Komparativna analiza aktuelnog načina plaćanja bolničkih usluga u Srbiji i projektovanog plaćanja po sistemu dijagnostički srodnih grupa u urologiji
Sažetak
Uvod/Cilj. Ukupni određeni budžet za kalendarsku godinu je tradicionalni način finansiranja bolnica u Srbiji. Dijagnostički srodne grupe (DSG) je način plaćanja u bolnicama koji je baziran na klasifikaciji bolesnika po grupama sa sličnim dijagnozama, gde se očekuje slična iskorišćenost bolničkih resursa. Cilj ovog rada bilo je poređenje aktuelnog načina plaćanja bolnice i projektovanih troškova pomoću metode plaćanja prema DSG u urologiji. Metode. Podaci su dobijeni iz informacionog sistema koji se koristi u Kliničko-bolničkom centru (KBC) „Dr Dragiša Mišović“ – Dedinje u Beogradu, Srbija. Glavni kriterijum izbora ustanova bio je uspostavljen bolnički informacioni sistem. U studiju je uključeno nasumično izabranih 994 bolesnika lečenih operativno i konzervativno u 2012. godini. Rezultati. Prosečni troškovi po aktuelnom načinu plaćanja bili su malo veći od projektovanog DSG, ali je varijabilitet bio dva puta veći (54 111 ± 69 789 prema 53 434 ± 32 509; p < 0,001). Univarijantnom analizom utvrđeno je da najveću korelaciju sa aktuelnim načinom plaćanja, kao i sa projektovanim pomoću DSG, ima broj dana hostpitalizacije (ρ = 0,842; p < 0,001 i ρ = 0,637; p < 0,001). Multivarijantnim regresionim modelima potvrđen je uticaj broja dana hospitalizacije na troškokove prema aktuelnom sistemu plaćanja (β = 0,843; p < 0,001), kao i prema projektovanom DSG sistemu plaćanja (β = 0,737; p < 0,001). Isti prediktor bio je i ključni za razliku aktuelnog načina plaćanja i projektovanog DSG načina plaćanja (β = 0,501; p < 0,001). Zaključak. Plaćanje prema DSG administrativno je složenije jer zahteva detaljno i standardizovano kodiranje dijagnoza i procedura, kao i informacije o prosečnoj potrošnji resursa (troškova) prema DSG. S obzirom na to da zbirni troškovi lečenja koji se plaćaju na dva načina, poređena u istraživanju, nisu bitno različiti, fokus na manje hirurške intervencije i u aktuelnom načinu plaćanja bolnica i po uvođenju plaćanja po DSG bio bi daleko isplatljiviji za bolnicu jer bi se smanjile velike varijacije u performansama lečenja (smanjenje dana hospitalizacije i komplikacija), a posledično i računa.
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