Abstract

Annotation. The approaches implemented in the National Health Service of Ukraine (NHSU) for entering interactions or treated cases into packages in the field of “Oncology”, as well as the system of their financing, need constant improvement. The aim of the study is to assess the main inconsistencies and inaccuracies in the existing grouping rules regarding treated cases/interactions in packages in the field of “Oncology” and to formulate proposals for improving the Medical Guarantees Program in the field of “Oncology” based on the findings. A descriptive-analytical study was conducted for 8 months of the year 2022 comparing clinical approaches and compliance with the rate for medical services provided to patients with oncological and oncohematological diseases within the oncology packages of the Medical Guarantees Program with a comparison to Australian coding standards. As a result of the analysis, certain problems were revealed in the existing grouping rules regarding treated cases/interactions in the packages in the field of “Oncology”: unclear criteria for the inclusion of a case in the package, particularly the inclusion of diagnoses that are not related to malignant neoplasms; duplication of diagnoses in packages, which contributes to double/triple funding of the case; lack of medical and automatic monitoring for the correct coding of the main diagnosis and interventions; lack of ongoing analysis of services provided in outpatient settings from the point of view of their compliance with the rate, as well as failure to apply timely preventive measures. The proposed ways of improving the Medical Guarantees Program in the field of “Oncology” will allow to improve the equipment of diagnostic and treatment units for providing medical service to cancer patients due to the use of released/saved funds, which will lead to an increase in the survival rate of patients, timely diagnosis of cancer in the early stages and prevention of new cases of oncological diseases.

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