scholarly journals Optimization of payment for therapy with genetically engineered biological drugs and selective immunosuppressants at the expense of compulsory medical insurance fund in a day hospital at the regional level

2021 ◽  
pp. 53
Author(s):  
M.V. Sura ◽  
T.V. Boyarskaya ◽  
E.V. Derkach
Keyword(s):  
Medical Insurance ◽  
Genetically Engineered ◽  
Regional Level ◽  
Insurance Fund ◽  
Day Hospital ◽  
Biological Drugs

scholarly journals Regional adaptation of the federal model of reimbursement for medical assistance based on clinical statistical groups: hospitalization of patients in need of genetically enginered biological preparations

2018 ◽  
Vol 11 (2) ◽  
pp. 44-52
Author(s):  
M. V. Sura ◽  
T. N. Ignatova ◽  
N. S. Rudneva ◽  
Yu. N. Sukhanova ◽  
N. G. Ulyanova ◽  
...  
Keyword(s):  
Day Care ◽  
Medical Insurance ◽  
Genetically Engineered ◽  
Insurance Fund ◽  
Medical Assistance ◽  
Medical Organization ◽  
Inpatient Facility ◽  
Regional Adaptation ◽  
The Russian Federation ◽  
Insurance Model

The existing model of financial support of medical assistance for clinical-statistical groups (CSGs) in 2018 provides for the reimbursement for hospital stay expenses by the compulsory medical insurance fund in patients claiming the need for genetically engineered biological products (GiBP) during their stay in a day-care or 24-hour inpatient facility. The payment is made to CSG no. 121 in a day care and to CSG no. 316 in a 24-hour inpatient facility. The heterogeneity of the expenses for therapy with GiBP necessitates further division of the Federal CSGs into subgroups located in the constituent parts of the Russian Federation. This process has been initiated in some parts of the country, and it is seen as a way of regional adaptation of the Federal Medical insurance model. The proposed subdivision of the Federal CSGs allows for setting the tariffs reflecting the real expenses incurred by a local medical organization due to the therapeutic use of GiBP. The models of such specific CSGs proposed by RF subjects (after an expert evaluation) can be taken as a basis for updating the Federal CSG model, taking into account the differences in the costs of different drug therapy regimens.

scholarly journals THU0206 А VERY EARLY (7-28 DAYS) RESPONSE ON JAK INHIBITOR TOFACITINIB IN PATIENTS WITH ACTIVE RHEUMATOID ARTHRITIS: EFFECT ON PAIN AND CENTRAL SENSITIZATION.

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 327.3-327
Author(s):  
A. Karateev ◽  
E. Filatova ◽  
E. Pogozheva ◽  
V. Amirdzhanova ◽  
E. Nasonov ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Central Sensitization ◽  
Early Time ◽  
National Registry ◽  
Genetically Engineered ◽  
Pain Severity ◽  
Signal Pathways ◽  
Jak Inhibitor ◽  
Jak Inhibitors ◽  
Biological Drugs

