(Draft) Final Report Seminar

「Indonesia Medan Haji General Hospital
Expansion Project」 Feasibility Study (F/S)
Final Report Seminar
2023. 11. 17. (Fri)
Professor Eun Woo Nam

(Project Manager)
Contents
1. Project background and purpose

2. F/S results in each fields
2.1. Medical plan
2.2. Education & training plan
2.3. Hospital operation plan
2.4. Hospital construction plan
2.5. Medical equipment plan
2.6. Hospital Information System plan
3. Estimated Project Cost

Project background and purpose
1.1. Background and Purpose of the Project
1. Background of project
• Facing NCDs and the double-burden of infectious diseases

• The need to build a Class A general hospital based on sustainable
community connection
• The provision of medical services is absolutely insufficient compared to the
medical services needs
2. Purpose of project promotion
Expansion of general hospital functions in line with international

standards to play a central role in public medical services
in North Sumatra Province, Indonesia
4
1.2. Project Execution Area
 Location analysis of project site
 The project site is located approximately 4km east of the center of Medan city. In addition, it is located
approximately 800m east of the eastern border of Medan City, so it has good accessibility from both
Medan City and the Delhi Serdang area.
 Major hospitals near the project site include Columbia Asia Hospital and Martha Friska Hospital.
 Columbia Asia Hospital is a Class A hospital with 227 beds and 25 departments, and Martha Friska
Hospital is a Class B hospital with 346 beds and 13 departments.
Figure 1. Location Map of North Sumatra Province 5

1.3. Scope of the Project
Division Project information
EDCF Hospital Construction Newly constructed Tower B (outpatient building)
construction Medical equipment Medical equipment supplies
- Warranty Period: 2 years after receipt of the transition confirmation
HIS Establishment HIS (Free maintenance period: 3 years after completion of final inspection)
Education training Domestic invitation training, on-site training and online training for detailed specialists, nurses, hospital
administrators, and medical (biomedical) technicians
Operation / Maintenance Hospital operation simulation support
(O&M) support - Medical equipment: 2 years after opening (Supervision of medical equipment consultant)
- Construction: 2 years of defect repair
Consulting Medical consulting Establishing medical plans, consulting hospital operations,
service and support simulating hospital operations
Construction/ Design (including geological survey) and construction supervision
supervision Preparation of bidding documents and supporting the entire bidding process
Medical equipment Support for evaluation of bids, including preparation of medical equipment lists and specifications
Medical equipment inspection, installation and training monitoring
HIS Support project management and training for basic design and HIS deployment
(Common) Bidding document preparation and bid evaluation, contract support

Bidding support
Indonesia Site preparation Organization of obstacles (including underground obstacles discovered by geological survey), demolition of
existing buildings, land survey, etc.
Infrastructure supply Infrastructure (electricity, water, roads, etc.) and infrastructure supply, construction permits
Customs clearance, Customs duties, customs clearance of imported goods, various taxes, etc.
public charge and tax, etc.
Operation and Management Environmental and social impact assessment
Consultant, business operator selection and project implementation
Securing medical personnel, securing hospital operating costs, securing resources for management costs, etc.
1.4. Project Implementation Schedule
F/S results in each field(team)
- 2.1. Medical plan -
2.1. Medical plan (1/8)
 Analysis of medical service area
 The new Tower B hospital aims to undergo both qualitative and quantitative expansion in terms of
medical staff, services, infrastructure, and scale. The goal is to meet the standards of a Class A
general hospital in the future. As a tertiary general hospital in North Sumatra Province, it will operate by
accepting referrals for severe cases of patients from the region.
- Primary Service Area: Medan City and Deli Serdang District
- Potential Service Area: Entire North Sumatra Province, as well as neighboring countries such as
Malaysia, Singapore, and Thailand
9
Haji General Hospital Medan
10
 Specialized Healthcare Service Demands
Category Healthcare Services
- Cancer service
- Cardiovascular service
- Stroke service
Flagship Services Designated by the - Urology-Nephrology service

Ministry of Health - Maternal and child health service
- Gastroentero-Hepatology service
- Tuberculosis service
- Diabetes Mellitus service
Requested by Hospital Associates - Orthopedic/Sport injury
 Basic Directions for the New Hospital

• Tower B will establish the function of an outpatient ward, and will be up A Class in the
future and equipped with medical services, human resources, buildings/infrastructure,
and equipment appropriate for the Class, to perform its function and role as the Class
A provincial hospital in North Sumatra, Indonesia.
Existing Hospital Tower A Tower B Total
219 beds
174 beds 62 beds 455 beds
(Currently operational)
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 Considerations for Establishing Specialized Centers and Clinical Departments
Category Content
 Due to increasing non-communicable diseases and inadequate

Changes in the Healthcare
healthcare environments and conditions, there is a demand for
Environment and Conditions
hospitals capable of treating severe diseases.
Characteristics of the  There is an inadequacy in providing specialized medical services

Medical Service Area for severe disease due to the shortage of Class A hospitals.
 Stakeholders of Rumah Sakit Umum Medan Haji are requesting the establishmen
Will and Expertise of Healthcare
t of specialized centers specializing in severe medical treatments such as a Trau
Service Providers
ma Center.
Regulations from the MOH  The hospital has been designated as a healthcare institution
and North Sumatra Provincial providing Flagship services at the intermediate level (Utama level)
Government in North Sumatra's healthcare system.
 Recognize and respond to major natural disasters and climate change in the
Natural disaster and
project area, as well as patients or diseases resulting from them, and arrange
climate change
treatment departments in consideration of the medical services
12
 Additional requested from Haji General Hospital Medan (2023. Oct. 10.)
13
 Additional requested from Haji General Hospital Medan (2023. Oct. 10.)
Category Content
• NICU, PICU, and maternity ward are excluded from Tower B. However, outpatient services
for pediatrics and obstetrics will be maintained because Tower B is an outpatient ward.
Excluding NICU/
 Haji General Hospital Medan plans to construct a separate pediatric and obstetrics
ICU PICU
integrated medical service building (Tower D) using their own budget, where NICU/PICU
will be located.
CVCU • A minimum of 10 beds are requested.

