syamsu Alam, SE.,MSi.,Ak.,CA

Moeslim Indonesia University
Phone Number; +6281342746625
Email: ancu_alam@yahoo.com

Prof. Dr. H. Gagaring Pagalung.,SE.,MSi.,Ak.,CA

Hasanuddin University
Phone Number; +628114108070
Email : gagaringpagalung@yahoo.com

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MANAGEMENT REVIEW OF ENVIRONMENTAL COSTS IN HOSPITAL IN
MAKASSAR

Tenriwaru
Syamsu Alam
Gagaring Pagalung

Doctoral Student Program in Economics Hasanuddin University

Phone Number; 081354303130
Email : tenri3@yahoo.com

Abstrack
This article discusses the environmental management of hospital costs. The
purpose of this article was to see how far the environmental accounting spawned
appropriate accounting model to capitalize on the value lost as a result of the
impact of hospital operations that pollute the environment. As a public
organization that serves public health, many hospital operations potentially cause
environmental problems because of the waste generated is the producer of
hazardous waste. Types of medical waste including radioactive waste, infectious
waste, pathology and anatomy, cytotoxic waste, chemical and pharmaceutical
waste that is harmful to suistanable development.If this is not appropriate waste
management, medical waste and pollutants produced can be harmful to the
surrounding environment and threaten the survival.

This research was conducted in three major hospitals in the Hospital Makassar
Wahidin Sudirohusodo (RS WS), RS. Ibnu Sina and RS Bhayangkara.
Data were analyzed by using qualitative descriptive analysis method to describe
the management of the environmental costs that occurred in the hospital.

The results showed that during the environmental costs have not been allocated
appropriately and accurately. All still joined as operating costs or general and
administrative costs. This will be bad for the resulting costs are likely to be
distorted and affect the performance of the hospital.

Keywords; The cost of the environment, Environmental Accounting, Cost

Analysis, waste management, sustainable development

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1. INTRODUCTION

Environmental accounting is combined with information on the benefits of

environmental costs into accounting practices. Besides environmental
accounting functions for identification, prioritization, quantification or
qualification and incorporation of environmental costs into business decisions.
Environmental accounting is used as a management tool to assess the
effectiveness of environmental conservation activities.

Environmental accounting is already commonly used in the companies, but for

the hospital not yet so familiar. Its use was applied when the company intends
to undertake environmental conservation as a form of responsibility for the
various activities that impact significantly on the environment. In its
application in Indonesia, there are still very many companies that have not
been used because of environmental accounting data retrieval is still difficult.
There are 3 data required, namely environmental management cost data, the
data overall cost of environmental conservation, and data necessary
investment. For that we need done in collaboration with the community in the
surrounding environment in order to facilitate in obtaining the data. For this
study will put emphasis on the cost of management of the environment in
relation to sustainable development.

The importance of environmental responsibility is a new paradigm in

development. Since it was first formulated in the 1980s, sustainable
development or sustainable development into the concept of development
which is used in many countries. The main principle is to build to meet the
needs of the present without compromising the needs of future generations
(Burritt and Lehman, 1995). Such development can be achieved if
development activities, in addition to the pursuit of economic interests, also
pay attention to kepetingan social / community and ecology / environment.

Environmental accounting particularly useful for environmental management

accounting management because it can provide information about the physical
inputs (materials, water, energy) and outputs (products, waste, emissions) as

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well as monetary information regarding all expenditures and savings relating
to the environment (UN DSD, 2001) , Such information can assist
management in managing the environment because the management has
enough information to control the use of materials, water and energy, waste
and emissions control, while controlling the cost of the environment. Various
decisions related to the environment can be taken with any information
enabling the improvement of environmental performance.

In order to attempt to achieve the goal of sustainable development of

environmentally necessary for full control of the environment in order to
achieve harmony and balance between man and the environment, the
realization of environmental beings have attitudes and actions to protect and
nurture the environment, ensuring the interests of generations the present and
the future, achieving preservation of the environment, the controlled use of
natural resources wisely and protection of an area against the business impact
and destruction of the environment.

Selg (1994) states that one way to do environmental protection in the long
term is to integrate environmental considerations into the company's
accounting system. Bebbington (2001) states that accounting plays a very
important role in managing the relationship between the company and the
environment.

