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TO A QUESTION ABOUT THE DIFFERENT APPROACHES TO THE METHODS OF PAYMENT ENDOSCOPIC SURGERY, DEPENDING ON THE CHANGES IN THE PROGRAM OF STATE GUARANTEES
M.D. Alekceeva N. U.1 2Candidate of Medical Science Lomakina E. A.
Russia, Irkutsk 1Irkutsk State Medical University 2Clinic of Irkutsk State Medical University
Abstract. In article the analysis of approaches to payment methods of medical care on the example of endoscopic transactions is provided. The problem of sufficiency of rates in system of compulsory medical insurance is discussed.
Ensuring universal access to effective health services of acceptable quality in all countries considered by the World Health Organization as a requirement at the present stage of development of society. In Russia today, the principle of accessibility and quality of health care for the citizens of detail is reflected in the Federal Law 21.11.2011 №323-FZ "On the basis of protection of citizens in the Russian Federation" and 29.11.2010 №326-FZ "On compulsory medicalinsurance in the Russian Federation". In accordance with Article 10 of the Federal Law №323-FZ, accessibility and quality of care provided, including the provision of medical organization of guaranteed medical care in accordance with the program of state guarantees of rendering free medical care to citizens.
The attention is drawn to a fundamental point when analyzing the changes in the content of the territorial program of state guarantees to citizens of the Russian Federation free medical care in the Irkutsk region (TPSG): the specification in terms of "free" health care appeared in TPSG title only in 2004, since the previous edition the program includes a section "List of types of medical care, funded by legal entities and individuals (paid service)."
She was named "Territorial program of state guarantees to citizens of the Russian Federation free medical care in the Irkutsk region in 2004" in 2004,while from 1997 to 2003 had the name "The program of state guarantees to provide medical care of the population of the Irkutsk Region" . It is undergoing significant changes and the content of the program itself. One good example is the change of payment methods of endoscopic operations in the provision of specialized medical care to the population.
Such service is provided on a paid basisaccording to the Addendum to TPSG 1998 "Endoscopic surgery on the personal initiative of citizens" (p.5.) and Addendum 1 to TPSG 1999 "Endoscopic Surgery" (p.42). This plank42 was excludedDecree of the Head of Administration of the Irkutsk Region 24.12.1999 №210-pg "On amendments and additions to the Decree of the Governor 05.01.1999 №3-n" On the program of state guarantees to provide the population of the Irkutsk region health care in 1999"(p. 2.6).
The paragraph was supplemented by the followingDecree of the Governor of the Irkutsk
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Region 17.04.2002 №279-p "On amendments and additions to the program of state guarantees to provide the population of the Irkutsk region medical care" in Addendum 1 of the program: "Medical institutions that perform medical insurance program are providing medical assistance to citizens on a contractual basisout a system of medical insurance of citizens health care in accordance with Article 20 Law of the Russian Federation "On medical insurance of citizens in the Russian Federation."
In accordance with section 5 of the Decree of the Administration of the Irkutsk Region 10.02.2005 №18-pa "On the Territorial program of state guarantees of Russian citizens free medical care in the Irkutsk region in 2005",paid medical services and voluntary health insurance provided under contracts with citizens and organizations for the provision of health care workers and their families above the Territorial program of state guarantees of the Russian Federation citizens to free medical care in the Irkutsk region in 2005 in accordance with applicable law (p. 5.6).
A separate tariff for endoscopic cholecystectomywas usedtogetherwiththeratesontheprofileof "surgery"from 2006 to 2016.
So, until July 1, 2009 tariff for 1 day bed on the profile "anesthesiology and reanimation" was appliedin conjunction with the tariff of 1 day bed on the profile of "surgery". From 1 July 2009, the cost of stay in intensive care and anaesthesiology department was included in the price of the stay in the surgical department and the newly designed uniform tariff for the cost of 1 bed-days in the surgical department to date has a name of "intensive surgery".
From 1 January 2015 in the Irkutsk region, calculation for the treated patients in the system ofcompulsory medicalinsurance was carried outon the clinical-profile group (the CPG), not on bed-days (complete case of treatment). Operation "endoscopic cholecystectomy" had a separate tariff and was paid by health insurance organizations in addition.
From 1 January 2016 in the Irkutsk region, the calculation of the treated patients is carried out by the CPG, the price of which already includes the cost of the medical organization to production endoscopic cholecystectomy.
As seen from the above given, since the introduction of compulsory health insurance system (CHI) in different periods of time in the Irkutsk region payment of endoscopic operations was performed in different ways: for out of pocket; as part of a general tariff for the provision of hospital care in the surgical department; a separate tariff. Moreover, thistariff was differentiated geographicallyin the Irkutsk region, for example: the tariff was approved in 2009 for endoscopic cholecystectomy in the southern districts of the Irkutsk region in the amount of 4 607,6 rubles, in the northern regions -. 4 726,8 rubles. The reason for the different approaches to the payment methods for endoscopic surgery is the lack of financial capacity of the industry to cover the cost of production endoscopic operations.
Held since 2005 on the basis ofClinicIrkutsk State Medical Universitymedicaleconomic analysis of the production of endoscopic surgery shows that the size of the tariff never covered and not covered today costs by medical organization for the provision of thesemedical services.
So, now the tariff for one complete case of treatmentin view of the endoscopic surgery is 26 829,29 rubles. And the actual costs with endoscopic cholecystectomy and diagnostic arthroscopy are 48 072,29 rubles and 49 126.76 rubles respectively.
Thus, the analysis of changing the approaches to specialized health care payment methods (in particular, endoscopic surgery) and the calculation of the actual costs of medical organizations in the production of these services indicates the failure of tariffs. At the same, legal opportunities for the medical organization are extremely limitedbyproviding medical services included in TPSG, for a paidfundament while maintaining high availability to the public health services. In this regard, the question remains adequate financial filling tariffs and strict quota volume of the individual health care services in the CHI system with the possibility for medical organizations legally rendering these services not only in the CHI system, but also as a paid medical activities.
REFERENCES
1. Federal Law 21.11.2011 №323-FZ "On the basis of protection of citizens in the Russian Federation".
2. Federal Law 29.11.2010 №326-FZ "On compulsory medicalinsurance in the Russian Federation".
3. Territorial program of state guarantees to citizens of the Russian Federation free medical care in the Irkutsk region in 2004.
4. Decree of the Governor of the Irkutsk Region 17.04.2002 №279-p "On amendments and additions to the program of state guarantees to provide the population of the Irkutsk region medical care".
5. Resolution of the Administration of the Irkutsk Region 10.02.2005 №18-pa the "On the Territorial program of state guarantees of Russian citizens free medical care in the Irkutsk region in 2005"/
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