Emergency Medical Center • Requested space dedicated for emergency deliveries and obstetric care only.
• A minimum of 10 beds are requested for CVCU.
Specialized Cardiac Services
• Secure 2 Catheterization Laboratories in Tower B.
• Install a central supply room suitable for the size of Tower B's surgical facilities.
Central Supply Room  The central supply room for the entire hospital, excluding Tower B, is planned in Tower
E (using the hospital's own budget).
Additional Inpatient Facility • Adding Inpatient Rooms through Space Planning Adjustments
Acquisition (e.g., for patients after heart surgery, stroke treatment, and HCU).
Operating Rooms • Additional operating rooms by adjusting the space planning.
14
 Composition of specialized center and medical department (1)
Center/Department Main Services and Roles
− Surgical services, systemic treatment services (e.g., chemotherapy, immu
- Oncology
Cancer center notherapy, hormonal therapy, targeted therapy, etc.), radiation
- Oncologic surgery
− therapy, etc. for cancer-related conditions.
Cardiovascular - Cardiology − No intervention services, cardiac catheterization services, open

center - Thoracic Surgery heart surgery services, etc
- Neurology
− Thrombolysis services, non-surgical vascular intervention services, surgic
Stroke center - Neurosurgery
al vascular interventions. etc.
- Pediatric Neurology
− Diagnosis and treatment of chronic kidney diseases.

− Adult and pediatric hemodialysis services.
Urology-
- Nephrology − Open reconstructive surgery for congenital anomalies of the kidney and ur
Nephrology
- Urology inary tract (CAKUT).
center
− Diagnostic services for functional urinary tract disorders.
− Kidney transplant candidates screening services and more.
Trauma center - Orthopedic surgery − Diagnosis, treatment, emergency care, preventive measures, etc.
− Health screening services for early disease detection, appropriate

Medical Checkup Center
treatment, etc.
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Center/Department Key services and roles
Emergency Center − Provision of emergency medical services.
− Diagnosis and treatment of conditions in geriatric medicine, rheumatology, gastroenterology,

Internal medicine
endocrinology, tropical medicine, and other internal medicine-related diseases.
General Surgery − Diagnosis and treatment of surgical conditions and diseases.
Pediatrics − Diagnosis and treatment of pediatric diseases by specialists.
Obstetrics and − Diagnosis and treatment of diseases of the female reproductive system, including high-risk preg
Gynecology nancies, fetal therapy, obstetrics, and gynecology.
Digestive surgery − Diagnosis and treatment of various diseases caused by the digestive system.
Ophthalmology − Outpatient-based ophthalmic procedures and surgical interventions.
Plastic and reconstruction − Plastic and reconstructive surgery and procedures for various conditions, including congenital de
surgery formities, trauma patients, cosmetic patients, and more.
16
Center/Department Key services and roles
Dermatology − Examination, diagnosis, and treatment of skin disorders.
Pulmonology − Diagnosis and treatment of various diseases caused by the respiratory system.
Dental − Dental treatments provided by various specialists, including orthodontics and dental preservation
− Diagnosis and treatment of various diseases in otology, rhinology, and head and neck surgery
Ear, Nose, Throat (ENT)
departments.
− Diagnosis and treatment through psychiatric consultations and examinations.

Psychiatry
− Provide collaborative care for patients under treatment in other departments.
Anesthesiology − Pain management (pain clinic) services.
− Lifestyle habit management, prevention and management of chronic diseases, post-treatment

Family Medicine
management of severe illnesses, lifelong health management, etc.
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- 2.2. Education & Training plan -
2.2. Education & Training plan (1/3)
 Overview of Education & training plan
 Sandwich Fellowship Model
• ‘Sandwich Fellowship’ refers to a process in which a “Fellow” from a developing country learns
medical technology or leadership by going back and forth between an educational institution in a
developed country and a medical institution in developing country for a certain period of time.
• This project seeks to maximize the development of the local medical system through training and
education by applying this educational model to both specialist training courses and nursing personnel
training courses.
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Figure 2. Sandwich Fellowship Model (Left circle – Developed country / Right circle – Developing country)
 Schedule for education & training program
 Education Plan intends to proceed from before the opening to after the opening.
* The schedule can be changed later in consultation with Medan Hajj General Hospital according to the education
subjects and their numbers.
• Invited training in countries other than Indonesia

− In the pre-opening stage, detailed specialists, middle-care nurses (responsible nurse level with 3
to 5 years of experience), hospital managers, and medical (medical) technicians will be
conducted.
• Indonesia Training Education

− Dispatch Korean experts according to the training curriculum in each field to conduct clinical
skills suitable for the local situation in Indonesia.
• Online Seminar
− The online seminar for detailed sub specialists and nursing personnel once a year from the
opening year to two years later will be conducted.
20
 Schedule for education & training program
2 years before 1 years before 1 year 2 years
Total no. Opening
Category Subject the opening the opening after the opening after the opening
of person
1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q
Detail Specialist
35 persons
(6 months x 1 times x 35 persons)
Middle-level Nurse Manager
(Category: Nurse Training) 100 persons
(2 weeks x 2 times x 50 persons)
Invitational
Hospital Manager
Training 14 persons
Medical (Biomedical) Technician

