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No1(2) 2019

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DOI 10.37219/2528-8253-2019-1-04
Samokhodsky VM
Diagnostic-combined groups as a personalization tool of doctor’s financial stimulation level and predictor of treatment cost
Samokhodsky Victor M.
Kirovohrad Regional Hospital, Otolaryngology Department, Doctor of Medical Sciences, Professor.
E-mail: VSamohodskiy@gmail.com

Abstract

Introduction: The mechanism of formation and use of clinical-statistical groups and diagnostic-combined groups (DSG) as a tool for determining the cost of physician work, personification of the level of financial stimulation of his quality work is proposed based on the example of ENT diseases of different degrees of complexity.
Purpose: As a result of the comparative characterization of physicians' work indicators management of diseases of five degrees of complexity, proposition to recommend the mechanism of substantiation of the levels of financial renumeration of the doctor and the possible options for reimbursement of a certain amount of the total cost of treatment.
Material and Methods: We performed retrospective analysis of case histories and outpatient charts of otorhinolaryngological patients of the regional hospital for 10 years. Taking into account certain features of the clinical course of the disease, indicators of the average working time of the doctor for the process of examination and treatment, we recommend clinical-statistical groups, divided into four which amounted to five DCG, ie diseases of five degrees of complexity. Also, a formula is proposed in which, on the basis of official data on the amount of salaries of doctors, the terms of their regulatory expenses, the so-called "increasing" coefficients, an attempt was made to determine the cost of physicians' work according to the degree of complexity of the disease and to identify possible sources of compensation to the patient from the amount of the total cost of treatment.
Results and discussion: Appropriate calculations indicated the opportunity to justify certain amounts of financial incentives for physicians, depending on the number of patients treated with varying degrees of complexity.
Possible official sources of financial compensation to the patient of a certain amount of the total cost of his treatment were also identified.
Conclusions: Given the creation of computer programs that would greatly simplify the corresponding calculations of the tables presented in the article, the recommended algorithm for practical implementation of the clinical-statistical groups and DCG system would be methodologically suitable for use in other (therapy, surgery, etc.) profile services of healthcare establishment.

Keywords

Diagnostic groups, the degree of complexity of diseases and surgical interventions, the cost of treatment, the cost of labor costs of the doctor financial sources, reimbursement of funds.


Reference

  1. Bogomolets O. [Ministry of Health cannot say how much money and for which patient should "go"]. Novosti meditsinyi i farmatsii. 2017;21(9):10-11. [Article in Ukrainian].
  2. Voronenko HH, Pashchenko VM. [Financial management of the basics of health economics]. Kiev;
    2011. 499 с. [Article in Ukrainian].
  3. Gavrilov VA. [Labor rate in the new conditions of the economic mechanism in health care. Issues of improvement and remuneration in health care] (collection of scientific papers). Moscow; 1989: 69-71. [Article in Russian].
  4. Golyachenko OM, Kuzmin IS, Kilivnik AF, Tsven PO, Golyachenko GB. [Mathematical modeling of health management processes]. Ternopil; 2015. 166 p. [In Ukrainian].
  5. Zabolotny DI, Samokhodsky VM. [Twenty-five innovative organizational and economic standards as an instrument of technology for reforming the process of improving the health of residents of the family doctor’s area of responsibility]. Zhurnal ushnyh, nosovyh i gorlovyh boleznej. 2018;(1):4-27. [Article in Ukrainian].
  6. Kvitashvili A. [Parliamentary hearings "Healthcare of Ukraine"]. Available:
    https://static.rada.gov.ua/zakon/new/par_sl/sl1612115.htm. [In Russian].
  7. Korniychuk OP. [Health of the Nation – a roadmap for reforming the medical industry]. Ukraïnskyĭ medychnyĭ chasopys . 2010;(5):4-7. [Article in Ukrainian].
  8. Korchagin VP. [Theoretical foundations of economic health care reform]. Moscow; 1991: 6-23. [Article in Russian].
  9. Matsuk D. [Electronic Health – Decomponent Model of Recognition in the World]. Ukraïnskyĭ medychnyĭ chasopys . 2019; 129(1):11. [Article in Ukrainian].
  10. Petrenko A. [The reform of the specialized link will be tested in the benefits]. Vashe zdorov’ya. 2019;(9-10):4-6. [Article in Ukrainian].
  11. Petrenko A. [Medical reform: 2019 should be a turning point for the entire industry]. Ukraïnskyĭ medychnyĭ chasopys . 2019;129(1):9. [Article in Ukrainian].
  12. Popovich VM. [Algorithm of clinical diagnosis and pharmacotherapy]. Zdorov’ya Ukrayini. 2017;(1):16-7. [Article in Ukrainian].
  13. Samokhodskyi VM. [Scientific substantiation of medical and economic mechanisms for reforming the management of the ENT service at the stage of transition to family medicine] [dissertation]. Kiev; 1994. 32 p. [In Ukrainian].
  14. Samokhodsky VN. [Hospital insurance medicine. Natural experiment (organizational, medicoeconomic and legal mechanisms]. Kirovograd; 2004. 242 p. [In Russian].
  15. Samokhodsky VM. [To the method of determining the cost of labor costs of a family doctor when performing preventive examinations]. Visnik sotsialnoyi gigieni ta organizatsiyi ohoroni zdorov’ya Ukrayini. 2011;(1):73-8. [Article in
    Ukrainian].
  16. Samokhodsky VM Golyachenko BA. [Medicoeconomic mechanisms for the implementation of organizational standards, criteria and standards as the basis for creating computer programs for the family doctor]. Visnik sotsialnoyi gigieni ta organizatsiyi ohoroni zdorov’ya Ukrayini. 2013. 56;(2):19-27. [Article in Ukrainian].
  17. Samokhodsky VM. [Justification of the organizational algorithm for predicting the cost of rehabilitation of residents of the family doctor’s area of responsibility]. Zhurnal ushnyh, nosovyh i gorlovyh boleznej. 2017;(5):88-96. [Article in Ukrainian].
  18. Samokhodsky VM, Smirnova VL, Panchyshyn NYA, Golyachenko BA. [Algorithm for the implementation of organizational and economic prerequisites for evidence-based screening and treatment management within health care institutions
    of three levels]. Visnik sotsialnoyi gigieni ta organizatsiyi ohoroni zdorov’ya Ukrayini. 2019;(1):18. [Article in Ukrainian].
  19. Ustinov A. [The Health of the Nation – A Roadmap for Reforming the Medical Industry]. Ukraïnskyĭ medychnyĭ chasopys . 2010;(5):4-7. [Article in Ukrainian].
  20. Ustinov A. [Medical reform: 2019 should be a turning point for the entire industry]. Ukraïnskyĭ medychnyĭ chasopys . 2019;120(1):8-11. [Article in Ukrainian].
  21. Tsimbalyuk V. [Physicians and experts insist on reforming the health care system]. Vashe zdorov’ya. 2017;(11-12):4. [Article in Ukrainian].
  22. Fridman E. Diagnosis Elected Groups. Millitary Medicine. 1989;154(5):255-8.
 

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