Background:The presence of central sensitization (CS) significantly burdens the course of rheumatoid arthritis (RA). JAK inhibitors block intracellular signal pathways including the ones responsible for synthesis of mediators and cytokines causing pain and CS. The application of JAK inhibitors is supposed to relieve pain and reduce CS severity promptly.Objectives:To evaluate JAK inhibitor effect on pain and signs of CS in patients with active RA 7 and 28 days after the start of therapy.Methods:Study group included 39 patients with RA, their age was 50.9±11.1, 79.5% of women, 89.7% of RF “+”, DAS28 5.8±0.6, receiving DMARDs (methotrexate 82.0% and leflunomide 18.0%), who were administered with tofacitinib 5 mg 2 times a day due to inefficiency or intolerance of genetically engineered biological drugs. There were assessed the pain severity using Brief pain inventory (BPI) questionnaire, the presence of neuropathic pain component (NPC) using PainDETECT questionnaire and signs of CS using Central Sensitisation Inventory (CSI) questionnaire at early time after tofacitinib administration.Results:Patients initially experienced a severe pain – 5.72±2.21 according to the visual analogue scale (VAS), 53.8% had signs of central sensitization (CSI ≥ 40), 17.9% had NPC (PainDETECT ≥18). 7 days after tofacitinib intake there was statistically reliable reduction of pain severity – up to 4.37±2.2 (р=0.01), pain decrease of 29.4±17.9% (BPI), NCP – PainDETECT from 12.9±5.5 to 10.6±5.6 (р=0.047) and CS – CSI from 43.1±12.8 to 35.9±11.2 (р=0.01). The effect had increased after 28 days: pain level (VAS) was 2.84±1.57 (р=0.000), pain decrease of 43.6±29.6% (BPI), PainDETECT 29.8±12.4 (р=0.000), CSI 26.4±13.9 (р=0.000).During this period there were no serious adverse reactions.Conclusion:The application of JAK inhibitor tofacitinib allows to reach a fast analgesic effect, also due to impact on CS and NCP.Source: National Registry patients with RADisclosure of Interests: :Andrey Karateev: None declared, Ekaterina Filatova: None declared, Elena Pogozheva: None declared, Vera Amirdzhanova: None declared, Evgeny Nasonov: None declared, Alexander Lila: None declared, V Mazurov: None declared, N Lapkina: None declared, Galina Lukina Speakers bureau: Novartis, Pfizer, UCB, Abbvie, Biocad, MSD, Roche, Tatiana Salnikova: None declared, Ruzana Samigullina: None declared, Diana Chakieva: None declared, Irina Marusenko: None declared, Olga Semagina: None declared, Marina Semchenkova: None declared

Analysis of comorbid conditions and tolerability of treatment with genetically engineered biological drugs and methotrexate in patients with psoriasis

Pharmateca ◽  
2021 ◽  
Vol 8_2021 ◽  
pp. 20-26
Author(s):  
S.E. Zhufina Zhufina ◽  
K.A. Fomin Fomin ◽  
E.V. Svechnikova Svechnikova ◽  
◽  
Keyword(s):  
Genetically Engineered ◽  
Comorbid Conditions ◽  
Biological Drugs

scholarly journals Methods to assess the efficiency of local budget performance of the compulsory medical insurance fund in the Volga Federal District

2018 ◽  
Vol 16 (6) ◽  
pp. 1014-1027
Author(s):  
N.T. Yashina ◽  
◽  
E.A. Khansuvarova ◽  
L.A. Chesnokova ◽  
E.S. Malysheva ◽  
...  
Keyword(s):  
Federal District ◽  
Medical Insurance ◽  
Insurance Fund ◽  
Local Budget

Reforming Payment Methods for Basic Medical Insurance to Accommodate Traditional Chinese Medicine (TCM) in China : A Case Study of Shaanxi Province

2020 ◽  
Author(s):  
FANG ZHOU ◽  
XIAOHAO ZHANG ◽  
ZHIGUO MA
Keyword(s):  
Medical Insurance ◽  
Diagnosis And Treatment ◽  
Shaanxi Province ◽  
Insurance Fund ◽  
Payment Methods ◽  
Treatment Services ◽  
Basic Medical Insurance ◽  
Medical Institutions ◽  
Insurance Funds ◽  
Basic Medical

Abstract Background: Traditional Chinese medicine (TCM) attaches importance to the philosophy of holism and disease prevention. Meanwhile, costs arising from TCM diagnosis and treatment services are relatively low. Such features cater to the needs of less developed countries and regions to increase the equity and accessibility of medical services and to save basic medical insurance funds. However, China’s current payment system for basic medical insurance fails to fully regard these features, thus unable to incent the demand for and supply of TCM services. Methods: Based on the analysis of the features or rather the advantages of TCM, the article, taking Shaanxi Province located in central China as an example, studies the status quo of economic development, coverage of TCM diagnosis and treatment services by basic medical insurance, implementation of payment methods for basic medical insurance in TCM medical institutions, and aims to explore the reformation of payment methods for basic medical insurance. Results: Statistics have shown that the economic power of Shaanxi Province is below average in China, as a result of which, Shaanxi Province is confronted with a general lack of basic medical insurance fund. On the other hand, the present payment methods for basic medical insurance fail to accommodate the features of TCM. Besides, only a very limited number of TCM medical institutions, service items and medicines are covered by basic medical insurance. Consequently, the advantages of TCM are not exploited to the full in a country that has always treasured TCM. Therefore, reformation in payment methods is pressing. Conclusion: In view of the economic and social development of Shaanxi Province, this article proposes to reform the payment methods for basic medical insurance by introducing a new medicinal-effect-based payment method to accommodate TCM. This payment method has the following four features. Firstly, it advocates strengthening process supervision of diagnosis and treatment activities in medical institutions, establishing a rating system for therapeutic or prophylactic effects, and implementing a reward and punishment mechanism accordingly. Secondly, special audit standards for TCM services shall be determined by the health care department of the people’s government together with the relevant TCM administrative department, more TCM institutions, service items and medicines shall be covered by basic medical insurance, and the negotiation mechanism with medical insurance institutions shall be adjusted. Thirdly, in pricing the fees and standards for TCM services, the price control administrations of the people’s government shall consult TCM experts, and dynamic price adjustments based on costs and professional technical values shall be made. Last but not least, outpatient diagnosis and treatment services shall be covered by basic medical insurance fund, a practice which will not only give full play to the advantages TCM services, but also help reduce the financial burden on patients and save medical insurance funds.