(40 days x 1 times x 3 persons 7 persons
40 days x 1 times x 4 persons)
Detail Specialist
24 persons
(30 days x 2 times x 12 persons)
Training
Nurse
in 30 persons
Indonesia
Medical (Biomedical) Technician
20 persons
(1 week x 4 times x 5 persons)
Detail Specialist
30 persons
(3 times x 10 persons)
Online
Nurse
60 persons
(3 times x 20 persons)
- 2.3. Hospital operation plan -
2.3. Hospital Operation plan (1/4)
 Organizational redesign of Medan Haji General Hospital
 When Medan Haji Hospital expands and opens as a Class A comprehensive hospital, The
organization of Medan Haji General Hospital Hospital was designed considering the following
matters.
 Calculation results of health care personnel
(compared to current and expansion)
Current Expand
(219 beds) (455 beds)
Hospital Director 1 1
Assistant Director 3 4
General Doctor 30 40
Dentist 8 8
Doctor
Specialist* 72 112
Total 110 160
Pharmacist 6 10
Pharmacist
Assistant 19 25
Hygienist 5 7
Physical Therapist 6 10
Nurse 260 455
Nursing
Aide 15 25
Midwife 8 10
Medical Technician 7 30
Gastrobiology 8 10
Nutritionist 19 25
anatomical pathology 18 30
Administrative 285 350
Total 770 1,152
 Decrease: Excluding rheumatology, infection, pediatric surgery, forensic medicine, gastroenterology, neoplasia, oncology, geriatrics, and pathology.
 Expand: Pediatric Neurology, Nephrology, Health Promotion Center
24
 Medan Haji General Hospital specialist calculation
category today expansion division today expansion
Total of specialists 72 112 Coracic Surgeon 1 3
Ophthalmologist 1 2 Forensic doctor 1 2
Orthopedic surgeon 3 4 Anatomic pathologist 4 5
Internal medicine 8 10 Endocrinologist 1 2
Pediatrics 9 10 Gastrointenologist 0
General surgeon 4 6 Nephologist 1 2
OBGY 4 5 Oncologist( chemotherapist ) 2
Cardiologist 7 7 Oncologi surgeon 1 5
Pulmonologist 4 5 Rheumatologist 1 2
ENT 3 3 geriatrics 1 2
Neurologist 2 3 Infectious disease 1 2
Dermatologist 4 4 Anesthesiologist 2 4
Psychiatrist 2 3 Rehabilitation medicine specialist 1 2
Urologist 1 2
Pediatric neurologist 2
Neuro Surgeon 2 4
Health Checkup Center specialist 3
Plastic Surgeon 1 2
Digestive surgery specialist 2
Pediatric Surgeon 1 2
 Hospital's Future Revenue Estimation (Year 10)
Categorized 2023 1st year 2nd year 3rd year 4th year 5th year 6th year 7th year 8th year 9th year 10th year
Outpatient 67,501 136,500 147,875 170,625 193,375 227,500 250,250 261,625 284,375 284,375 284,375
Number of patients Inpatient 39,272 107,675 116,070 124,465 125,925 129,210 132,860 134,320 136,145 137,605 140,890
Total 106,773 244,175 263,945 295,090 319,300 356,710 383,110 395,945 420,520 421,980 425,265
Outpatient 20.7 26.9 26.9 29.0 29.0 31.1 31.1 31.1 31.1 31.1 31.1
Averagedaily cost of
care per person
Inpatient 101.0 131.3 131.3 141.4 141.4 151.5 151.5 151.5 151.5 151.5 151.5
Outpatient 1,398,044 3,675,249 3,981,520 4,947,450 5,607,110 7,067,786 7,774,565 8,127,954 8,834,733 8,834,733 8,834,733
Inpatient 3,966,326 14,137,207 15,239,430 17,598,703 17,805,140 19,574,595 20,127,549 20,348,731 20,625,208 20,846,390 21,344,049
Diagnostics 73,991 73,991 73,991 73,991 73,991 73,991 73,991 73,991 73,991 73,991 73,991
Revenue and Testing
Etc 258,970 859,912 927,908 1,088,435 1,130,247 1,286,184 1,346,999 1,374,737 1,422,204 1,432,882 1,456,907
Total 5,697,331 18,746,359 20,222,849 23,708,580 24,616,488 28,002,556 29,323,104 29,925,413 30,956,137 31,187,996 31,709,680
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- 2.4. Architectural plan -
2.4. Architectural plan (1/13)
○ BUILDING SUMMARY
Building Category Description
Site Area 62,054 m2
Building Coverage
Building Area 2,045 m2 3.3% (Legal: 60%)
Ratio
Tower B Gross Area 19,700 m2 Floor Area Ratio 26.96% (Legal: No Limit)
No. of Floor 1st floor underground / 8th floor above ground (10 Floors)
Parking Area Required Area: 3,940 m2 (Legal: 20% or more of Gross Area)
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○ SPACE PROGRAM
F/S F/S
Category Department No. of Category Department No. of
Area (m2) Area (m2)
Beds Beds
Emergency Plastic and reconstruction Surgery 76
Emergency 965
Center Obstetrics and Gynecology 234
Trauma Center Orthopedics Surgery 164 ENT (Ear, Nose, and Throat) 105
Oncology, Oncologic Ophthalmology 123
Cancer Center 104 Outpatient
Surgery
Dental 125
Neurology, Neurosurgery,
Stroke Center 351 Anesthesiology 125
Pediatric Neurology
Cardiology, Thoracic Outpatient Injection, Pharmacy 161
Cardiac Center 234
Surgery Sub-total 3,723
Urology Radiology 396
Nephrology, Urology 105
-Nephrology center HCU (High Care Unit) 10 409
Outpatient Medical Check-up(MCU) Center 355 ICU (Intensive Care Unit) 12 283
General Surgery 117 Diagnostics & CVCU (Cardiovascular Care Unit) 10 212
Treatment Operation (Cardiac: 1, Large: 5, Standard: 4) 2,018
Internist 398
Cath Lab (2) 295
Digestive surgery 78
Lab (Diagnostic, Pathology, Stem cell) 819
Pediatric 351
Sub-total 4,432
Psychiatry 117 2 Beds Ward (14) 28 420
Pulmonary 156 SVIP Ward (2) 2 86
Ward
Family Medicine 78 N/S and Auxiliary Rooms, Waiting Area 280
Dermatology 166 Sub-total 786
Supply CSSD (Central Sterile Supply Department) 464
Hospital Staff, Conference Room, Locker Room,
Administration Room, Reception, Office, Director
Administration
Room, Semina Room, Storage, Study Room, Staff 1,019
& Education
Room, Complain Reception Room, Insurance
Consulting Room
Computer Room, Disaster Prevent Room, MDF,
Etc. Facilities 178
Prayer Room, Cafe
Utility Mechanical, Electrical, Generator Room, UPS,
1,110
Facilities Medical Gas Room, etc.
Net Area Total 12,677
Public Area Total 7,023
Grand Total 62 19,700
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 Status of Project Site (2023)
Tower A Tower B
TOWER A
현황 사진 키맵
① Front Road ② Entrance
Parking Area
③ Entryway to Tower B ④ Tower A
⑤ Boarder of Tower A and B ⑥ Obstacles in the Site

 Master Plan (2022)
TOWER
B
31
 Section Diagram
< Previous > < Revised >
GARDEN RF GARDEN
OPERATION 8F EDUCATION CSSD
OPERATION 7F WARD HCU
ICU CSSD 6F ICU OPERATION
ICU, CVCU, PICU, NICU 5F CATH LAB CVCU OPERATION
SVIP ROOM 4F LAB
OB/GYN 3F OUTPATIENT
LAB 2F OUTPATIENT
OUTPATIENT, PHARMACY 1F OUTPATIENT, PHARMACY
IGD RADIOLOGY GF IGD RADIOLOGY
B1F MECH, ELEC ROOM / WWTP
Outpatient Supply IGD Diagnostic &Treatment Operation

ICU Cath Lab Ward Staff & Education Support
 Ground Floor Plan (IGD / Radiology)
IGD ENT.
(AMBUL.)
IGD ENT.
OUTDOOR
RAMP
MAIN ENT.

