vspВопросы современной педиатрииCurrent Pediatrics1682-55271682-5535Издательство «ПедиатрЪ»10.15690/vsp.v13i4.1085vsp-168Research ArticleОБМЕН ОПЫТОМEXCHANGE OF EXPERIENCEПЕРСПЕКТИВЫ ИСПОЛЬЗОВАНИЯ КЛИНИКО-СТАТИСТИЧЕСКИХ ГРУПП ДЛЯ ОПЛАТЫ МЕДИЦИНСКОЙ ПОМОЩИ В ПЕДИАТРИИ И НЕОНАТОЛОГИИDIAGNOSTIC-RELATED GROUPS IN PEDIATRICS AND NEONATOLOGY: PERSPECTIVESАвксентьеваМ. В.Avksent'evaM. V.

Avksent'eva Mariya Vladimirovna, PhD, Deputy Director of the Center for Technology Assessment in Health Care of the Russian Presidential Academy of National Economy and Public Administration, professor of Public Health and Preventative Medicine Department of I. M. Sechenov First MSMU

avksent@yahoo.comРоссийская академия народного хозяйства и государственной службы при Президенте РФ, Москва; Первый Московский государственный медицинский университет им. И.М. СеченоваРоссияRussian Presidential Academy of National Economy and Public Administration, Moscow; I.M. Sechenov First Moscow Medical UniversityRussian Federation201402082014134Вопросы современной педиатрии5462Copyright © Авксентьева М.В., 20142014Авксентьева М.В.Avksent'eva M.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vsp.spr-journal.ru/jour/article/view/168

С 2012 г. в Российской Федерации осуществляется внедрение клинико-статистических групп (КСГ). Цель этой работы― унифицировать методы оплаты медицинской (стационарной и стационарозамещающей) помощи. В настоящее время действует вторая версия модели КСГ, утвержденная приказом Федерального фонда обязательного медицинского страхования от 14.11.2013 г. № 229. В действующей модели КСГ (приказ Федерального фонда обязательного медицинского страхования от 14.11.2013 г. № 229) случаи лечения детей в основном оплачиваются по тем же правилам, что и взрослых. Исключением являются отдельные КСГ для неонатологии, лечения сахарного диабета и острого лейкоза у детей. Разработанная на федеральном уровне модель КСГ предназначена для использования на всей территории Российской Федерации, однако не является окончательной и будет дорабатываться, в т.ч. путем увеличения числа педиатрических групп. Каждой КСГ соответствует свой коэффициент относительной затратоемкости, на основе которого рассчитывается тариф на случай госпитализации, входящий в данную группу. В субъектах Федерации могут применяться поправки к коэффициенту относительной затратоемкости КСГ в целях адаптации модели к региональным условиям, а также выделяться подгруппы из действующих КСГ по установленным правилам.

Diagnostic-related groups (DRG) are being implemented in Russian Federation since 2012 for hospital and day hospital payment. Unification of provider-payment methods and increase of health care efficiency are considered as the main goal of DRG. Presently the 2d version of Russian DRG model is approved by the Federal Fund of mandatory medical insurance, order from 14.11.2013 № 229. Treatment of children is mostly paid for by the same rules as adults’ treatment just now. There are several separate neonatal groups, as well as separate groups for diabetes and acute leukemia in children. The federal DRG model should be used in all regions of Russia, still it’s not final now and has to be improved. For example, number of pediatric groups will be increased. Each DRG has its own weight coefficient for calculating the tariff. The regions in RF can use correction coefficients to adjust the model. Besides regions can extract subgroups from basic DRG on the basis of standard methodology.

