Научно-практический журнал Медицинские технологии. Оценка и выбор
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Issue № 29 | 2017 (3)

Abstract

This review deals with current situation and future of the mobile medical applications (mmApps) in Russia and entire world. We described a points of view from leading world healthcare regulators (e. g. WHO and FDA), main trends in control of use and quality requirements. Also we have analyzed publication activity about this topic since 2007 year and developed two classifications of mmApps, that was the first attempt to classify mmApps in Russia. Obstacles in use of mmApps in Russia are also observed.

Keywords

mHealth, electronic health, mobile medical applications, health technology assessment.

For citations

Soshnikov S. S., Gorkavenko F. V., Vladimirov S. K., Nochevkin E. V., Borisenko A. A., Kotlyar V. A., Frolkova A. B. Classification of Mobile Medical Applications, Principles and Ethical Standards for their Implementation in Clinical Practice. Medical Technologies. Assessment and Choice. 2017; 3(29): 53–58.

Issue № 29 | 2017 (3)

Abstract

The author discusses the problems of legal and normative regulation for the regional drug lists for provision of certain categories of citizens with medicines for outpatient treatment. The drugs included into such lists are financed from the regional budgets in the Framework of Regional Programs of State Guarantees of Free Medical Care/ The number of drugs included into the lists in different regions of Russia were compared as well as correspondence of regional lists with the vital and essential drugs list (VEDL) approved by the Government. Data on efficacy of drugs included into regional lists but not into VEDL were analyzed. There is great variability in the number of drugs included into regional lists between the regions. Besides discrepancy between regional lists and VEDL is obvious, being also different in different regions. Some regions with deficient Program of State Guarantees have much larger number of drugs in regional list if compared with VEDL, but the inclusion is not based on scientific evidence of efficacy. The article ends with recommendations how to improve the process of regional drug lists formation.

Keywords

regional drug list, Program of State Guarantees of Free Medical Care, Vital and Essential Drug List (VEDL ).

For citations

Sura M. V. Provision of Medicines for Outpatient Treatment Financed from the Regional Budgets in the Framework of Regional Programs of State Guarantees of Free Medical Care. Medical Technologies. Assessment and Choice. 2017; 3(29): 41–52.

Issue № 29 | 2017 (3)

Abstract

The article describes the main provisions of the Russian law concerning organization and payment for outpatient medical care. The authors disuss several problems, particularly the lack of a system of drug insurance, staff disproportions, lack of physicians responsible for the coordination of all stages of medical care, lack of effective mechanisms of encouragement of medical organizations to implement preventive measures, excessive financial penalties and insufficient funding of the primary stage of medical care.

Keywords

primary health care, outpatient facilities, organization of medical care, payment for medical care.

For citations

Lazareva M. L., Fedyayev D. V., Melnikova L. S. Legal and Regulatory Framework of the System of Payment and Organization of Outpatient Care in the Russian Federation. Medical Technologies. Assessment and Choice. 2017; 3(29): 31–40.

Issue № 29 | 2017 (3)

Abstract

The transfer of high-tech medical assistance for payment under insurance principles through the use of Russian Diagnostic-Related Groups (ruDRG) is due to the need to address one of the main objectives of public health policy – to increase the availability of high-quality high-tech medical care for the population of Russia. The solution of this task requires the development of not only scientifically based organizational approaches, but also the application of adequate financial mechanisms for reimbursing the costs of medical organizations providing this type of medical assistance in the compulsory health insurance system. The process of transferring VMP to insurance principles is associated with a number of problems, the solutions to which are discussed in this article. In this regard, the following tasks are of particular importance: updating the list of VMP for compliance with the criteria for referring to this type of medical care; problems of comparing the structure of the VMP with the principles of the formation of clinical and statistical groups; justification of the level of financial costs.

Keywords

high-tech medical care, specialized medical care, clinical and statistical groups, the nomenclature of medical services.

For citations

Brutova A. S., Obukhova O. V., Bazarova I. N. The Problems of Transferring High-Tech Medical Care to Russian Diagnostic-Related Groups (ruDRG). Medical Technologies. Assessment and Choice. 2017; 3(29): 22–30.

Issue № 28 | 2017 (2)

Abstract

The article describes a range of issues that arise during the implementation of private-public partnership in the field of health care. Possible solutions of the problems are proposed.

Keywords

private-public partnership, structuring, project administration, Samara Oblast

For citations

Navasardyan A. S. On Some Issues of the Implementation of Private-Public Partnership Projects in Health Care. Medical Technologies. Assessment and Choice. 2017; 2(28): 40–43.

Issue № 27 | 2017 (1)

Abstract

The article describes possible directions of concretization of the Program of State Guarantees fоr free Medical care for Russian Citizens within existing types, conditions and forms of medical care, the general approach to determining the direction of concretization of the Program of State Guarantees. The authors consider proposals on some types of care and present cost calculations for their implementation.

Keywords

healthcare financing, Program of State Guarantees, efficiency of healthcare system.

For citations

Fedyaev D. V., Lukyantseva D. V., Ignatyeva V. I. Аpproaches to Concretization of the Program of State Guarantees fоr free Medical care for Russian Citizens. Medical Technologies. Assessment and Choice. 2017; 1(27): 15–22.