scholarly journals Healthcare Supply Chain Network Coordination Through Medical Insurance Strategies with Reference Price Effect

2019 ◽  
Vol 16 (18) ◽  
pp. 3479
Author(s):  
Gao ◽  
Wang
Keyword(s):  
Decision Making ◽  
Supply Chain ◽  
Healthcare System ◽  
Reference Price ◽  
Medical Insurance ◽  
Patient Choice ◽  
Insurance Fund ◽  
Supply Chain Network ◽  
Price Effect ◽  
The Social

China has established the universal medical insurance system and individual out of pocket costs have decreased, however, the average healthcare expenditure of the Chinese population and the expenses of the whole society have increased substantially. One major challenge which impedes the progress of attaining sustainable development of the social healthcare system in China is that the number of hospital admissions is disproportionate. Superior hospitals are overcrowded, whereas subordinate hospitals are experiencing low admissions. In this paper, we apply the game theory model to coordinate the healthcare supply chain network, which is composed of the government, medical insurance fund, superior hospitals, subordinate hospitals and patients. Especially by taking the reference price effect into account, this paper analyzes different medical insurance reimbursement strategies and their influence on patient choice and the healthcare supply chain network. The result shows that the reference price effect increases the leverage of medical insurance, guides patients’ choice, optimizes the allocation of medical resources and reduces the medical expends. In comparison to a decentralized decision- making strategy, a centralized decision- making strategy can stimulate both superior hospital and subordinate hospital’s cooperative intentions which benefits the social healthcare system.

scholarly journals Use of Janus kinase inhibitors in the treatment of immunoinflammatory rheumatic diseases: safety issues

2021 ◽  
pp. 76-84
Author(s):  
B. S. Belov ◽  
N. V. Muravyeva ◽  
G. M. Tarasova ◽  
M. M. Baranova
Keyword(s):  
Rheumatic Diseases ◽  
Kinase Inhibitors ◽  
Infectious Complications ◽  
Genetically Engineered ◽  
Janus Kinase ◽  
Biological Drugs ◽  
Janus Kinase Inhibitors ◽  
Safety Issues ◽  
European League Against Rheumatism ◽  
Poor Tolerance

There has been clear progress in rheumatology in recent decades with the introduction of genetically engineered biological drugs (GEBDs) as well as targeted baseline anti-inflammatory drugs, which include Janus kinase inhibitors (i-JAKs). To date, i-JAKs have been actively used and studied in various immunoinflammatory rheumatic diseases (IIRDs) – rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis (AS), as well as psoriasis, atopic dermatitis and inflammatory bowel disease. In order to summarize the accumulated experience, the experts of the European League Against Rheumatism developed a consensus, which outlined the main principles and provisions concerning the rational use of i-JAKS in patients with IIRDs. At the same time, much attention is paid to the problem of the safety of these drugs. In the present article, issues related to various aspects of the safety of the use of i-JAKs in patients with IIRDs are discussed in detail, namely: dose adjustments due to drug interactions, contraindications, pre-screening, and risk assessment. Possible adverse events related to infectious complications, malignancies, thromboembolic phenomena, and gastrointestinal perforation were analyzed. The significance of clinical and laboratory monitoring in catamnestic follow-up of patients receiving i-JAKs is emphasized. A program for further research on the mentioned problem is presented. It includes studies of the efficacy and safety of «switching» between i-JAKs in patients with poor tolerance of a particular drug or who do not respond to treatment, evaluation of the effect of i-JAKs on comorbidities including cardiovascular disease and osteoporosis, studies of the long-term safety of i-JAKs based on actual practice data, and of the effectiveness and safety of i-JAKs and GEBDs combination therapy in patients with severe RA or other conditions, etc. This consensus is designed to inform and target physicians seeking to achieve optimal use of these drugs in patients with IIRDs, as well as patients themselves and other interested parties, including facility administrators. The recommendations will undoubtedly be expanded and supplemented as new data accumulate.