33
 1st Floor Plan (Outpatient)

34
 2nd Floor Plan (Outpatient)

35
 3rd Floor Plan (Outpatient)

36
 4th Floor Plan (Laboratory, Medical Check-up)

37
 5th Floor Plan (Operation / CVCU / Cath Lab)

38
 6th Floor Plan (Operation)

39
 7th Floor Plan (Ward / HCU)

40
 8th Floor Plan (Education / CSSD)

41
- 2.5. Medical Equipment plan -
2.5. Medical Equipment plan (1/7)
 Planning for medical equipment by room
Sortation Medical equipment
Department of Internal Medicine, Surgery, Obstetrics and Gynecology, Pediatrics, Dentistry, Ophthalmology, D
ermatology, Urology, Psychiatry, Plastic and Reconstructive Medicine, etc
Outpatient department Otoscope, ophthalmoscope, digital sphygmomanometer, ECG, ENT Unit, Nebulizer, Audiometer, colposcope,
obstetric ultrasound diagnostic, 3D imaging system, Slit Lamp, ARK (automatic refractometer), A/B Scan, Fun
dus Camera, CO2 Laser, Fractional Laser and other accessories, etc
Cancer center CT (128 Slices), DR (digital X-ray), R&F, mammography, ultrasound diagnostics (general), and other accessor
(Diagnostic radiation) ies
Cardiac Examination ECG, Holter Monitoring System, Stress ECG, Tilt Table, defibrillator and other accessories, etc
Angiography, IABP (intra-aortic balloon pump), 3D Cardiac Mapping, Patient Monitor, defibrillator and other ac
Cath. Lab.
cessories, etc
Stroke center EEG , vascular screening, ultrasound, ECG and other accessories, etc
Urology - Nephrology Center Urodynamic system, bladder volume measurement system, other accessories, etc
Medical Check-up
Pulmonary fuction test, spirometer, inspirometer, stretcher cart and other accessories, etc
respiratory examination room
Medical Check-up
Gastroscopy, colonoscopy, bronchoscopy, and other accessories, etc
(Endoscopy room)
Medical Check-up
EMG, Audiometer, Tympanometer, OAE/ABRand other accessories;
(Functional Testing Laboratory)
43
 Planning for medical equipment by room
Sortation Medical equipment
Diagnostic Medical Laboratory Biochemical analyzer, hematology analyzer, electrolyte analyzer, immunoassay, blood culture, Tissue Processor
(with anatomical pathology) , Microtome, centrifuge, clean bench, and other accessories
Emergency room
Mobile X-Ray, Side Lamp, Portable Ultrasound Diagnostic, infrared Thermometer, Emergency Cart, Defibrillator,
(Resuscitation, emergency opera
Infusion Pumps and other accessories, etc
ting room, laboratory)
Emergency Obstetrics Room Delivery table, Colpovision, Fetal Monitor, anesthesia machine and other accessories, etc
Electro-hydraulic operating table, anesthesia machine, laparoscope, arthroscope, surgical microscope, Harmonic
Major Surgery
Scalpel and other accessories, etc
Hydraulic operating table, operating lamp, electrosurgical unit, hyper-hypthermia, phacoemulsification, orthopedi
Minor Surgery
c operating table, scrub station and other accessories, etc
Cardiac operating Theatre C-Arm X-ray, Hyper-Hypothermia and other accessories, etc
Patient Monitor, ventilator (for adults, infants, children), Infusion/Syringe Pump, defibrillator, suction pump, Oxyg
ICU
en Tent, Air Mattress, ECG, Central Monitoring System, Oxygen generator, other accessories, etc
Medicine packing machine, tablet crushing machine, precision scales, safety medicine cabinet, vaccine storage r
Pharmacy (ICU, O.R., In-Out)
efrigerators and other accessories, etc
Central Supply Room Steam sterilizer, ultrasonic cleaner, plasma sterilizer and other accessories, etc
Morgue Mortuary refrigerators, lifts, autopsy table and other accessories, etc
Others Bed Head Unit, Flowmeter, Wall Suction, , RFID and other accessories, etc
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 Medical equipment project cost for each room
No. Sortation Cost (US$) Ratio
1 Outpatient 1,830,000 9.15%
2 Special Center 6,270,000 31.35%
3 Medical Check-up Center 1,080,000 5.40%
4 Laboratory Medicine 1,550,000 7.75%
5 Emergency Medicine Center 1,050,000 5.25%
6 Operating Theatre 4,520,000 22.60%
7 ICU 2,330,000 11.65%
8 Supports 510,000 2.55%
9 Others 860,000 4.30%
Sum (US$) 20,000,000 100.00%
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 Budget for Medical Equipment
No. Department Amount No. Department Amount
I. OUTPATIENT 1,830,000 IV. LABORATORY MEDICINE 1,550,000
1 Internal Medicine 40,000 1 Diagnostic Laboratory 1,160,000
2 Pediatric 225,000 2 Anatomical Pathology Lab. 290,000
3 Adult Neurology 20,000 3 Blood Collection 100,000
4 General Surgery 20,000 V. EMERGENCY MEDICINE CENTER 1,050,000
5 Orthopedic Surgery 20,000 1 Emergency Medicine, Triage 50,000
6 Thoracic Surgery 10,000 Observation, Burn Treatment, Pediatric, Gastro Lavage
2 440,000
7 Neuro Surgery 10,000 & Others
8 Urology 10,000 3 Resuscitation Room 75,000