Issue № 26 | 2016 (4)

Abstract

One of the types of payment for outpatient medical care (MC) in the system of compulsory medical insurance is standard capitation payments for enrolled persons. It considers the indicators of efficiency of medical facilities, which may include costs of medical care provided in other medical organizations (for a unit of MC). What is the difference between this type of payment and standard capitation payments for enrolled persons combined with payments for a unit of MC? What efficiency indicators are used in Russian regions to implement this type of payment? The author tries to answer these questions based on the experience of the subjects of the Russian Federation.

Keywords

types of payment for medical care, capitation payments, asset holding, efficiency indicators.

For citations

Saitgareyev R. R. The Indicators of Efficiency in Capitation Payments for Outpatient Care. Medical Technologies. Assessment and Choice. 2016; 4(26): 26–31.

Issue № 25 | 2016 (3)

Abstract

In his address to the Federal Assembly of the Russian Federation on 3 December 2015, the President of Russia specified the directions of the development of health care and mandatory health insurance. They included the end of the transition to the insurance principles of payment for health care services, and improved financial support of high-tech medical care in leading federal medical organizations. It was also underlined that the most complicated and expensive high-tech services conducted by health care institutions of federal executive authorities should be a separate expenditure item in the system of mandatory health insurance. In the light of these considerations, it seems practical to trace the development of high-tech medical care in the last 20 years, and to define possible limitations and prospects of its full transition to insurance principles of payment in the system of mandatory health insurance. The results of the study are discussed in this paper.

Keywords

high-tech medical care, mandatory health insurance.

For citations

Obukhova O. V., Brutova A. S., Bazarova I. N., Artamonova E. N. Experience, Results and Prospects of the Transition to Insurance Principles of Payment for High-Tech Medical Care. Medical Technologies. Assessment and Choice. 2016; 3(25): 34–41.

Issue № 24 | 2016 (2)

Abstract

The article describes the stages of the update of the Russian federal model of financing of medical care according to diagnosis related groups (DRGs) in cardiovascular diseases since 2012. The estimated charge rates for medical care in patients with heart failure (HF) are defined. The data on the real cost of hospitalization of patients with HF to day-and-night hospitals are shown. Relative cost weights (CW) of high-cost drug therapy in patients with HF are calculated on the example of Krasnodar Krai.
Since 2012, significant changes were made in the federal model of DRGs including cardiologic groups. In the model of 2015, non-surgical cardio-vascular diseases for day-and-night hospitals belonged to three profiles of medical care: Cardiology (DRGs 66–71), Therapy (DRGs 193–197), and rheumatology (DRGs 174–175). The RC values were 0.70-3.48 depending on the group. Patients with HF were subject to hospitalization incase of DRG 196: Other heart diseases (level 1) (RC = 0.78), and DRG 197: Other heart diseases (level 2) (RC = 1.54). The last group included hospitalizations with special invasive methods of examination of heart and vessels. The average estimated cost of hospitalization of patients with HF were 17,00 RUB and 35,00 RUB for DRG 196 and DRG 197, respectively, according to federal CW values.
According to the expert opinions, the average actual cost of hospitalization of patients with HF was 32 094.15 RUB in 2014. It was 1.5 times higher than in case of other diseases included into DRG 173: Other heart diseases (CW = 0.87). Along with this, HF was the most frequent cause of hospitalization (about 60% of all cases) in the discussed DRGs. This aspect should be taken into account during the development of DRG model in 2016when considering possible separation of a group of patients with HF with a multiplying CW of 1.4. This will enable to meet the real financial needs of medical facilities in the management of such patients.
The possibility of financing of high-cost drug therapy in patients with HF on the regional level was studied on the example of Serelaxin. The course of this drug during hospital stay costs 155,246.00 RUB. The model of the creation of a subgroup for hospitalization of patients, who need Serelaxin, was considered on the example of Krasnodar Krai in the framework of DRG 173: Other heart diseases (CW = 0.87). It showed that the supply of 2% of hospitalized HF patients with Serelaxin (the minimal number of hospitalizations of patients with HF, who need this drug; the average value is 7% according to experts) with a target CW = 10.57 will result in RC = 0.74 in the remaining subgroups (hospitalizations of patients in DRG 173 including those with HF without administration of Serelaxin) after redistribution of the available amount of financial resources. Further expert studies are required to assess the possibility of such reduction of CW.

Keywords

diagnosis related groups (DRGs), relative cost weight (CW), cardiology, heart failure, Serelaxin.

For citations

Sura M.V. Diagnosis Related Groups in Cardiology. Financing of High-Cost Drug Therapy in Patients with Heart Failure. Medical Technologies. Assessment and Choice. 2016; 2(24): 58–66.

Issue № 24 | 2016 (2)

Abstract

The financial stabilization of health care system and the improvement of the its quality and availability for the population is a very important issue in Russia. Today, less than 3.4% of public funds are spent on health care, which makes it difficult to meet basic needs for medical drugs, products and services, not to mention the access to novel methods of treatment and medical technologies. This situation is complicated by the fact that a significant part of the resources devoted to health care (20-40% according to expert estimations) is used inefficiently. In conditions of economic slowdown, the Russian government have to improve the effectiveness of health care spending. The important tools for this are the optimization of the model of health care funding, the search for additional financial resources,as well as the implementation of more effective methods of administration and delivery of medical services.

Keywords

model of health care, health care system, fundingand organization of health care, sources of financing of health care, subjects and objects of health care, tariff setting, definition of the requirements for health care organizations, quality control in health care, principles of organization of the insurance-based model of funding of health care.

For citations

Tatarinov A.P., Melnikova L.S. Optimization of the health financing system: an overview of survey results. Medical Technologies. Assessment and Choice. 2016; 2(24): 41–57.