Analiza systemu wyceny usług ambulatoryjnej opieki specjalistycznej w Polsce po 2011 roku na tle rozwiązań zagraniczych i modeli teoretycznych

• Autorzy: Monika Raulinajtys-Grzybek

Warianty tytułu

Analysis of the Pricing System of Specialist Ambulatory Health Services in Poland on the Background of Foreign Solutions for and Model Theory

• Języki publikacji: PL

Abstrakty

Celem artykułu jest analiza wyceny usług ambulatoryjnej opieki specjalistycznej w Polsce w świetle teoretycznych rozważań na temat budowy systemów wyceny oraz rozwiązań, jakie funkcjonują w tej dziedzinie w innych krajach Unii Europejskiej oraz w Stanach Zjednoczonych.(fragment tekstu)

EN

The article attempts to characterize the pricing of specialist outpatient services in Poland. As a point of reference were taken theoretical considerations on the diagnosis-related groups and the impact of the construction of the system on the severity of drawbacks, which are mentioned in the literature. Also the foreign pricing models were presented. Pricing of specialist ambulatory services in Poland was modelled on solutions that exist e.g. in England or the United States. They are based on the system of diagnostic groups. Unfortunately, the analysis indicates that the clinical and cost uniformity of groups, which determine proper functioning of the system, are preserved only to a limited degree. Compared with most foreign models it can also be noted, that Polish system lacks incentives for complex treatment and that the payer takes discretionary approach to setting prices. In most of the analysed countries prices are formulated based on costs of service providers.(original abstract)

Słowa kluczowe

PL

Opieka zdrowotna; Procedura diagnozowania; Wycena

EN

Health care; Diagnostic procedure; Valuation

• Czasopismo: Zdrowie Publiczne i Zarządzanie
• Rocznik: 2015
• Tom: 13
• Numer: nr 1
• Strony: 115--125