9 Dermatology 160,000 4 Emergency Operating Room 130,000
10 Ophthalmology 400,000 5 Emergency Neonatal Obstetric Service Room 115,000
11 Ear, Nose, Throat (ENT) 140,000 6 Emergency Radiology & Laboratory 200,000
12 Psychology 10,000 7 Emergency Pharmacy 40,000
13 Anesthesiology, Pain Clinic 10,000 VI. OPERATING THEATRE 4,520,000
14 Dentistry 460,000 1 Operating Theatre Unit, Major Surgery 2,750,000
15 Ob/Gy 230,000 2 Operating Theatre Unit, Minor Surgery 920,000
16 Pulmonology 10,000 3 Cardiac Operating Theatre 420,000
17 Oncology Surgery 15,000 4 Preparation for Operating Theatre 130,000
18 Plastic & Reconstruction Surgery 10,000 5 Recovery for Operating Theatre 260,000
19 Cardiology 10,000 6 Pharmacy for Operating Theatre & ICU 40,000
20 Kids Surgery 10,000 VII. ICU 2,330,000
21 Digestive Surgery 10,000 1 ICU & HCU (22 Beds) 1,520,000
II. SPECIAL CENTER 6,270,000 2 CVCU (10 Beds) 810,000
1 Cancer Center / Diagnostic Radiology 2,150,000 VIII. SUPPORTS 510,000
2 Cardiovascular Center / Cardiac Examination 350,000 1 Pharmacy for Out/In-Patient 110,000
3 Cath. Lab. 3,300,000 2 CSSD 400,000
4 Stroke Center 210,000 IX. OTHERS 860,000
5 Urology-Nephrology Center 260,000 1 Morgue 120,000
III. MEDICAL CHECK-UP CENTER 1,080,000 2 Laundry 260,000
1 Respiratory Examination 150,000 3 Medical Gas Equipment 150,000
2 Endoscope 750,000 4 Others 330,000
3 Functional Test 180,000 GRAND TOTAL (US$) 20,000,000
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 Overseas ( Korea ) dispatch training
- Even if a problem occurs with medical equipment, we provide practical training on systematic management
methods, such as equipment inspection methods and troubleshooting training, so that users and medical
technicians can respond appropriately, ensuring long-term problem-free use.
- We plan to train a total of 7 medical technicians at Medan Haji Hospital on maintenance and repair of medical
equipment for 40 days in two sessions of 3 and 4 each.
- In the case of Korean-made medical equipment, we work with manufacturers/suppliers to increase overall
understanding of the product from the production process, provide training on quality control methods before
shipment and repair work in case of failure, and provide Korean medical equipment that uses the same or
similar equipment. It is designed to enable people to acquire skills in operating equipment through direct
practical training and how to use it at hospitals, and to increase the effectiveness of the training.
 Domestic (Indonesia) training
- Korean medical equipment experts (two engineers each in the electronic and mechanical fields) are
dispatched twice a year to inspect the medical equipment of the newly built Indonesian
hospital for 15 days each time, and provide management methods for medical equipment provided from
overseas (Korea). and retraining on shortcomings on simple troubleshooting methods.
- Consider selecting specific medical equipment that requires additional training and dispatching experts for
that equipment to provide intensive training.
Education 1st education 1st education 2nd education 2nd education
15 days 15 days
electronic medical e
quipment
Equipment operation training and troubleshooting
15 days 15 days
mechanical equipm
ent
Equipment operation training and troubleshooting
 Operating & Maintenance (O&M)
- Medical equipment suppliers must dispatch professional engineers to Indonesia at planned intervals to
check the hospital's medical equipment management , operation and maintenance status, and if
necessary, provide after-sales service for the equipment and operate within the planned period (2 years).
and education and training for maintenance must be provided .
- Medical equipment experts (one each in the electronics and mechanical fields) were dispatched to
Indonesia twice a year (7 days each time) for two years after the hospital opened to provide training
and inspection on operation and management of the equipment.
- In the case of equipment that is difficult to maintain smoothly even with education and training by a
hospital's Electro-medical Technician among the supplied equipment, the equipment supplier will
designate a competent local medical equipment maintenance organization (or company) to perform its
own maintenance locally. This leads to maintenance being possible.
Time D+1 year D+2 year
1st half 2nd half 1st half 2nd half
machine 7 days 7 days 7 days 7 days
former 7 days 7 days 7 days 7 days
Equipment operation and maintenance refre

Support Re-check equipment status and training
sher training
- 2.6. Hospital Information System plan -
2.5. Hospital Information System plan (1/4)
 Medan Haji General Hospital HIS construction outline and design procedure
To implement a hospital information system to support the best hospital in the Medan region as a class A hospital and to
build a system that can create the basis for QI (Quality Improvement) and QPS (Quality Patient Safety) indicator models for
future JCI certification, and hospital management. It is necessary to implement a dashboard for various statistical support
and monitoring and a bridging system to support public/private insurance linkage.
 As an intelligent system for implementing Medan Haji Hospital's integrated HIS , it has business support
To-Be HIS
model definition
functions tailored to the user level and aims to implement an integrated hospital information system
equipped with optimization functions for easy access from the user's perspective .
Design  Currently in use ( AVIAT, Indonesia ) product ) by phosphorus unit The design should be designed to
Requirements minimize the impact of user changes using the operating system as a reference model .
 Medan Haji HIS emphasizes interoperability and complies with international standards (HL7, ICD 10, ICD
Design method 9CM, DICOM ) is applied to present a design methodology that can configure applications, functions , data ,
and technology architecture that can support JCI certification in the future.
HIS aligned Package