Environmental performance is the result of environmental management. One

component of environmental management can improve environmental
performance are environmental accounting. Research Perez et al. (2007);
Henri and Journeault (2010); Burhany (2011) have consistently found an
association or positively influence the implementation of environmental
accounting for environmental performance. Environmental accounting
particularly useful for environmental management accounting management
because it can provide information about the physical inputs (materials, water,
energy) and outputs (products, waste, emissions) as well as monetary
information regarding all expenditures and savings relating to the environment
(UN DSD, 2001) , Such information can assist management in managing the

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environment because the management has enough information to control the
use of materials, water and energy, waste and emissions control, while
controlling the cost of the environment. Various decisions related to the
environment can be taken with any information enabling the improvement of
environmental performance.

The hospital is a public service institution that actually provide health services
to the public, but it can not be denied in its operations poses environmental
effects of the potentially interfere with the survival of future generations when
the resulting waste management problems are not handled properly.

Potential problems are most likely caused by hospital waste is the

environmental pollution that could interfere with the survival of the
environment. If it is integrated with the accounting, the question is what is the
cost incurred by the institution in order pengangan waste and how the
treatment of these costs. Are treated as elements that affect the cost of
services. If it affects the cost of services, then we want to examine in this work
are the items what is covered in the hospital management business dealing
with waste.

Potential problems are most likely caused by hospital waste is the

environmental pollution that could interfere with the survival of the
environment. If it is integrated with the accounting, the question is what is the
cost incurred by the institution in order pengangan waste and how the
treatment of these costs. Are treated as elements that affect the cost of
services. If it affects the cost of services, then we want to examine in this work
are the items what is covered in the hospital management business dealing
with waste.

Similarly, research Dian Imanina Burhany and Nurniah (2014) Environmental

Management Accounting As A Tool To Improve Environmental Performance
in Sustainable Development, this study highlights the importance of having an
understanding of management accounting environment, especially mining
companies that have a large contribution in generating waste impact on

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 environmental degradation , The results showed that the management is quite
understand the importance of environmental performance in sustainable
development, management accountants well-informed about environmental
management accounting and environmental management accounting system
effective for improving environmental performance.

This study highlights the handling of waste management in three hospitals in

the city of Makassar, the RS Wahidin Sudiro Husodo (RSWS), Ibn Sina
Hospital, RS Bhayangkara. The reason researchers took samples to three
hospitals is because they are a major hospital and hospital representative
enough as to the level of outpatient visits and hospitalizations were high that
the potential to produce enough medical waste harmful to the environment if
not handled properly.

The aim of this research was to see how far the environmental management
accounting spawned appropriate accounting model to capitalize on the value
lost as a result of the impact of hospital operations that pollute the
environment.

2.THEORICAL BASED

2.1 Stakeholder Theory

Freeman et, al. (2002) explains that the organization is not an entity that operates
for its own sake, but provide benefits to stakeholders. Stakeholders are defined as
"a group or individual who can memenagruhi or affected by the achievement of
organizational goals". This definition describes the existence of an organization
influenced by the support provided by the stakeholders of the organization, so that
organsisasi should map the stakeholders, identifies the main stakeholders and
secondary stakeholders, alignment between stakeholders and organizations, as
well as the effects (economic, technological, social, political and managerial ).

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 2.2. Sustainable Development
Sustainable development is development that meets the needs of the present
without compromising the ability to meet the needs of future generations.
World Commission on Environment and Development (WCED), quoted by
Burritt and Lehman (1995) defines sustainable development as "development
that meets the needs of the present without compromising the ability of future
generations to meet Reviews their own needs." The latest definition shows
three aspects contained in sustainable development is "development that does
not destroy or undermine the ecological, economic or social basis on the
which continued development depends" (Herath, 2005). Thus, it can be said
that the core of sustainable development is to meet the needs of the present
generation without compromising the needs of future generations, by
fulfilling three aspects: economic, social and environmental.
Sustainable development does not just concentrate on environmental issues.
Wider than the scope of sustainable development includes three policies:
economic development, social development and environmental protection.
The documents of the UN, especially the 2005 World Summit outcome
document mentions all three dimensions are interrelated and constitute the
driving pillars for sustainable development.

