Regional adaptation of the federal model of reimbursement for medical assistance based on clinical statistical groups: hospitalization of patients in need of genetically enginered biological preparations

Sura, M. V.; Ignatova, T. N.; Руднева, Н. С.; Sukhanova, Yu. N.; Ulyanova, N. G.; Khudyaev, A. S.; Shelyakin, Valery A.; Scherbakov, D. V.

doi:10.17749/2070-4909.2018.11.2.044-052

Cited by 4 publications

(2 citation statements)

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“…С мая 2018 г. номенклатуру предполагается использовать в создании единой государственной информационной системы в сфере здравоохранения в части формировании баз данных обезличенной информации по отдельным нозологиям и профилям оказания медицинской помощи 5 . Кроме того, с учетом положений номенклатуры реализуется право на получение социального налогового вычета налогоплательщиками в части расходов на услуги по лечению в медицинских организациях Российской Федерации, имеющих лицензии на осуществление медицинской деятельности, выданные в соответствии с законодательством Российской Федерации 6,7 , осуществляется реклама ме- 1 Федеральный закон от 21.11.2011 г. № 323-ФЗ (ред.…”

Section: Introductionunclassified

“…Кроме того, к номенклатуре предъявляются новые требования в связи с расширением сферы ее применения. Так, с 2013 г. номенклатура стала основой кодирования медицинских услуг при отнесении случаев стационарного лечения к клинико-статистическим группам [4], что, с одной стороны, значительно увеличило ее востребованность в субъ- 8 ектах Российской Федерации, а с другой -выявило отсутствие в ней ряда широко применяющихся услуг и неоднозначное восприятие терминологии [5,6,7].…”

Section: Introductionunclassified

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The Principles of International Classification of Health Interventions of World Health Organization

Tyurina

2018

Medical Technologies. Assessment and Choice (Медицинские Технологии. Оценка И Выбор)

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The application of the nomenclature of medical services in the Russian Federation revealed limitations of its structure and content. The analysis of international experience in the classification of medical interventions can help to improve this nomenclature. World Health Organization has prepared a draft of the International Classification of Health Interventions (ICHI), which should be a part of a family of health-related international classifications. It is not yet finished and cannot be used for the classification of medical services on a national level; however, its main principles have already been formulated. All interventions are classified according to three levels (axes): target of intervention; action (the essence of intervention), and means. Lists of types of targets, actions and means have been developed, and recommendations on the classification and coding of medical interventions have been proposed for various situations. There are significant differences in the approach to the classification of medical interventions between ICHI and the Russian nomenclature of medical services. A detailed comparative analysis of the classification principles in ICHI and in the nomenclature is needed.

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Section: Introductionunclassified

The Principles of International Classification of Health Interventions of World Health Organization

Tyurina

2018

Medical Technologies. Assessment and Choice (Медицинские Технологии. Оценка И Выбор)

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Optimization of payment for therapy with genetically engineered biological drugs and selective immunosuppressants at the expense of compulsory medical insurance fund in a day hospital at the regional level

Sura¹,

Boyarskaya²,

Derkach³

2021

Med. Tech. Asses. and Choice

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Medical care payment improvement within diagnosis-related groups of patients with severe asthma requiring biologic disease-modifying drugs by regional adaptation mechanism in the Moscow Region

et al. 2021

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Objective: scientific rationale of changing approaches to medical care payment for hospitalization of patients suffering from severe asthma (SA) that require the prescription of biologic disease-modifying drugs (bDMDs) within the constraints of diagnosis-related groups (DRGs) on the level of the Moscow Region.Material and methods. For the federal model regional adaptation, the authors used the mechanism of subgroups selection in the structure of basic DRG No. 336 st36.003 and No. 139 ds36.004 “Treatment with biologic disease-modifying drugs and selective immunosuppressants” in the round-the-clock (RH) and day-time hospital (DH). Budget impact analysis (BIA) was performed to provide scientific and economic feasibility for the improvement of medical care payment for bDMDs proscribed to patients with SA within DRG at the level of the Moscow Region.Results. The analysis of cost of drug therapy and medical services per 1 case of hospitalization of patients with SA, that required bDMDs therapy, considering the classification criterion (international nonproprietary name of drugs and drug therapy regimens), showed 10 subgroups in DRG No. 336 st36.003 (level 1) and 9 subgroups in DRG No. 139 ds36.004. Expert estimates on the rate of hospitalizations and drug dosage regimen indicated for patients with SA were used to calculate the relative cost weights (CW). The highest CW was observed in the subgroup that received benralizumab in RH (CW=7.46) and in DH (CW=12.08) conditions. BIA demonstrated 110,103,901.53 rubles (or 31%) budget savings for the health care system of the Moscow Region.Conclusion. The implementation of the adapted DRG federal model in the conditions of the health care system of Moscow Region is an economically feasible approach to the organization of the inpatient medical care provided to patients with SA needing bDMDs prescription.

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Regional adaptation of the federal model of reimbursement for medical assistance based on clinical statistical groups: hospitalization of patients in need of genetically enginered biological preparations

Cited by 4 publications

References 0 publications

The Principles of International Classification of Health Interventions of World Health Organization

The Principles of International Classification of Health Interventions of World Health Organization

Optimization of payment for therapy with genetically engineered biological drugs and selective immunosuppressants at the expense of compulsory medical insurance fund in a day hospital at the regional level

Medical care payment improvement within diagnosis-related groups of patients with severe asthma requiring biologic disease-modifying drugs by regional adaptation mechanism in the Moscow Region

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