Issue № 24 | 2016 (2)
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.
diagnosis related groups (DRGs), relative cost weight (CW), cardiology, heart failure, Serelaxin.
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.