Figure 1. Scheme of sustainable development :

at the confluence of three preoccupations.

Sustainable development scheme: at the intersection of the three pillars, the

Universal Declaration of Cultural Diversity (UNESCO, 2001) further explore the
concept of sustainable development, by stating that "... cultural diversity is
important for humans as well as the importance of biodiversity for nature". Thus

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the "development not only understood as economic development, but also as a
means to achieve the satisfaction of intellectual, emotional, moral, and spiritual".
in this view, cultural diversity is the fourth policy of sustainable development
policy sphere.

Systematics sustainable development (PK) which consists of three construction

namely economic, social, and environmental (Cato, 2009 pp. 36-37; Adams,
2006); is inseparable from the economic activity that includes the production and
consumption of resources. The economic outlook is rooted in an analysis of the
effectiveness and efficiency requires the development of science and technology
innovation to improve the optimization of resource use. This led to the
preservation of the environmental systems that lead to an ecological balance and
sustainable development.
2.3. Green Economy VS Green Accounting

According to (UNEP; the United Nations Environment Programme) in a report

entitled Towards Green Economy mentioned, the Green Economy is an economy
that is able to improve the welfare and social justice. Green Economy wants to
eliminate the negative impact of economic growth on the environment and
scarcity of natural resources.

From the definition given UNEP Green Economy in the sense of a simple
sentence can be interpreted as a low-carbon economy (do not produce emissions
and environmental pollution), saving natural resources and social justice. In
addition, the green economy approach is meant to synergize the three basic
values: profit, people, and planet. This view calls for economic actors not only
maximize profit alone, but must also make a positive contribution to the
community and participate in protecting the environment. The concept of green
economy is expected to be a way out. Being a bridge between the growth of
development, social justice and environmental friendly and saving natural
resources.

The concept of green accounting is already started developing since the 1970s in
Europe, followed by starting the development of studies related to the issue of

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green accounting in the 1980s (Bebbington, 1997; Gray, et al., 1995). In the
developed countries such as those in Europe (Roussey, 1992), Japan (Djogo,
2006) will concern environmental issues is growing rapidly both in theory and
practice. This is evidenced by the many regulations related to this environment.
Cooper explained the terms of green accounting in his article as follows; The
introduction of "green accounting", however well thoughtout, will, under the
present system of accounting phallogocentric, do nothing to AVERT today's
environmental crisis. In fact, it could a make matters even worse (Cooper, 1992,
p. 36).

Another term associated with green environmental accounting is accounting as

defined by Mehenna and Vernon (2004), namely the provision of environmental
management information to assist management in deciding the price, control
overhead and reporting environmental information to the public. McHugh (2008)
explain this in terms of environmental performance Sustainability Accounting.
While Lindrianasari (2007) gives the term with the Environmental Accounting
Disclosure. In addition, green accounting is also linked to the Triple Bottom Line
Reporting. The last term is also known as the Social and Environmental Reporting
which in its financial reporting, the company reported operational activity of the
company's performance, environmental performance and social performance and
Ralph Milne (1999). Other terms may also be used for example
EnvironmentalAccounting, Social Responsibility Accounting, etc. Harahap
(2002).

2.4. Environmental Costs and Environmental Management Accounting

Hansen and Mowen (2007: 780) classify environmental costs by developing

quality environmental cost of quality model adopted cost model in total quality
management. With the approach of quality, environmental costs are grouped into
prevention costs, repair costs, internal failure costs and external failure costs.

Environmental management accounting provide important benefits for companies

include the provision of full information for decision making (Burritt et al., 2002).
Such information can reveal hidden opportunities, such as the process of better

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waste management, reduction of energy consumption and materials or
opportunities for recycling materials. From an environmental perspective, this
information can also be used in the development of more efficient processes that
lead to innovation. Adams (2002), found that companies that present
environmental information system can develop better internal controls and directs
the decision-making is better anyway.

