ONCOLOGICAL SERVICE PROVISION WITHIN THE MEDICAL CARE GUARANTEE PACKAGE OF THE NATIONAL HEALTH SERVICE "TREATMENT AND FOLLOW-UP OF ADULTS AND CHILDREN WITH HEMATOLOGICAL AND ONCOHEMATOLOGICAL DISEASES IN OUTPATIENT AND IN-PATIENT SETTINGS"

Abstract

Introduction. The approaches to the criteria for assigning a treated case/interaction to oncology packages and the principles of their payment introduced by the National Health Service need to be improved in order to prevent the introduction of inadequate tariffs, in particular, failure to provide services in the amount specified in the tariff or, on the contrary, double/triple funding, which can lead to a significant increase in the costs of financing oncology medical services. The aim of the study is the identification of the main defects and gaps in the existing rules of the grouper regarding the assignment of a treated case/interaction to the oncology package "Treatment and follow‑up of adults and children with hematological and oncohematological diseases in outpatient and inpatient settings" and, on this basis, developing suggestions for improving services in this direction. Materials and Methods. A descriptive-analytical study of the analysis of medical services provided in the oncology package 38 "Treatment and follow-up of adults and children with hematological and oncohematological diseases in outpatient and inpatient settings" for the first 8 months of 2022 was performed according to the data of the National Health Service of Ukraine and the normative legal acts that regulate the issue of implementing the Medical Guarantees Program. Results. The study assessed the correctness of the criteria for the entry of Electronic Medical Records into package 38 compared to the Australian coding standards and analyzed the consistency of payment according to the rate for the provided medical services to patients with oncological and oncohematological diseases within the limits of all interactions of package 38. Certain inconsistencies in the selection of diagnoses for inclusion in the list of reasons for providing medical services and the vagueness of the criteria for including a case in the package were revealed, when a specific diagnosis is a criterion for inclusion in both the 38th package and the corresponding DRG, but with different funding. It was established that 1/5 of all children within the framework of this package sought medical help in an outpatient setting only once or twice, and the list of interventions does not correspond to the package rate; among adults, there was a significant number of patients who sought medical care 1 or 2 times in an outpatient setting, and paid for these cases at the full rate. The findings indicate an urgent need for two-stage medical monitoring of all interactions established for oncological diagnoses within the framework of the therapeutic package. The first automatic monitoring should be carried out according to certain indicators with the formation of "a red list of interactions", and then doctors check these interactions, even in manual mode. Conclusions. On the basis of the results, recommendations were developed regarding changes to the Medical Guarantee Program in oncology, namely to the interactions in the package "Treatment and follow-up of adults and children with hematological and oncohematological diseases in outpatient and inpatient settings", which relate to the grounds for providing services within the framework of oncology packages and coordination of medical services provided to patients with oncohematological diseases with a tariff that will allow for proper payment of the medical services and will improve the provision of medical services.