методы оплаты медицинской помощиклинико-статистические группыкоэффициент относительной затратоемкостинеонатологияпедиатрияmedical care provider payment methodsdiagnostic related groupsweight coefficientneonatologypediatricsReferencesO’Dougherty Sh., Cashin C., Samyshkin E., Ibraimova A., Katsaga A., Kutanov E., Lyachshuk K., Zues O. Case-based hospital payment systems. In: Designing and Implementing Health Care Provider Payment Systems. How to Manuals. J. C. Langenbrunner, C. Cashin, S. O’Dougherty (eds.). The International Bank for Reconstruction and Development. The World Bank. 2009. Ch. 2. P. 125–214.O’Dougherty Sh., Cashin C., Samyshkin E., Ibraimova A., Katsaga A., Kutanov E., Lyachshuk K., Zues O. Case-based hospital payment systems. In: Designing and Implementing Health Care Provider Payment Systems. How to Manuals. J. C. Langenbrunner, C. Cashin, S. O’Dougherty (eds.). The International Bank for Reconstruction and Development. The World Bank. 2009. Ch. 2. P. 125–214.Postanovlenie Pravitel’stva Rossiiskoi Federatsii ot 22 oktyabrya 2012 goda № 1074 «O programme gosudarstvennykh garantii (PGG) besplatnogo okazaniya grazhdanam meditsinskoi pomoshchi na 2013 god i na planovyi period 2014 i 2015 godov» [Resolution of the Government of the Russian Federation № 1074 “On the Program of State Guarantees (PSG) for Providing Free Health Care for Citizens during the 2013 and the planning period of 2014 and 2015” dated October 22, 2012]. Moscow, 2012.Postanovlenie Pravitel’stva Rossiiskoi Federatsii ot 22 oktyabrya 2012 goda № 1074 «O programme gosudarstvennykh garantii (PGG) besplatnogo okazaniya grazhdanam meditsinskoi pomoshchi na 2013 god i na planovyi period 2014 i 2015 godov» [Resolution of the Government of the Russian Federation № 1074 “On the Program of State Guarantees (PSG) for Providing Free Health Care for Citizens during the 2013 and the planning period of 2014 and 2015” dated October 22, 2012]. Moscow, 2012.Rekomendatsii po formirovaniyu sposobov oplaty meditsinskoi pomoshchi v ramkakh programmy gosudarstvennykh garantii (PGG) na osnove grupp zabolevanii, v tom chisle KSG (pis’mo Ministerstva zdravookhraneniya Rossiiskoi Federatsii ot 20 dekabrya 2012 goda № 14-6/10/2-5305) [Recommendations for the Formation of Payment Methods for Medical Assistance under the State Guarantee Program (SGP) according to the Groups of Diseases, including DRG (the letter of the Ministry of Health of the Russian Federation of December 20, 2012 № 14-6/10/2-5305)]. Moscow, 2012.Rekomendatsii po formirovaniyu sposobov oplaty meditsinskoi pomoshchi v ramkakh programmy gosudarstvennykh garantii (PGG) na osnove grupp zabolevanii, v tom chisle KSG (pis’mo Ministerstva zdravookhraneniya Rossiiskoi Federatsii ot 20 dekabrya 2012 goda № 14-6/10/2-5305) [Recommendations for the Formation of Payment Methods for Medical Assistance under the State Guarantee Program (SGP) according to the Groups of Diseases, including DRG (the letter of the Ministry of Health of the Russian Federation of December 20, 2012 № 14-6/10/2-5305)]. Moscow, 2012.Postanovlenie Pravitel’stva Rossiiskoi Federatsii ot 18 oktyabrya 2013 goda № 932 «O programme gosudarstvennykh garantii (PGG) besplatnogo okazaniya grazhdanam meditsinskoi pomoshchi na 2014 god i na planovyi period 2015 i 2016 godov» [Resolution of the Government of the Russian Federation № 932 “On the Program of State Guarantees (PSG) for Providing Free Health Care for Citizens during the 2014 and the planning period of 2015 and 2016” dated October 18, 2013]. Moscow, 2013.Postanovlenie Pravitel’stva Rossiiskoi Federatsii ot 18 oktyabrya 2013 goda № 932 «O programme gosudarstvennykh garantii (PGG) besplatnogo okazaniya grazhdanam meditsinskoi pomoshchi na 2014 god i na planovyi period 2015 i 2016 godov» [Resolution of the Government of the Russian Federation № 932 “On the Program of State Guarantees (PSG) for Providing Free Health Care for Citizens during the 2014 and the planning period of 2015 and 2016” dated October 18, 2013]. Moscow, 2013.Prikaz FFOMS ot 14.11.2013 № 229 «Ob utverzhdenii «Metodicheskikh rekomendatsii po sposobam oplaty spetsializirovannoi meditsinskoi pomoshchi v statsionarnykh usloviyakh i v dnevnykh statsionarakh na osnove grupp zabolevanii, v tom chisle kliniko-statisticheskikh grupp (KSG) i kliniko-profil’nykh grupp (KPG) za schet sredstv sistemy obyazatel’nogo meditsinskogo strakhovaniya». Dostup iz informatsionno-spravochnoi sistemy «Konsul’tant Plyus». 15.07.2014 [Directory of Federal Compulsory Medical Insurance Fund № 229 “On Approval of the “Guidelines on the Available Methods of Specialized Medical Care in a Hospitals and day hospitals according to the Groups of Diseases, including Diagnosis-Related Group (DRG) and Speciality-Related Groups (SRG) at the Expense of the Compulsory Health Insurance” dated November 14, 2013. Access from the reference system “Consultant Plus” on July 15, 2014].Prikaz FFOMS ot 14.11.2013 № 229 «Ob utverzhdenii «Metodicheskikh rekomendatsii po sposobam oplaty spetsializirovannoi meditsinskoi pomoshchi v statsionarnykh usloviyakh i v dnevnykh statsionarakh na osnove grupp zabolevanii, v tom chisle kliniko-statisticheskikh grupp (KSG) i kliniko-profil’nykh grupp (KPG) za schet sredstv sistemy obyazatel’nogo meditsinskogo strakhovaniya». Dostup iz informatsionno-spravochnoi sistemy «Konsul’tant Plyus». 15.07.2014 [Directory of Federal Compulsory Medical Insurance Fund № 229 “On Approval of the “Guidelines on the Available Methods of Specialized Medical Care in a Hospitals and day hospitals according to the Groups of Diseases, including Diagnosis-Related Group (DRG) and Speciality-Related Groups (SRG) at the Expense of the Compulsory Health Insurance” dated November 14, 2013. Access from the reference system “Consultant Plus” on July 15, 2014].Prikaz Minzdrava Rossii ot 10.12.2013 № 916n «O pere chne vidov vysokotekhnologichnoi meditsinskoi pomoshchi». Dostup iz informatsionno-spravochnoi sistemy «Konsul’tant Plyus». 15.07.2014 [Directory of the Ministry of Health of Russia № 916n “On the List of High-tech Medical Care” dated December 10, 2013 Access from the reference system “Consultant Plus” on July 15, 2014].Prikaz Minzdrava Rossii ot 10.12.2013 № 916n «O pere chne vidov vysokotekhnologichnoi meditsinskoi pomoshchi». Dostup iz informatsionno-spravochnoi sistemy «Konsul’tant Plyus». 15.07.2014 [Directory of the Ministry of Health of Russia № 916n “On the List of High-tech Medical Care” dated December 10, 2013 Access from the reference system “Consultant Plus” on July 15, 2014].

The authors declare that there are no conflicts of interest present.