IFAC (2005) divides the three uses and benefits the environment or environmental
management accounting management accounting / EMA. Firstly, compliance or
adherence, where beneficial EMA to support environmental protection through
compliance with environmental regulations and internal environmental policy
making. This can be done by planning and implementing investment to control
pollution, to replace toxic materials, and reporting waste and emissions produced
to the regulator. Second, eco-efficiency, in which the benefit is provided in the
form of simultaneous support for a reduction in costs and environmental impact
through the use of energy, water.

2.5. Environmental Management Cost Analysis

2.5.1 Environmental Accounting (Accounting Environment)

Environmental accounting is environmental costs that inclusion into the

accounting practices of companies or government agencies. Meanwhile, according
to the United States Environmental Protection Agency or the United States
Environment Protection Agency (US EPA), environmental accounting is a
function that describes the environmental costs that must be considered by the
company's stakeholders in identifying ways to reduce or avoid costs at the same
time with efforts to improve the environmental quality of Ronald Hilton (2008).

Therefore, environmental accounting has the same meaning as the environmental

cost accounting is as merger benefits and costs of environmental information into
the accounting practices of companies or governments to identify ways to reduce
or avoid the cost of repairs, Environmental Accounting specifically define and
incorporate all costs environment into the company's financial statements. When

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these costs are clearly identified, the company will tend to take advantage of
opportunities to reduce environmental impacts.

2.5.2.Environmental Quality Cost Model

I Wayan Suartana (2010) states in total environmental quality model, the ideal
situation is no damage to the environment. Damage is defined as direct
degradation of the environment, such as the emission of solid residue, liquid, or
gas into the environment (eg, water pollution and air pollution), or indirectly
degradation such as the use of raw materials and energy unnecessarily.

Sigar Tigor Benjamin Tambunan (2007) classifying environmental costs into four
categories:

1. Costs of Environmental Prevention (environmental prevention costs), are the

costs for the activities undertaken to prevent waste produced and / or waste that
can harm the environment.Example: Evaluation and selection of suppliers,
evaluation and selection tools for pollution control, process and product design to
reduce and eliminate waste, training of employees, the environmental impact
study, environmental risk audits, recycling products, obtaining ISO 14001.3

2. Cost of Environmental Detection (detection environmental costs), are the costs

for activities performed to determine that the product, process, and other activities
at the company have met the environmental standards applicable or not.
Example: Audit environmental activities, inspection of products and processes,
the development of environmental performance measures, the implementation of
pollution testing, verification of the environmental performance of suppliers, as
well as the measurement of the level of contamination.

3. Environmental Costs Internal Failure (failure of internal environmental costs),

are the costs of activities undertaken since it produces waste and trash, but not
discharged to the outside environment. Example: Operation of equipment to
reduce or eliminate pollution, treatment and disposal of toxic waste, pollution
equipment maintenance, licensing facilities to produce waste, and recycling the
remaining ingredients.

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4. The cost of failure of the External Environment (external environmental
failure), are the costs for activities undertaken as well as removing waste or waste
into the environment. This fee is divided into two external failure costs Realized
(Realized external failure costs) is experienced and costs paid by the company.
External failure costs were not realized (unrealized External failure costs) or
social costs caused by the company, but experienced and paid for by the parties
outside the company. Examples of failure costs eksernal realized are: cleaning the
polluted lake, oil spill cleanup, cleanup of contaminated groundwater, the use of
raw materials and energy inefficiently, settlement of personal injury claims work
practices are not environmentally friendly, etc. Examples of social costs are:
covers medical care because of the polluted air (individual welfare), loss of use of
the lake as a place of recreation for pollution (degradation), the loss of jobs due to
contamination (individual welfare), and the destruction of ecosystems due to the
disposal of solid waste (degradation).

3. RESEARCH METHODS

3.1 Research Design

This study used a descriptive approach verification conducted through interviews

relating to the management of the hospital waste treatment costs. This type of
research is descriptive verification that wish to see the extent of the environmental
management accounting spawned appropriate accounting model to capitalize on
the value lost as a result of the impact of hospital operations that pollute the
environment.

3.2 Variable Research

The research variables consisted of the independent variable environmental

management accounting and the dependent variable of sustainable development.
This variable testing conducted by interview to the hospital management relating
to environmental processing costs in this case hospital waste.

