| Abstrakt: |
Introduction: Based of tht author's doctoral dissertation of tht problems of insurance medicine, relevant monographs and scientific articles, an attempt is presented to substantiate tht option of transforming our purely governmental national system of insurance medicine. Purpose: Using more than thirty of our innovative organizational and medico-economic standards, criteria and regulations, in tht process of their "activation" in the conditions of a full-scale experiment under the pilot project program in the Health Care institutions of various levels of medical district, to determine the level of their effectiveness to justify the specified transformation during the launch of our system of insurance medicine. Materials and methods: The object of the study was all residents (up to 2000) of the family physician's area of responsibility. On the basis of structural-logical analysis and the use of medical-economic standards, doctors' labor costs, distribution of otolaryngological diseases into clinical-statistical groups (CSG) and diagnosticrelated groups (DRG), as well as the degree of their complexity and the complexity of possible surgical interventions, thanks to the formula for calculating the labor costs of doctors and treatment process we obtained evidencebased information about real "budget" cost of treatment of diseases of a certain CSG. Results and discussion: At the first in trade part mental stage of insurance medicine, the main tool should be a system of medical and economic standards, which include the price of labor costs, in particular doctors, wage fund, rates of increasing coefficients for the treatment of complex diseases, the level of financial incentives for doctors and the like. The tables present a mechanism for calculating the evidence-based cost of treating diseases of varying degrees of complexity and physician salaries, as well as the possibilities of forming both an adequate amount of funds that "follow the patient" and forecasting the health improvement budget for the family physician's area of responsibility. Conclusions: Presented an algorithm for the implementation of our medical and economic standards, the feasibility of which has been proven in the "field" conditions of the field experiment in the process of professional management, can constitute, under conditions of its continuous improvement, the medical and economic basis for the start of our system of budgetary and insurance medicine. [ABSTRACT FROM AUTHOR] |
