Martynchik S.A., ^Sokolova O.V., Potemkin E.L.
I.M. Sechenov First Moscow State Medical University, Moscow

Contacts: Svetlana A. Martynchik, e-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

Abstract. The paper outlines development of a system to form clinical and statistical groups on the basis of clinical homogeneity, similarity of cost structures and resources as a tool to improve remuneration and funding of the hospital within the system of voluntary health insurance.

The purpose of the study was to develop an algorithm to form clinical and statistical groups in order to establish standards that are applicable to the assessment of volume of care and cost per completed inpatient case of vascular diseases of the brain. The algorithm to form clinical and statistical groups was developed on the basis of evidence-based grouping of patients by diagnosis (ICD -10) and actual cost per completed case according to the range of health services, with due regard to the following categories: input intensities, complexity of follow-up and levels of inpatient care. Setting rates for clinical and statistical groups for vascular diseases of the brain are considered the decision rules and procedures for the standardization of cost related to health services per completed case in order to establish technology and expenditure standards that would serve basis for determining cost per completed inpatient case. Activity on development of clinical and statistical groups consists of the following steps: 1) typing patients according to "clinical homogeneity and economic equivalence of consumed resources"; 2) determining coefficients of resources consumed; 3) calculating weight adjustment factors of value, with due regard to complexity of patient follow-up and its level; 4) establishing standards of financial cost and differentiated charges per completed case. Within the formed system of clinical and statistical groups of patients with cerebrovascular diseases, selection criteria of clinical and statistical groups were developed including permissible variation of parameters: average cost based on the adjustment factors, average length of treatment, mortality, and percentage of inadequate health care.

Keywords: clinical and statistical groups, remuneration per completed inpatient case, vascular diseases of the brain, voluntary health insurance.

References

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