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3.3 Sample Research

The study was conducted at three hospitals in the city of Makassar namely,
Wahidin Sudiro Husodo RS, RS Bhayangkara, and Ibn Sina Hospital. Selection of
this hospital was purposively. The criteria are Wahidin Sudiro Husodo a
government hospital type A which became a reference in eastern Indonesia, RS
RS Bhayangkara is managed by the National Police and the final Ibn Sina
Hospital is a private hospital run by the Foundation endowment UMI. The third
hospital had a rate of outpatient visits and hospitalizations were high that also has
the potential to produce waste, whether it is medical waste, liquid waste and
household waste on a large scale that could potentially pollute the environment.

3.4 Data and Data Collection Techniques

The research data is primary and secondary data, collected through interviews and
review of the literature related to the topic of this research.

3.6 Data Analysis Methods

Data were analyzed by using qualitative descriptive analysis method such as a

description of how the treatment of the hospital management to waste
management costs. Perform cost analysis with the following steps:

a. Identify activities that are directly related to the environment and that are not
directly related to the environment.

b. How absorption costs of the identified activities

c. Identify how much it costs to mengkompesasi environmental damage caused by

waste generated.

4. RESULTS AND DISCUSSION

4.1. Hospital Waste Management Wahidin Sudiro Husodo (RS ~ WS)

The hospital was established in 1994 and is located within the campus of the
University of Hasanuddin (UNHAS) in Tamalanrea. The hospital is a teaching
hospital for the medical faculty of Hasanuddin University students and referral

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hospital in East Indonesia. Currently hospitals RS WS is a legal entity BLU
(Public Service Board) and the hospitals with international service standards.

Evidence of the seriousness of the hospital management to make RS as RS

international standards on international services by the deposit certificate sweet
fruit Joint Commission International or JCI as a sign that this hospital has
achieved international accreditation and desrahkan directly by the Minister of
Health Prof. Dr. dr. Nila Farid Moeloek, Sp.M (K) In his speech, the Minister of
Health congratulated the whole range of Hospital Dr. Wahidin Sudirohusodo, the
Supervisory Board and the Board of Directors and all employees / work for him
on the success achieved in reaching JCI accreditation.

In Indonesia there are six JCI accredited government hospitals, namely Hospital
Dr. Cipto Mangunkusumo, Sanglah Hospital in Denpasar, Jakarta Fatmawati
Hospital, Dr. Sardjito Hospital and Dr dr Wahidin Sudirohusodo Makassar, as
well as the Gatot Subroto Army Hospital in Jakarta. This certificate is a
recognition internasioanal standard of services provided by hospitals WS as the
Academic Medical Center Hospital.

Of course, all aspects of the service including maximizing environmental

management RS is always hygienic and uncontaminated by both the waste
generated medical waste, radioactive waste, liquid waste and other household
waste.

In preparing the financial statements, the hospital management WS standard based

on the financial statements abbreviated RS PABLU (Accounting Guideline Public
Service Board). From the interviews we did with the hospital management show
that the costs related to environmental costs, the financial statements of RS is not
allocated specifically as environmental costs. Costs directly related to hygiene,
environmental sanitation and cleaning service included as a cost, then the cost is
not directly related to environmental preservation entered as maintenance costs.
Entry in the burden of maintenance costs and costs related services directly
entered as general and administrative expenses. Uptake of the cost required for the

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maintenance and conservation of the waste associated with handling large even
this is not only 0.8-1% in 2014.

For the management of hospital waste is available a special tool that can be used
to handle various types of waste generated. The main tool which is owned
namely:
a. Incinerator; This tool is a waste crusher using high temperature combustion of
solid waste that fall into the category of hazardous and toxic waste (B3). Then the
ash produced from the combustion is handled by a third party in this case PT
Multazam which is a private company that transports waste.

b. Autoclub used for the sterilization of medical waste. This tool numbers quite a
lot, because it is used in every installation in the environment RSWS.

c. RBC tool is used to manage liquid waste.

d. As for household waste generated is handled by the Department of Health of

Makassar.

Uptake of the biggest costs for handling this waste comes only from the
procurement of equipment and maintenance costs are not great. Strategic steps
that have been carried out with regard to the handling of waste RS RS WS ie meet
international standards by completing all requirements relating to waste handling.
Then the handling of this waste has become a vision and mission in public health
services, as stated in the vision and mission of RS WS.

