Научно-практический журнал Медицинские технологии. Оценка и выбор
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DRG-based Payment for Medical Care in Mandatory Health Insurance: Regional Adaptation

Issue № 30 | 2017 (4)

Abstract

Since 2012, a unified model of payment for hospital care based on diagnosis related groups (DRGs) is being implemented in the Russian system of mandatory health insurance. Today, two mechanisms of the regional adaptation of this model are defined on the federal level. The first one is adjustment coefficients (coefficient for the level of medical care in health care organization, coefficient for the complexity of treatment, management coefficient), and the second one is distinguishing subgroups within standard DRGs. The analysis of tariff agreements in regions revealed significant transregional differences in interpretation and application of the established rules. They vary from strict compliance with the approved algorithms to arbitrary and often distorted interpretation of federal recommendations. The obtained data suggest that tighter restrictions are needed on the federal level in respect of regional adjustment coefficients, including those for day hospitals. The experience of some regions in distinguishing subgroups in standard DRGs including drug treatment schedules may be useful for further subdivision of DRGs on the federal level.

Keywords

diagnosis-related groups (DRG), coefficient for the level of medical care in health care institution (CLC), coefficient for the complexity of treatment of patient (CCT), management coefficient (MC), subgroups of DRG.

For citations

Sura M. V. DRG-based Payment for Medical Care in Mandatory Health Insurance: Regional Adaptation. Medical Technologies. Medical Technologies. Assessment and Choice. 2017; 4(30): 11–20.

mt_30_2017-4_11-20