A.Yu. Unizhaeva¹, S.A. Martynchik^2
1City Clinical Hospital #36, Moscow Healthcare Department, Moscow
² Research Institute of Public Health and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow

Summary. The document defines principles of surgical management of patients with deep thermal burns and factors affecting effectiveness of the hospital budget expenses. Program activities to optimize budget expenses per completed case of inpatient care for deep thermal injuries have been identified according to the literature available: active surgical tactics, modern methods of transplantation of cultured skin cells and their equivalents, rational use of expensive drugs and antibiotics. The paper demonstrates that the goal-directed program planning in combustiological facilities requires an economic feasibility analysis of budgeting technologies and programs. The document also reviews cost-effective ways to fund programs of high-tech care delivery through improved methods of cost standardization using enlarged units of care, grouping patients according to clinical criteria and cost criteria, establishing differential rates to achieve new goals: predictability, cost-saving incentives, and efficient resource management. The document illustrates that the system of program budgeting in Combustiology implemented by most European countries though the method of diagnosis-related groups serves a tool to plan global budget with a focus on performance of hospitals and transition from retrospective reimbursement to a proactive one. The document demonstrates that the main phase of implementation of the goal-directed program budgeting in Russian specialized burn centers (burn care departments at a multi-field hospital) is introduction of a mechanism of governmental (municipal) work tasks. This paper also specifies the content of this funding mechanism, i.e. cost reimbursement of burn treatment is based on standard financial expenses per completed inpatient case rather than on the cost of burn treatment on the basis of actual amount of services provided.

Keywords. Burn injury; thermal burns; program activities; cost standardization; clinical and statistical groups; standards of financial expenses; goal-driven program budgeting.

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