在国家卫生服务医疗保障一揽子计划中提供肿瘤服务"在门诊和住院环境中对患有血液病和肿瘤血液病的成人和儿童进行治疗和随访"

Nataliya Husak, V. Zub, A. Kotuza
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The approaches to the criteria for assigning a treated case/interaction to oncology packages and the principles of their payment introduced by the National Health Service need to be improved in order to prevent the introduction of inadequate tariffs, in particular, failure to provide services in the amount specified in the tariff or, on the contrary, double/triple funding, which can lead to a significant increase in the costs of financing oncology medical services.\nThe aim of the study is the identification of the main defects and gaps in the existing rules of the grouper regarding the assignment of a treated case/interaction to the oncology package \"Treatment and follow‑up of adults and children with hematological and oncohematological diseases in outpatient and inpatient settings\" and, on this basis, developing suggestions for improving services in this direction.\nMaterials and Methods. A descriptive-analytical study of the analysis of medical services provided in the oncology package 38 \"Treatment and follow-up of adults and children with hematological and oncohematological diseases in outpatient and inpatient settings\" for the first 8 months of 2022 was performed according to the data of the National Health Service of Ukraine and the normative legal acts that regulate the issue of implementing the Medical Guarantees Program.\nResults. 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引用次数: 0

摘要

介绍。需要改进国家卫生服务体系制定的将治疗病例/相互作用分配给肿瘤一揽子服务的标准和支付原则,以防止收费不足,特别是不能按收费标准规定的数额提供服务,或者相反,提供两倍/三倍的资金,这可能导致肿瘤医疗服务的融资成本大幅增加。该研究的目的是确定石斑鱼现行规则中关于将已治疗病例/相互作用分配给肿瘤学一揽子计划的主要缺陷和差距,"在门诊和住院环境中对患有血液病和肿瘤血液病的成人和儿童进行治疗和随访",并在此基础上提出改进这方面服务的建议。材料与方法。根据乌克兰国家卫生服务体系的数据和规范医疗保障方案实施问题的规范性法律法案,对2022年前8个月肿瘤学一揽子方案38 "门诊和住院血液病和肿瘤血液病成人和儿童的治疗和随访"中提供的医疗服务进行了描述性分析研究。与澳大利亚编码标准相比,该研究评估了将电子医疗记录录入第38包的标准的正确性,并根据在第38包的所有相互作用范围内向肿瘤和血液肿瘤疾病患者提供医疗服务的比率,分析了支付的一致性。在选择将诊断列入提供医疗服务的理由清单方面存在某些不一致之处,将病例列入一揽子方案的标准也不明确,因为某一具体诊断既是列入第38个一揽子方案的标准,也是列入相应的DRG的标准,但供资方式不同。经证实,在这一一揽子方案框架内的所有儿童中,有五分之一的儿童只在门诊环境中寻求过一两次医疗帮助,而且干预措施清单与一揽子方案的比率不符;在成年人中,有相当数量的患者在门诊环境中寻求1或2次医疗护理,并按全额支付这些病例的费用。研究结果表明,迫切需要对治疗方案框架内为肿瘤诊断建立的所有相互作用进行两阶段医学监测。首先应根据一定的指标进行自动监测,形成“相互作用红色清单”,然后医生对这些相互作用进行检查,甚至采用人工模式。根据调查结果,提出了关于肿瘤学医疗保障方案改革的建议,即“门诊和住院环境中患有血液病和肿瘤血液病的成人和儿童的治疗和随访”一揽子计划中的相互作用。其中涉及在肿瘤学一揽子计划框架内提供服务和协调向血液肿瘤患者提供医疗服务的理由,收费标准将允许适当支付医疗服务费用,并将改善医疗服务的提供。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
ONCOLOGICAL SERVICE PROVISION WITHIN THE MEDICAL CARE GUARANTEE PACKAGE OF THE NATIONAL HEALTH SERVICE "TREATMENT AND FOLLOW-UP OF ADULTS AND CHILDREN WITH HEMATOLOGICAL AND ONCOHEMATOLOGICAL DISEASES IN OUTPATIENT AND IN-PATIENT SETTINGS"
Introduction. The approaches to the criteria for assigning a treated case/interaction to oncology packages and the principles of their payment introduced by the National Health Service need to be improved in order to prevent the introduction of inadequate tariffs, in particular, failure to provide services in the amount specified in the tariff or, on the contrary, double/triple funding, which can lead to a significant increase in the costs of financing oncology medical services. The aim of the study is the identification of the main defects and gaps in the existing rules of the grouper regarding the assignment of a treated case/interaction to the oncology package "Treatment and follow‑up of adults and children with hematological and oncohematological diseases in outpatient and inpatient settings" and, on this basis, developing suggestions for improving services in this direction. Materials and Methods. A descriptive-analytical study of the analysis of medical services provided in the oncology package 38 "Treatment and follow-up of adults and children with hematological and oncohematological diseases in outpatient and inpatient settings" for the first 8 months of 2022 was performed according to the data of the National Health Service of Ukraine and the normative legal acts that regulate the issue of implementing the Medical Guarantees Program. Results. The study assessed the correctness of the criteria for the entry of Electronic Medical Records into package 38 compared to the Australian coding standards and analyzed the consistency of payment according to the rate for the provided medical services to patients with oncological and oncohematological diseases within the limits of all interactions of package 38. Certain inconsistencies in the selection of diagnoses for inclusion in the list of reasons for providing medical services and the vagueness of the criteria for including a case in the package were revealed, when a specific diagnosis is a criterion for inclusion in both the 38th package and the corresponding DRG, but with different funding. It was established that 1/5 of all children within the framework of this package sought medical help in an outpatient setting only once or twice, and the list of interventions does not correspond to the package rate; among adults, there was a significant number of patients who sought medical care 1 or 2 times in an outpatient setting, and paid for these cases at the full rate. The findings indicate an urgent need for two-stage medical monitoring of all interactions established for oncological diagnoses within the framework of the therapeutic package. The first automatic monitoring should be carried out according to certain indicators with the formation of "a red list of interactions", and then doctors check these interactions, even in manual mode. Conclusions. On the basis of the results, recommendations were developed regarding changes to the Medical Guarantee Program in oncology, namely to the interactions in the package "Treatment and follow-up of adults and children with hematological and oncohematological diseases in outpatient and inpatient settings", which relate to the grounds for providing services within the framework of oncology packages and coordination of medical services provided to patients with oncohematological diseases with a tariff that will allow for proper payment of the medical services and will improve the provision of medical services.
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