current work
with the Implementation
Process review Medan Haji
goals of Apply
Define how General
Medan target system methodology
Design to build a Hospital
Haji process design
procedure target system summer To-Be HIS
General target system solstice optimal model
Hospital data design Hospital GAP development
model Analysis
definition
51
 Medan Haji General Hospital To-Be project structure diagram
- Medan Haji General Hospital HIS integrated goal diagram examines the Indonesian medical environment and includes
Patient Management, Electric Medical Record, Nursing; Control Pannel, Accounting, LIS, RIS, Medical Support, Pharmacy,
ERP, PLUGS In ( Insurance connection, LIS/RIS connection, Bed Queue link ), etc. Optimize with model and Global Standard
(HL7 FHIR, ICD 10, 1CD 9CM, DICOM) was applied.
52
 Medan Haji Hospital To-Be hardware configuration diagram
53
 Medan Haji Hospital To-Be PACS configuration diagram
- Secure DB stability with PACS DB clustering configuration and secure data storage stability with main storage and backup
- DICOM image acquisition through organic connection with medical equipment (X-ray, MRI, CT, ETC) provides
- To revitalize heart disease specialization Provides
54
Estimated Project Cost
3.1. Estimation of Total Cost
EDCF
Classification Foreign Indonesia Total (USD)
Local Sum
Korea 3rd Sub
1. Direct Project Cost 26,784,976 10,699,670 37,484,646 20,710,470 58,195,116 5,754,500 63,949,616
1) Building Construction 6,311,676 4,446,770 10,758,446 18,909,273 29,667,719 0 29,667,719
2) Medical Equipment 7,992,600 6,252,900 14,245,500 0 14,245,500 5,754,500 20,000,000
3) HIS 4,957,728 4,957,728 339,080 5,296,808 5,296,808
4) Consulting Service 7,522,972 0 7,522,972 1,462,117 8,985,090 0 8,985,090
a) Medical Planning Consulting 383,856 0 383,856 120,148 504,004 0 504,004

b) Hospital Operating Consulting 448,437 0 448,437 67,580 516,017 0 516,017
c) HIS Consulting 803,192 0 803,192 0 803,192 0 803,192
d) Design 1,239,080 0 1,239,080 236,349 1,475,429 0 1,475,429

e) CM 850,617 0 850,617 600,194 1,450,811 0 1,450,811
f) Medical Training & Edu 3,304,675 0 3,304,675 272,961 3,577,636 0 3,577,636

g) Medical Equipment Consulting 493,115 0 493,115 164,885 658,000 0 658,000
2. Tax & Utility 0 0 0 0 0 6,401,463 6,401,463
3. Contingency costs 3,250,808 2,235,161 5,485,969 2,964,906 8,450,876 0 8,450,876

1) Physical Contingency 1,361,880 534,984 1,896,864 1,028,053 2,924,917 0 2,924,917
2) Price Contingency 1,888,928 1,700,178 3,589,106 1,936,853 5,525,958 0 5,525,958

4. Loan Charge 66,646 66,646 66,646 0 66,646
Total 30,102,430 12,934,832 43,037,262 23,675,376 66,712,638 12,155,963 78,868,601

Ratio to EDCF Costs 45.12% 19.39% 64.51% 35.49% 100.00%
Ratio to Total Costs 38.17% 16.40% 54.57% 30.02% 84.59% 15.41% 100.00%
* The cost table is under review of KEXIM and this can be changed and updated. 56
3.2. Financial Feasibility Analysis
 Overview and Assumptions

– This analysis is performed by business entities to estimate actual monetary
costs and revenues and assess the economic value of this project
– The Discounted Cash Flow (DCF), the Financial Internal Rate of Return (F-
IRR), and Financial Net Present Value (F-NPV) will be used to perform
financial feasibility analysis
 To estimate the cost flow for each category, certain assumptions were utilized for annual cost
projections
– Building Construction, Medical Equipment, Consulting Service (Medical Plan Consulting,
Hospital Operation Consulting, HIS consulting Design, CM, Medical Education and Training,
Medical Equipment Consulting), HIS, Operation Cost
 Cost Flow Analysis

– The flow of nominal value costs and present value costs incurred from the beginning of this
project until 2057 is as follows:
– The total nominal cost is $1,751,864,424, and the total present value cost is $391,526,425
 To estimate medical revenue and costs, the expanded hospital based on the current hospital's
revenue and expenditure were used
– The bed occupancy rate for the first year was estimated at 74.5% (from January to June at Haji
General Hospital Medan)
– Indonesian Ministry of Health specifies an ideal hospital bed occupancy rate range of 60-85%
– The average number of days of stay from 2015 to 2019 would remain at 5 days
 Medical Revenue and Expenditure is as follows:

Category 1st Year 2nd Year 3rd Year 4th Year 5th Year 6th Year 7th Year 8th Year 9th Year 10th Year
Inpatient 3,675,249 3,981,520 4,947,450 5,607,110 7,067,786 7,774,565 8,127,954 8,834,733 8,834,733 8,834,733
Outpatient 14,137,207 15,239,430 17,598,703 17,805,140 19,574,595 20,127,549 20,348,731 20,625,208 20,846,390 21,344,049
Diagnosis and Examination 73,991 73,991 73,991 73,991 73,991 73,991 73,991 73,991 73,991 73,991
Revenue Other 859,912 927,908 1,088,435 1,130,247 1,286,184 1,346,999 1,374,737 1,422,204 1,432,882 1,456,907
Government Grant (Addition
9,967,204 9,541,483 8,762,422 10,570,908 9,911,220 9,684,740 10,208,150 10,335,716 11,295,659 12,000,265
al Budget)
Sub total 28,713,563 29,764,332 32,471,002 35,187,396 37,913,776 39,007,844 40,133,563 41,291,852 42,483,656 43,709,945
Labor costs 15,725,592 16,425,685 18,772,212 21,118,738 23,465,265 24,169,223 24,894,300 25,641,129 26,410,362 27,202,673
Material costs 2,413,249 2,478,407 2,545,324 2,614,047 2,684,627 2,757,112 2,831,554 2,908,005 2,986,522 3,067,158
Management costs 1,732,246 1,779,017 1,827,050 1,876,380 1,927,043 1,979,073 2,032,508 2,087,385 2,143,745 2,201,626
Expenditure Purchasing medical equipme
nt and maintanance of comp 8,362,873 8,588,671 8,820,565 9,058,720 9,303,306 9,554,495 9,812,466 10,077,403 10,349,493 10,628,929
uting system
Other 479,603 492,552 505,851 519,509 533,536 547,942 562,736 577,930 593,534 609,559
Sub total 28,713,563 29,764,332 32,471,002 35,187,396 37,913,776 39,007,844 40,133,563 41,291,852 42,483,656 43,709,945
 Indonesia's average inflation rate of 2.57% during the period from 2020 to 2022 was used to project
the annual medical revenue for the 2028 to 2057 years after the opening
 To estimate medical revenue and costs, the expanded hospital based on the current hospital's
revenue and expenditure were used
– The bed occupancy rate for the first year was estimated at 74.5% (from January to June at Haji
General Hospital Medan)
– Indonesian Ministry of Health specifies an ideal hospital bed occupancy rate range of 60-85%
– The average number of days of stay from 2015 to 2019 would remain at 5 days
 Medical Revenue and Expenditure is as follows:

Category 1st Year 2nd Year 3rd Year 4th Year 5th Year 6th Year 7th Year 8th Year 9th Year 10th Year
Inpatient 3,675,249 3,981,520 4,947,450 5,607,110 7,067,786 7,774,565 8,127,954 8,834,733 8,834,733 8,834,733
Outpatient 14,137,207 15,239,430 17,598,703 17,805,140 19,574,595 20,127,549 20,348,731 20,625,208 20,846,390 21,344,049
Diagnosis and Examination 73,991 73,991 73,991 73,991 73,991 73,991 73,991 73,991 73,991 73,991
Revenue Other 859,912 927,908 1,088,435 1,130,247 1,286,184 1,346,999 1,374,737 1,422,204 1,432,882 1,456,907
Government Grant (Addition
9,967,204 9,541,483 8,762,422 10,570,908 9,911,220 9,684,740 10,208,150 10,335,716 11,295,659 12,000,265
al Budget)
Sub total 28,713,563 29,764,332 32,471,002 35,187,396 37,913,776 39,007,844 40,133,563 41,291,852 42,483,656 43,709,945
Labor costs 15,725,592 16,425,685 18,772,212 21,118,738 23,465,265 24,169,223 24,894,300 25,641,129 26,410,362 27,202,673
Material costs 2,413,249 2,478,407 2,545,324 2,614,047 2,684,627 2,757,112 2,831,554 2,908,005 2,986,522 3,067,158
Management costs 1,732,246 1,779,017 1,827,050 1,876,380 1,927,043 1,979,073 2,032,508 2,087,385 2,143,745 2,201,626
Expenditure Purchasing medical equipme
nt and maintanance of comp 8,362,873 8,588,671 8,820,565 9,058,720 9,303,306 9,554,495 9,812,466 10,077,403 10,349,493 10,628,929
uting system
Other 479,603 492,552 505,851 519,509 533,536 547,942 562,736 577,930 593,534 609,559
Sub total 28,713,563 29,764,332 32,471,002 35,187,396 37,913,776 39,007,844 40,133,563 41,291,852 42,483,656 43,709,945
 Indonesia's average inflation rate of 2.57% during the period from 2020 to 2022 was used to project
the annual medical revenue for the 2028 to 2057 years after the opening
 Financial Feasibility Analysis Results
Category Total Revenue (R) Total Cost (C) FNPV FIRR R/C Ratio
Evaluation Criteria - - Positive value (+) greater than 9% greater than 1.0
Project 305,504,919 345,077,523 -85,507,995 - 0.89
– These results indicated that the project is financially not feasible
– However, this does not mean the project lacks economic feasible. It has low profitability,
suggesting the need for its implementation with government involvement
– These results indicate the need for government intervention to implement it as a public project
due to the lack of or low revenue
 Overview and Assumptions
– This analysis will be reviewed, taking into account demand forecasting, as well as the scale,
scope, and duration of the project
– Comparing and analyzing the benefits and costs of public projects from a societal perspective by
considering the costs (inputs) and outcomes (outputs) of available alternatives simultaneously
– To estimate benefits and costs are converted into economic prices, the social discount rate is
applied
→ To calculate and analyze the Economic Internal Rate of Return (E-IRR), Economic Net Present
Value (E-NPV), and the Economic Benefit/Cost Ratio (E-B/CR)
Category Content
Social discount rate 9%
Project implemented period 78 months (Construction 24 months)
Analysis period 2024~2057 years

 The results of contributing to the local economy through the establishment of medical institutions
 Benefits from reducing premature deaths
 Shortening treatment times and hospitalization periods
Benefit items
 Benefits from reducing domestic transportation costs
 Benefits from reducing overseas transportation costs
 Benefits from preventing outflow of overseas patients
Cost items Project cost, Operational cost (Labor cost, Material cost, Management Cost, Other)
Evaluation indicator B/C Ratio, NPV, IRR

 The basic assumptions of the economic feasibility study for this project are as follows.
– The project is estimated to have a consultant selection and design period in 2024, with
construction periods from 2025 to 2026
– After completion in 2027, a simulation will be carried out for two months
– It is assumed that the hospital will open in 2028, so it is estimated that benefits will be available
starting from that year
– Subsequently, maintenance and management will be conducted for 36 months.
– In consideration of the EDCF feasibility study guidelines, the tax, contingency and etc. were
excluded from the analysis
 Benefit Estimation Period

– Estimated period is set to 30 years, assuming the period from 2028 to 2057 after construction
for 30 years, referencing the research of the Korea Development Institute's standard guidelines
 Social Discount Rate

– A social discount rate of 9% per year is applied
 The benefits of this project were estimated focusing on benefits that can be converted into monetary
terms
 The benefits considered are as shown in the table below

