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Diagnosis-related groups and payments for the treatment of malignant neoplasms in the model of 2019

https://doi.org/10.17749/2070-4909.2019.12.3.169-177

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Abstract

The article addresses the model of diagnosis-related groups (DRG) updated according to the new tariffs in the compulsory medical insurance. Especially emphasized are changes made in the DRG model of 2019, which resulted from the previous work on the development and revision of the clinical recommendations in oncology, as well as the regulation changes in the healthcare system. In addition, the article describes the functioning of the DRG model in 2018 and the payment for cancer care and also provides examples from the practice of chemotherapy. The modifications made in the 2019 model are carefully discussed in terms of: expanding the list of oncological diagnoses, creating and characterizing new DRG groups, updating the coding system and the structure of reference books, changing the Guidebook recommendations and the Instruction related to oncological groups. Clarifications are given regarding frequently asked questions on payments for the medical care in oncology within the current DRG model.

 

 

About the Authors

D. V. Fedyaev 
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

Deputy Head of the Department for Methodological Support of Payment for Medical Care, Center for Expertise and Quality Control of Medical Care, Ministry of Health of the Russian Federation;

Research Fellow at the Laboratory for HTA, Institute of Applied Economic Research of the Russian Academy of Science, Research Associate at the Health Care Finance Research Center



V. V. Omelyanovskiy 
Russian Presidential Academy of National Economy and Public Administration, Federal State Educational Institution of Higher Professional Education; Research Institute of Finance, Ministry of Finance of the Russian Federation
Russian Federation

MD, PhD, Professor, Head of the Healthcare Finance Center at the Research Financial Institute, Ministry of Finance of the Russian Federation

Researcher ID: P-6911-2018;

Scopus Author ID: 6507287753



M. L. Lazareva 
Center for Healthcare Quality Assessment and Control of the Ministry of Health of the Russian Federation
Russian Federation
Chief Specialist, Department for Methodological Support of Payment for Medical Care


Yu. V. Seryapina
Center for Healthcare Quality Assessment and Control of the Ministry of Health of the Russian Federation
Russian Federation
Chief Specialist, Department for Methodological Support of Payment for Medical Care


Yu. A. Ledovskikh
Center for Healthcare Quality Assessment and Control of the Ministry of Health of the Russian Federation
Russian Federation
MD, PhD, Chief of the Department of Methodological Support for Standardization


References

1. Avksentyeva M.V., Omelyanovskiy V.V., Petrovskii A.V. et al. New Approaches to the Development of Diagnostic Related Groups for Cancer Pharmacotherapy in Russian Federation. Meditsinskie tekhnologii. Otsenka i vybor (in Russ). 2018; 2 (32): 8-23.

2. Kovaleva M.Yu., Sukhorukikh O.A. Clinical guidelines. History of creation and development in the Russian Federation and abroad Remedium. Zhurnal o rynke lekarstv i meditsinskoi tekhniki (in Russ). 2019; 1 (2): 6-14. DOI:10.21518/1561-5936-2019-1-2-6-14.

3. Fedyaev D.V., Akimov O.V., Zuev A.V. Algorithm of Hospital Cases Classification in the Russian Model of Diagnostic Related Groups: Need for Improvement. Meditsinskie tekhnologii. Otsenka i vybor (in Russ). 2018; 2 (32): 24-33


For citation:


Fedyaev  D.V., Omelyanovskiy  V.V., Lazareva  M.L., Seryapina Y.V., Ledovskikh Y.A. Diagnosis-related groups and payments for the treatment of malignant neoplasms in the model of 2019. FARMAKOEKONOMIKA. Modern Pharmacoeconomic and Pharmacoepidemiology. 2019;12(3):169-177. (In Russ.) https://doi.org/10.17749/2070-4909.2019.12.3.169-177

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ISSN 2070-4909 (Print)
ISSN 2070-4933 (Online)