Twórcy

autor

Monika Raulinajtys-Grzybek

• Szkoła Główna Handlowa w Warszawie

Bibliografia

• Narodowy Rachunek Zdrowia za 2012 rok, Główny Urząd Statystyczny, http://stat.gov.pl/obszary-tematyczne/zdrowie/zdrowie/narodowy-rachunek-zdrowia-za-2012-rok,4,5.html; dostęp: 24.06.2015.
• Health at a Glance 2013 OECD Indicators, OECD, 2013, www.oecd.org/els/health-systems/Health-at-a-Glance-2013.pdf; dostęp: 24.06.2015.
• Leister J.E., Stausberg J., Comparison of cost accounting methods from different DRG systems and their effect on health care quality, "Health Policy" 2005; 74: 47.
• Evers S. et al., Predicting the cost of hospital stay for stroke patients: the use of diagnosis related groups, "Health Policyˮ 2002; 61: 23-25.
• Jegers M., Kesteloot K., De Graeve D., Gilles W., A typology for provider payment systems in health care, "Health Policyˮ 2002; 60: 255-273.
• Waters H.R., Hussey P., Pricing health services for purchasers - a review of methods and experiences, "Health Policy" 2004; 70: 175-184.
• Woodin J., Zarządzanie systemem i kontraktowanie w opiece zdrowotnej, w: K. Walshe, J. Smith (red.), Zarządzanie w opiece zdrowotnej, Oficyna, Warszawa 2011: 265.
• Fetter R.B., Thompson J.D., Mills R.S., A system for cost and reimbursement control in hospitals, "The Yale Journal of Biology and Medicineˮ 1976; 49: 123-136.
• Fetter R.B., Mills R.E., Riedel D.C. et al., The application of diagnostic specific cost profiles to cost and reimbursement control in hospitals, "Journal of Medical Systems" 1977; 1: 137-149.
• Kuntz L., Scholtes S., Vera A., DRG cost weight volatility and hospital performance, "OR Spectrum" 2008, April: 331-335.
• Wilke M., Höcherl E., Scherer J., Janke L., Introducing the new DRG-based payment system in German hospitals: a difficult operation?: Experience and attempts at a solution from a surgery point of view, "The European Journal of Health Economicsˮ 2001, June: 79-85.
• Felder S., The variance of length of stay and the optimal DRG outlier payments, "International Journal of Health Care Finance and Economics" 2009, September: 279-289.
• Vitikainen K., Linna M., Street A., Substituting inpatient for outpatient care: what is the impact on hospital costs and efficiency?, "The European Journal of Health Economics" 2010; 11: 395-404.
• Hughes J.S., Lichtenstein J., Magno L., Fetter R.B., Improving DRGs. Use of procedure codes for assisted respiration to adjust for complexity of illness, "Medical Careˮ1989; 27: 750-757.
• Wood T.J., Thomas S.E., Severity of illness and diagnosis related groups, "Medical Journal of Australia" 1986; 143: 79-81.
• Finkler S.A., Flexible budget variance analysis extended to patient acuity and DRGs, "Health Care Management Reviewˮ 1985; 10: 21-34.
• Partsch M., Held M., Rechnen für Gerechtigkeit, "Gesundheit und Gesellschaft" 2004; 11: 24-29.
• Lisowska K., NFZ zmienia zasady finansowania ambulatoryjnej opieki specjalistycznej, "Rynek Zdrowia", 15.06.2011, http://www.rynekzdrowia.pl/Finanse-i-zarzadzanie/NFZ-zmienia-zasady-finansowania-ambulatoryjnej-opieki-specjalistycznej,109940,1.html; dostęp: 24.06.2015.
• Rozporządzenie Ministra Zdrowia z dnia 27 maja 2011 roku w sprawie świadczeń gwarantowanych z zakresu ambulatoryjnej opieki specjalistycznej (Dz.U. 2011 Nr 111 poz. 653).
• Zarządzenie nr 29/2011/DSOZ Prezesa Narodowego Funduszu Zdrowia z dnia 14 czerwca 2011 roku w sprawie określenia warunków zawierania i realizacji umów w rodzaju ambulatoryjna opieka specjalistyczna.
• Zarządzenie nr 79/2014/DSOZ Prezesa Narodowego Funduszu Zdrowia z dnia 5 grudnia 2014 roku w sprawie określenia warunków zawierania i realizacji umów w rodzaju ambulatoryjna opieka specjalistyczna.
• Wójtowicz M., Problemy z klasyfikacją JGP na styku AOS - szpital, "Rynek Zdrowia", 12.10.2011, http://www.rynekzdrowia.pl/Finanse-szpitali/Problemy-z-klasyfikacja-JGP-na-styku-AOS-szpital,112522,1012.html; dostęp: 24.06.2015.
• Kulesher R.R., Wilder M.G., Prospective Payment and the Provision of Post-Acute Care: How the Provisions of the Balancet Budget Act of 1997 Altered Utilization Patterns for Medicare Providers, "Journal of Health Care Finance" 2006; 33(1): 1-16.
• Wilson S.F., Shorten B., Marks R., Costing the ambulatory episode: implications of total or partial substitution of hospital care, "Australian Health Review" 2005; 29(3): 360-365.
• Averill R.F. et al., Design of a prospective payment patient classification system for ambulatory care, "Health Care Financing Review" 1993; 15(1): 71.
• Duncan D.G., Servais C.S., Preparing for the new outpatient reimbursement system, "Healthcare Financial Managementˮ 1996; 50(2): 42.
• Ambulatory patient groups, "Health Care Financing Review" 1998; statistical supplement: 128-130.
• Asubonteng P., Middleton R., Munchus G., Ambulatory patient groups and redefining the roles of health care providersʼ delivery services in the USA, "Health Manpower Management" 1996; 22(1): 16-20.
• Daniels P., Improving ambulatory surgery reimbursement, "Nursing Managementˮ 1997; 28(5): 40M.
• Epstein D., Mason A., Smith P.C., HealthBASKET - Health Benefits and Service Costs in Europe SP21-CT-2004-501588, WP6: Costs and health benefits for England, Centre for Health Economics, University of York, York YO10 5DD England UK, 2005.
• NHS, A simple guide to Payment by Results, Department of Health, 2011.
• NHS, Payment by Results Step-by-Step Guide: Calculating the 2013-14 National Tariff, Department of Health, 2013.
• Reference costs guidance for 2012-13. A draft for NHS feedback, Department of Health, 2012.
• Bilde L., Ankjær-Jensen A., HealthBasket Work Package 6 Health Benefits and Service Costs in Europe SP21-CT-2004-501588, Approaches for Cost and Price Assessment in the Danish Health Sector, DSI, Danish Institute for Health Services Research, 2005.
• Bellanger M., Or Z., Paris V., Tardif L., HealthBasket Work Package 6 Health Benefits and Service Costs in Europe SP21-CT-2004-501588, Work Package 6: Approaches for Cost Assessment & Price Setting in Practice France, 2005.
• Sánchez-Martínez F., Abellán-Perpiñán J.-M., Martínez-Pérez J.-E., Iván Moreno I., Health Basket- Health Benefits and Service Costs in Europe SP21-CT-2004-501588, Spanish Cost/Price Assessment Report, Universidad de Murcia, CRES - Universitat Pompeu Fabra, 2005.
• Oostenbrink J.B., Rutten F.F.H., Health Basket- Health Benefits and Service Costs in Europe SP21-CT-2004-501588, Cost Assessment and Price Setting in the Dutch Healthcare System, Institute for Health Policy and Management Erasmus MC, Rotterdam 2005.
• Schreyögg J., Tiemann O., Busse R., HealthBasket Work Package 6 Health Benefits and Service Costs in Europe SP21-CT-2004-501588, Work Package 6: Approaches for Costing and Pricing in Practice Germany, Department of Health Care Management, Faculty of Economics and Management, Berlin University of Technology, 2005.
• Gaál P., HealthBasket Work Package 6 Health Benefits and Service Costs in Europe SP21-CT-2004-501588, Work Package 6: Approaches for Cost Assessment & Price Setting in Practice Hungary, Semmelweis University Health Services Management Training Centre, 2005.
• Fattore G., Torbica A., Health Basket- Health Benefits and Service Costs in Europe SP21-CT-2004-501588, Approaches for cost/ price assessment in practice. County report: Italy, 2005.
• Raulinajtys-Grzybek M., Ambulatory Patient Groups: Impact on the Service Structure and Providers' Behaviour, "Paradigm" 2014; 18(2): 121-134.
• Raulinajtys-Grzybek M., Wycena usług ambulatoryjnej opieki specjalistycznej, ABC, Warszawa 2014.

Identyfikatory

DOI

10.4467/20842627OZ.15.012.4125