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Main arrow Archive of previous Issues arrow ╣1 2013 (29) arrow Effective ways to reimburse expenses and rationalize budgeting technologies and programs in inpatient burn care
Effective ways to reimburse expenses and rationalize budgeting technologies and programs in inpatient burn care Print
Tuesday, 19 March 2013

A.Yu. Unizhaeva1, S.A. Martynchik2
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.



  1. Alekseev AA, Lavrov VA. Selected works on combustiology. Moscow: Nauchnaya kniga; 2009. 275 p. (in Russian).
  2. Alekseev AA, Krutikov MG, Yakovlev VP. Burn infection. Etiology, diagnosis, prevention, and treatment. Saratov: Vuzovskaya kniga; 2010. 416 p. (in Russian).
  3. Evteev AA, Tyurnikov YuI, Malyutina NB, Kal'yanov AB, Sukhov TKh, Gorelova EG. Traditions and innovations in using the means of local treatment in patients with deep burns. [Internet]. 2006 [cited 2012 Oct 28]. Available from: http://www.burn.ru/rubrics/show/show/?id=3682 (in Russian).
  4. Zinov'ev EV. The ways for improving the results of medical care provided to patients with major deep burns living outside the regional administrative centers. Dr.Sci.Med [thesis]. Nizhniy Novgorod; 2008. 39 p. (in Russian).
  5. ôRecommendations on result-oriented methods of payment for medical care in healthcare facilities which take part in realization of the Regional program of state guarantees for providing free medical care to the citizens of the Russian Federationö, the Letter of the MoH&SD ╣ 20-0/10/2-5067 of June 29, 2009. [Internet]. 2009 [cited 2012 Oct 13]. Available from: http://www.zdrav.ru/library/regulations/detail.php?ID=25467 (in Russian).
  6. ôOn approving the standards for medical care provision to patients with thermal and chemical burns of the head, neck, body, shoulder girdle, upper extremity, wrist and hand, hip joint area, lower limb, ankle joint, foot, and thermal and chemical burns of respiratory tractsö, the Regulation of MoH&SD of the RF of July 21, 2006, ╣569 [Internet]. 2006 [cited 2012 Oct 5]. Available from: http://lawrussia.ru/bigtexts/law_3012/index.htm (in Russian).
  7. ôOn approving the standard of medical care provision to patients with thermal burns of an unspecified degree in several areas of the bodyö, the Regulation of the MoH&SD of the RF of August 28, 2007 N 566. [Internet]. 2007 [cited 2012 Oct 5]. Available from: http://lawrussia.ru/texts/legal_634/doc634a996x923.htm (in Russian).
  8. ôOn formation and improvement of the government state task for providing in 2011 high technology medical care to the citizens of the RF from the federal budgetö, the Regulation of the MoH&SD of the RF of December 31, 2010 ╣ 1248Ý. [Internet]. 2010 [cited 2012 Oct 9]. Available from: http://www.minzdravsoc.ru/docs/mzsr/orders/1155 (in Russian).
  9. Tyurnikov YuI. The current aspects of diagnostic and treatment care in thermal injury. Plasticheskaya khirurgiya i kosmetologiya 2012; (2): 257-266 (in Russian).
  10. ô On changes in some legislative acts of the RF in connection with improvements of the legal status of government (municipal) institutionsö, the Federal Law of May 08, 2010 N 83-ďă. [Internet]. 2010 [cited 2012 Oct 10]. Available from: http://pravo-med.ru/legislation/fz/6214/ (in Russian).
  11. Khafiz'yanova R.Kh., Burykin I.M., Aleeva G.N. Compensation for expenses and management account in healthcare facilities on the base of a mixed case. Ekonomika zdravookhraneniya 2010;151:44ľ51 (in Russian).
  12. Abston S, Blakeney P, Desai M, Edgar P, Heggers JP, Herndon DN, Hildreth M, Nichols RJ. Closure of the burn wound. [Internet] 2009 [cited 2012 Oct 26]. Available from: http://www.totalburncare.com/orientation_wound_closure.htm
  13. Boyce S. Opportunities and Obstacles with Engineered Human Skin [Internet] 2007 [cited 2012 Oct 24]. Available from: http://wtec.org/stem_cell_workshop/presentations/26-Boyce.pdf
  14. Halim AS, Khoo TL, Yussof SJM. Biologic and synthetic skin substitutes: An overview Indian. J. Plast. Surg 2010; 43 (Suppl): S23ľS28.
  15. Lotter O, Jaminet P, Amr A, Chiarello P, Schaller HE, Rahmanian-Schwarz A. Reimbursement of burns by DRG in four European countries: an analysis. Burns 2011; 37(7):1109-1116.
  16. Ong YS, Samuel M, Song C. Meta-analysis of early excision of burns. Burns 2006;32(2):145-150.
  17. Sahin I, Ozturk S, Alhan D, Açikel C, Isik S. Cost analysis of acute burn patients treated in a burn centre: the Gulhane experience. J. Ann. Burns Fire Disasters 2011; 24(1):9ľ13.
  18. Sánchez JA, Perepérez SB, Bastida JL, Mercedes MM. Cost-Utility Analysis Applied to the Treatment of Burn Patients in a Specialized CenterFREE. Arch. Surg 2007;142(1):50-57.
  19. Shores JT, Gabriel A, Gupta S. Advances in Skin & Wound Care. The Journal for Prevention and Healing 2007;20(9):493ľ508.
  20. Trueman P. The economics of Burn care. [Internet]. Mölnlycke Health Care 2011 December 28. 2011 [cited 2012 Oct 22]. Available from: http://www.molnlycke.com/com/Knowledge/Burn-care/The-economics-of-Burn-care/
  21. Use of skin substitutes. [Internet]. 2005 [cited 2012 Oct 24]. Available from: http://www.eplasty.com/images/PDF/ManageBurnWound-part3.pdf
  22. Wynn B╬, Bergamo G. Payments For Burn Patients Under Californiaĺs Official Medical Fee Schedule For Injured Workers. [Internet] 2005 [cited 2012 Oct 27]. Available from: http://www.rand.org/pubs/working_papers/2005/RAND_WR263-1.sum.pdf

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