4.2. Waste Management RS Bhayangkara

RS Bhayangkara is owned hospitals Police and its management accountable to the

Police Headquarters. The hospital is located on the road Mappaodang Makassar.
From interviews with parties related to the handling of waste revealed that this
hospital for medical waste is not managed but delivered to the Forensic
Laboratory (Labfor) police. This Labfor burning / handling medical waste B3.
Then for household waste in cooperation with the Health Department of
Makassar. Actually, this hospital has an incinerator to burn waste mediknya, but
until now has not functioned because it has not dropped its operational license

15
from the Ministry of Environment (MOE). There are eligibility requirements are
met incinerator so that the permit can not be granted.

For the cost of environmental management almost say nil or very small and is
allocated only as cleaning fee. Moreover there is no longer the allocation of other
costs related to environmental preservation.

4.3. Ibn Sina Hospital Waste Management

Hospital "Ibn Sina" YW-UMI Makassar is hospital grade B, based on the standard
of service, equipment, space and power hospitals (Directorate General of Medical
Services Ministry of Health of the Republic of Indonesia, 1994).The hospital has
not had a medical waste incinerator, so the B3 waste generated in the ketigakan to
PT Multazam. Then the wastewater produced made manually drain behind the
hospital. Lastly, household waste generated is handled by the Department of
Health of Makassar. Costs incurred for the treatment of hospital waste are all
treated as operating expenses and no special allocation as the environmental
recovery costs. And operating costs even this is not distinguished as the cost of
cleanliness, so it makes just as operating costs so difficult to trace as
environmental costs. Uptake costs consumed for the treatment of hospital waste
was not big only around 0.2-1% per year.

4.6. DISCUSSION

These results indicate that the hospital has not had its own environmental costs.
All still joined as operating costs or general and administrative costs. Weakness is
very prominent with the accounting treatment like this is difficult to do the
identification of how much we cost absorption should in waste management. The
impact is hard to get management accurate information regarding the cost
absorption in the waste management chain. This of course will affect the
performance of the organization, there may be costs uptake inaccurate.

Some organizations can not achieve optimal performance because of irregularities

in the management of costs. Effect of inaccurate cost management will have an
impact on the cost of services to be distorted. If it happens something like this, it

16
will affect the amount to be paid by the people to get health care. Cases like this a
lot happening Indonesia, huge medical expenses to be incurred but not qualified
because many costs are not the right target. This happens because of the absence
of a clear cost analysis, so that the public may pay dearly for the price should be
cheap or otherwise pay cheap to expensive price. Of course this will affect the
performance of the organization in this regard suistanable organizations because
information about the company's profits are not representative.

Other weaknesses revealed during the interview is long and convoluted procedure
of permission to operate Incinerator. Until now already operate the RS WS has not
gone down despite the operational license from the Ministry of Environment. So
also the supervisor of the Environmental Agency and the City of the province are
not routinely checked on the implementation of EIA in hospital, or if there are
findings are not followed up. This needs attention and cooperation of all parties,
especially acting as the impact of environmental pollution will damage the quality
of the environment.

Other weaknesses revealed during the interview is long and convoluted procedure
of permission to operate and Incinerator. Until now already operate and the RS
WS has not gone down despite the operational license from the Ministry of
Environment. So Also the supervisor of the Environmental Agency and the City
of the province are not routinely checked on the implementation of EIA in
hospital, or if there are findings are not Followed up. This needs attention and
cooperation of all parties, especially acting as the impact of environmental
pollution will damage the quality of the environment.

6. SUGGESTIONS

The need for cooperation and intense communication of all parties associated with
the management of the hospital setting in this case the handling of medical wastes
that are hazardous to health and environment. Such as permit procedures could be
more simple then important also held dissemination to stakeholders about the
dangers of medical waste and penalties for miss it.

17
Then for the hospital management had time to do a proper cost analysis of the
target so there is no error in the decision-making relating to the determination of
the cost of services produced by RS. Surely this would have an impact on hospital
performance improvement because the costs were well controlled.

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