Category Methods References
Benefits of contributing to the

Consumption expenditure benefits within the community are estimated by c 2015 Kenya Advanced Institute
Contribution effect local economy through the onsidering the number of additional personnel scheduled to be hired, the wa
of Science & Technology
to local economy establishment of medical ges of Indonesian doctors, nurses, and biomedical technicians, and the house
hold net savings rate Feasibility Study Report
institutions
Effects of Health Benefits of reducing early Using Indonesia's average annual expected income, we estimate the social va
lue produced by the economically active population among those who are ac
improvement death Income loss tually economically active.
Shorten treatment time and Calculated using the average treatment time and hospitalization period for o
hospital stay utpatients and inpatients, using daily and hourly wages
Economic feasibility analysis
guidelines for KOICA project
Benefits of reducing domestic Calculate the benefits of reducing domestic transportation costs using Indone
Time/transportation
transportation costs sian hourly wages, travel time, and expected number of visitors.
cost savings
Benefits of reducing overseas Calculate the benefit of reducing overseas transportation costs is calculated b
y considering the number of annual overseas medical tourists, travel time, ho
transportation costs urly wage, and average flight time.
Benefits from preventing Calculate the benefit of reducing overseas medical expenses by using the ann Cost-benefit analysis of ODA
Reducing medical costs ual number of overseas medical tourists, travel time, and average medical ex
outflow of overseas patients penses in Indonesia and abroad. projects (KIEP, 2012)
 Economic Feasibility Analysis Results
Category Total Benefit (B) Total Cost (C) NPV IRR B/C Ratio
Evaluation Criteria - - Positive value (+) greater than 9% greater than 1.0
Project 505,432,112 391,526,425 1,599,928 28.23% 1.29
– These results indicated this project is judged to be competitive in terms of economic feasibility
– The present value of annual flow for costs and benefits is as follow
 The availability of cost and other data for economic feasibility assessment is constrained due
to limitations in data sources, estimated data based on specific assumptions can be used
 Since the estimates generated during the process of deriving benefits and costs can lead to
variations in economic assessment results due to errors
→ It is necessary to review changes in results depending on changes in benefits and

discount rates
 Sensitivity analysis was conducted for construction costs and benefits, with variations of
±10%, and discount rates with variations of ±3%
 The sensitivity analysis results for changes in construction costs are as follows
Baseline
Category Cost Decrease by 10% Cost Increase by 10%
Total Costs (Present Value)
NPV 1,439,935 1,013,861 1,439,935
Benefit Decrease by 10%
B/C ratio 1.29 1.15 1.06
NPV 2,026,002 1,599,928 1,173,854
Baseline
B/C ratio 1.45 1.29 1.19
NPV 2,612,070 2,185,995 1,759,921
Benefit Increase by 10%
B/C ratio 1.58 1.40 1.29
 The sensitivity analysis results for changes in the discount rate are as follows
Category 6% 9% (Baseline) 12%
NPV 3,412,914 1,599,928 431,768

Baseline
B/C ratio 1.34 1.29 1.26
Conclusion
 The number of beds increases to 455 beds.
Existing Hospital Tower A Tower B Total
219 beds
174 beds 62 beds 455 beds
(Currently operational)
 Medan Haji general hospital will be to perform its function and role as the Class A
provincial hospital in North Sumatra, Indonesia.
 WHO Health Promoting Hospital certified(Indonesian HPH Network).
 Total cost : 78,901,956 USD (EDCF : 66,712,638 USD, Indonesia : 12,189,318 USD)
EDCF
Classification Foreign Indonesia Total (USD)

Local Sum
Korea 3rd Sub
Total 30,555,060 12,831,045 43,386,105 23,326,534 66,712,638 12,189,318 78,901,956
Ratio to EDCF Costs 45.80% 19.23% 65.03% 34.97% 100.00%
Ratio to Total Costs 38.73% 16.26% 54.99% 29.56% 84.55% 15.45% 100.00%
 B/C Ratio : 1.34
 In conclusion, 「Indonesia Medan Haji General Hospital Expansion Project」 is presumed

economically feasible project.
Thank you
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「Indonesia Medan Haji General Hospital

Expansion Project」 Feasibility Study (F/S)

Final Report Seminar

2023. 11. 17. (Fri)

Professor Eun Woo Nam

1. Project background and purpose

3. Estimated Project Cost

• Facing NCDs and the double-burden of infectious diseases

2. Purpose of project promotion

Expansion of general hospital functions in line with international

Figure 1. Location Map of North Sumatra Province 5

(Common) Bidding document preparation and bid evaluation, contract support

Haji General Hospital Medan

Flagship Services Designated by the - Urology-Nephrology service

 Basic Directions for the New Hospital

Existing Hospital Tower A Tower B Total

 Considerations for Establishing Specialized Centers and Clinical Departments

 Due to increasing non-communicable diseases and inadequate

Characteristics of the  There is an inadequacy in providing specialized medical services

CVCU • A minimum of 10 beds are requested.

Operating Rooms • Additional operating rooms by adjusting the space planning.

Cardiovascular - Cardiology − No intervention services, cardiac catheterization services, open

− Diagnosis and treatment of chronic kidney diseases.

− Health screening services for early disease detection, appropriate

Emergency Center − Provision of emergency medical services.

− Diagnosis and treatment of conditions in geriatric medicine, rheumatology, gastroenterology,

General Surgery − Diagnosis and treatment of surgical conditions and diseases.

Pediatrics − Diagnosis and treatment of pediatric diseases by specialists.

Ophthalmology − Outpatient-based ophthalmic procedures and surgical interventions.

Dermatology − Examination, diagnosis, and treatment of skin disorders.

− Diagnosis and treatment through psychiatric consultations and examinations.

Anesthesiology − Pain management (pain clinic) services.

− Lifestyle habit management, prevention and management of chronic diseases, post-treatment

• Invited training in countries other than Indonesia

• Indonesia Training Education

Medical (Biomedical) Technician

Total of specialists 72 112 Coracic Surgeon 1 3

Ophthalmologist 1 2 Forensic doctor 1 2

Orthopedic surgeon 3 4 Anatomic pathologist 4 5

Internal medicine 8 10 Endocrinologist 1 2

General surgeon 4 6 Nephologist 1 2

OBGY 4 5 Oncologist( chemotherapist ) 2

Cardiologist 7 7 Oncologi surgeon 1 5

Neurologist 2 3 Infectious disease 1 2

Psychiatrist 2 3 Rehabilitation medicine specialist 1 2

Building Category Description

Site Area 62,054 m2

① Front Road ② Entrance

③ Entryway to Tower B ④ Tower A

⑤ Boarder of Tower A and B ⑥ Obstacles in the Site

OPERATION 8F EDUCATION CSSD

OPERATION 7F WARD HCU

ICU CSSD 6F ICU OPERATION

ICU, CVCU, PICU, NICU 5F CATH LAB CVCU OPERATION

SVIP ROOM 4F LAB

OUTPATIENT, PHARMACY 1F OUTPATIENT, PHARMACY

IGD RADIOLOGY GF IGD RADIOLOGY