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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

https://doi.org/10.17749/2070-4909.2018.11.2.044-052

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Abstract

The existing model of financial support of medical assistance for clinical-statistical groups (CSGs) in 2018 provides for the reimbursement for hospital stay expenses by the compulsory medical insurance fund in patients claiming the need for genetically engineered biological products (GiBP) during their stay in a day-care or 24-hour inpatient facility. The payment is made to CSG no. 121 in a day care and to CSG no. 316 in a 24-hour inpatient facility. The heterogeneity of the expenses for therapy with GiBP necessitates further division of the Federal CSGs into subgroups located in the constituent parts of the Russian Federation. This process has been initiated in some parts of the country, and it is seen as a way of regional adaptation of the Federal Medical insurance model. The proposed subdivision of the Federal CSGs allows for setting the tariffs reflecting the real expenses incurred by a local medical organization due to the therapeutic use of GiBP. The models of such specific CSGs proposed by RF subjects (after an expert evaluation) can be taken as a basis for updating the Federal CSG model, taking into account the differences in the costs of different drug therapy regimens.

About the Authors

M. V. Sura
Center for Healthcare Quality Assessment and Control of the Ministry of Health of the Russian Federation ; Russian Presidential Academy of National Economy and Public Administration, Federal State Educational Institution of Higher Professional Education.
Russian Federation

Sura Mariya Vladimirovna – MD, PhD, Leading Researcher at the Center for Health Technology Assessment;  Senior Staff Member at the Center for Finance Healthcare Research.

10-5 Khokhlovskii pereulok, Moscow 109028; 82 Vernadskogo prospect, Moscow 119571.



T. N. Ignatova
Ministry of Health of the Orenburg region.
Russian Federation
Ignatova Tatyana Nikolaevna – MD, PhD, Head of the Department of Medical Assistance to Children. 33 Tereshkovoj Str., Orenburg 460006.


N. S. Rudneva
Tula Regional Clinical Dermato-venereal Dispensary.
Russian Federation

Rudneva Natalya Sergeevna – MD, PhD, Physician-in-Chief,   Chief Freelance Dermatologist of the Tula Region.

1a 1 Str. M. Raskovoy proezd, Tula 300053, Tula region.



Yu. N. Sukhanova
Ministry of Health of the Orenburg region.
Russian Federation

Sukhanova Yuliya Nikolaevna – Head of the Department of Economic Analysis and Health Insurance.

33 Tereshkovoj Str., Orenburg 460006.



N. G. Ulyanova
Territorial fund of compulsory medical insurance of the Orenburg region.
Russian Federation

Consultant, Department of Territorial Program for the Compulsory Health Insurance in the Orenburg region.

19 Fabrichnyy per., Orenburg 460014.



A. S. Khudyaev
Territorial fund of compulsory medical insurance of the Sverdlovsk region.
Russian Federation
Khudyaev Andrey Sergeevich – Head of the Financial and Economic Department. 54 Moskovskaya Str., Ekaterinburg 620102.


V. A. Shelyakin
Territorial fund of compulsory medical insurance of the Sverdlovsk region.
Russian Federation

Shelyakin Valeriy Aleksandrovich – Director.

54 Moskovskaya Str., Ekaterinburg 620102.



D. V. Scherbakov
Territorial fund of compulsory medical insurance of the Tula region.
Russian Federation

Scherbakov Denis Valeryvich – MD, PhD, Head of the Compulsory Health Insurance Department.

7 prospekt Krasnoarmeyskiy, Tula 300041.



References

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For citation:


Sura M.V., Ignatova T.N., Rudneva N.S., Sukhanova Y.N., Ulyanova N.G., Khudyaev A.S., Shelyakin V.A., Scherbakov D.V. 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. FARMAKOEKONOMIKA. Modern Pharmacoeconomic and Pharmacoepidemiology. 2018;11(2):44-52. (In Russ.) https://doi.org/10.17749/2070-4909.2018.11.2.044-052

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ISSN 2070-4909 (Print)
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