Approaches to developing mechanisms for medical care centralization at the interterritorial level

Background. As new high-tech methods of treatment and diagnostics are introduced into the basic compulsory health insurance program, the focus on creating separate regional healthcare systems is becoming less effective. The creation of the necessary infrastructure requires disproportionately large investments, while the needs of the population in most regions do not provide adequate loading of newly created facilities. A promising solution to these problems is the centralization of delivering certain types of medical care (MC) on the basis of interregional medical centers.

Objective: development of approaches to identifying medical interventions that are appropriate to provide in specialized interregional centers.

Material and methods. The criteria for selection of medical interventions including MC profiles and diagnosis-related groups (DRGs) of diseases, which potentially require centralization were developed. On the basis of statistical analysis, data on specialized MC provided in inpatient settings by “Pediatric surgery” and “Traumatology and orthopedics” profiles were analyzed to identify regions with low and high levels of hospitalizations in order to determine the need for centralization or the creation of interregional centers.

Results. The analysis enabled to identify the territorial subjects of the Russian Federation (RF) where the issue of MC centralization would be relevant to increase its availability to the insured population in the territory of certain subject. Besides, the study identified regions, in which the number of hospitalizations significantly exceeded the average indicators in the RF. It is advisable to create interregional MC centers on the basis of such subjects.

Conclusion. The presented analysis of individual profiles and DRGs across the territorial subjects of the RF showed the objective differences in the extent of provided MC. The proposed methodology for determining DRGs and identifying subjects of the RF that have a surplus or deficit in the provision of MC can form the basis for approaches to identifying “MC centralization points”.

1. Decree of the Government of the RF dated 28.12.2023 No. 2353 “On the Program of state guarantees of providing free medical care to citizens for 2024 and for the planning period of 2025 and 2026”. Available at: https://base.garant.ru/408323431/ (in Russ.) (accessed 15.03.2024).

2. Federal Law dated 21.11.2011 No. 323-FZ “On the basics of public health protection in the Russian Federation”. Available at: https://base.garant.ru/12191967/ (in Russ.) (accessed 15.03.2024).

3. Dobrolyubova E.I., Starostina A.N. Efficiency of regional public expenditure on education and healthcare: evaluation from the citizens’ perspective. Financial Journal. 2022; 14 (4): 64–78 (in Russ.). https://doi.org/10.31107/2075-1990-2022-4-64-78.

4. Federal Law dated 29.11.2010 No. 326-FZ “On compulsory health insurance in the Russian Federation”. Available at: https://base.garant.ru/12180688/ (in Russ.) (accessed 15.03.2024).

5. Letter of the Ministry of Health of the RF dated 19.02.2024 No. 31-2/200 “On methodological recommendations on ways to pay for medical care at the expense of compulsory health insurance”. Available at: https://www.garant.ru/products/ipo/prime/doc/408486489/ (in Russ.) (accessed 15.03.2024).

6. Order of the Ministry of Health of the RF dated 13.10.2017 No. 804n “On approval of the nomenclature of medical services”. Available at: https://base.garant.ru/71805302/ (in Russ.) (accessed 15.03.2024).

7. Federal State Statistics Service. Demographics. Population size and composition. Available at: https://rosstat.gov.ru/folder/12781 (in Russ.) (accessed 15.03.2024).