scholarly journals Application of Smart Healthcare in LTCI, Outpatient Mutual-Aid Guarantee Mechanism, and Sustainability of Medical Insurance Fund for Urban Employees

2022 ◽  
Vol 2022 ◽  
pp. 1-10
Author(s):  
Yating Ren ◽  
Zhe Yang
Keyword(s):  
Long Term Care ◽  
Population Aging ◽  
Medical Insurance ◽  
Insurance Fund ◽  
Mutual Aid ◽  
Care Needs ◽  
Term Care ◽  
Smart Healthcare ◽  
Long Run

With the aggravation of population aging and the increase of life expectancy, long-term care insurance (LTCI) system has been established to meet the medical and long-term care needs of the increasing elderly population. In China, LTCI system is currently not a stand-alone insurance, but it is attached to the national basic medical insurance fund for urban employees (MIUE). As a result, the expenditure of LTCI is a part of the expenditure of the MIUE, which has an impact on the sustainability of the MIUE. By modeling the income and expenditure of MIUE, especially including the expenditure of LTCI, this study optimized an LTCI system with a higher individual out-of-pocket payment ratio of LTCI and implementation of the outpatient mutual-aid guarantee mechanism (OMAGM), which could improve the sustainability of the MIUE. The study also reveals the following: (i) solely increasing individual out-of-pocket payment ratio of LTCI to 20%–50% can only postpone the deficit on Social Pooling Accounts (SPAs) by 1 or 2 years, and the effect is very limited. (ii) Besides a higher individual out-of-pocket payment ratio, further implementation of a partial OMAGM from 2022 will postpone the deficit on SPAs by 7–9 years, and the implementation of a complete OMAGM from 2022 will postpone the deficit by 14–18 years. Accordingly, China should implement OMAGM as soon as possible to enhance the solvency of MIUE fund, and, in the long run, an independent LTCI scheme should be established to ensure the stability and sustainability of the LTCI fund and the MIUE fund.

Main Changes in the Model of Diagnosis-Related Groups in Russia in 2020

2020 ◽  
pp. 19-29
Author(s):  
Maria Leonidovna Lazareva ◽  
Inna Alexandrovna Zheleznyakova ◽  
Maria Vladimirovna Avxentyeva ◽  
Denis Valerievich Fedyaev ◽  
Alexandr Vladimirovich Zuev ◽  
...  
Keyword(s):  
Diagnosis Related Groups ◽  
Chronic Viral Hepatitis ◽  
Genetically Engineered ◽  
Classification Criteria ◽  
Correction Factors ◽  
Biological Drugs ◽  
Viral Hepatitis C ◽  
Inpatient Settings ◽  
Day Hospitals ◽  
Chronic Viral Hepatitis C

Since 2013 a diagnosis-related groups (DRG) model has been introduced for the payment of medical care provided in inpatient settings and the day hospitals in Russia at the federal level. The DRG model is improved annually by the increasing of DRG number and specifying the classification criteria for attributing treatment cases to a particular group. In this article, we describe the main changes in the DRG model in 2020 compared with the last year. Main changes include the creation of new classification criteria for the formation of DRG, new DRG in the oncology profile, the changes in the DRG for epilepsy and chronic viral hepatitis C treatment, as well as for the use of genetically engineered biological drugs and selective immunosuppressants. The article also describes the innovations regarding the general approaches to paying for health care with respect to DRG: the rules for applying regional correction factors and for simultaneous payment for two DRG within one treatment case.

Sign in / Sign up

Export Citation Format

Share Document