No3(4) 2021
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DOI 10.37219/2528-8253-2021-3-04 |
Zabolotny D.I., Samokhodsky V.M., Ponomarenko N.V.
Algorithm of innovative medical and economic standards as a basis for the
transformation of hypothetical predictions of the launch of insurance
medicine |
Zabolotny Dmitry I
State Institution “Institute of otolaryngology named after Prof. O.S.
Kolomiychenko of the National Academy of Medical Sciences of Ukraine”; Kyiv,
Ukraine. Director
Doctor of Medical Sciences, Professor, Academician of the National Academy
of Medical Sciences of Ukraine
E-mail: amtc@kndio.kiev.ua
https://www.scopus.com/authid/detail.uri?authorId=6701512931
https://orcid.org/0000-0001-9429-4414
Samohodskiy Viktor M.
Kirovograd Regional Hospital, Otolaryngology Department
Doctor of Medical Sciences, Professor
E-mail: VSamohodskiy@gmail.com
Ponomarenko NV
Communal non-profit enterprise "Polyclinic Association" of the City Council
of Kropyvnytskyi |
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Abstract
Introduction: Based of tht author's doctoral dissertation of tht
problems of insurance medicine, relevant monographs and scientific articles,
an attempt is presented to substantiate tht option of transforming our
purely governmental national system of insurance medicine.
Purpose: Using more than thirty of our innovative organizational and
medico-economic standards, criteria and regulations, in tht process of their
"activation" in the conditions of a full-scale experiment under the pilot
project program in the Health Care institutions of various levels of medical
district, to determine the level of their effectiveness to justify the
specified transformation during the launch of our system of insurance
medicine.
Materials and methods: The object of the study was all residents (up
to 2000) of the family physician's area of responsibility. On the basis of
structural-logical analysis and the use of medical-economic standards,
doctors' labor costs, distribution of otolaryngological diseases into
clinical-statistical groups (CSG) and diagnosticrelated groups (DRG), as
well as the degree of their complexity and the complexity of possible
surgical interventions, thanks to the formula for calculating the labor
costs of doctors and treatment process we obtained evidencebased information
about real "budget" cost of treatment of diseases of a certain CSG.
Results and discussion: At the first in trade part mental stage of
insurance medicine, the main tool should be a system of medical and economic
standards, which include the price of labor costs, in particular doctors,
wage fund, rates of increasing coefficients for the treatment of complex
diseases, the level of financial incentives for doctors and the like. The
tables present a mechanism for calculating the evidence-based cost of
treating diseases of varying degrees of complexity and physician salaries,
as well as the possibilities of forming both an adequate amount of funds
that "follow the patient" and forecasting the health improvement budget for
the family physician's area of responsibility.
Conclusions: Presented an algorithm for the implementation of our
medical and economic standards, the feasibility of which has been proven in
the "field" conditions of the field experiment in the process of
professional management, can constitute, under conditions of its continuous
improvement, the medical and economic basis for the start of our system of
budgetary and insurance medicine. |
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Keywords
Medico-economic mechanisms, treatment and related groups, degree of disease
complexity, cost of physician labor and treatment process, total cost of
diagnostic-related group treatment. |
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