Actual issues of providing and paying for medical care within compulsory medical insurance in patients with retinal diseases

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OBJECTIVE

To assess medical care (intravitreal administration of the drugs) for patients with retinal diseases in the Russian Federation, to compare availability of intravitreal administration of the drugs in Russia with this parameter in other countries, to analyze the modern payment system for specialized medical care within the basic compulsory health insurance program for this medical procedure.

MATERIAL AND METHODS

Intravitreal administration of the drugs in patients with retinal diseases in the Russian Federation was assessed using data from the registers of compulsory health insurance accounts. Payment system for intravitreal administration of the drugs was estimated considering the number of admissions by diagnosis-related group «Eye surgery (level 5)» (st21.005 and ds21.006) in the context of ICD-10 diagnoses, nomenclature of medical services, levels of medical organizations and correction factors for this diagnosis-related group. Availability of intravitreal administration of the drugs was compared with this parameter in other countries considering IQVIA (Institute for Human Data Science Reports) report on procurement of angiogenesis inhibitors and statistical data on the prevalence of age-related macular degeneration and diabetic macular edema for 2019.

RESULTS

Mean number of admissions for intravitreal administration of the drugs in Russia is 2.99 cases per 10 000. Only 35% of admissions were aimed at intravitreal administration of the drugs. One patient receives near 2.15 these procedures in Russia. Actual availability of angiogenesis inhibitors is 9.6—11.7 times lower than the required level.

CONCLUSION

We found imperfection of modern payment system for medical care in patients with retinal diseases regarding the balance of diagnosis-related group «Eye surgery (level 5)». Absence of unified approaches to planning and insufficient availability of medical care for patients with retinal diseases in the regions of Russia were also observed.

Keywords:

intravitreal administration

angiogenesis inhibitors

age-related macular degeneration

diabetic retinopathy

retinal diseases

Authors:

Kovaleva S.A.

Center for Expertise and Quality Control of Medical Care

Fedyaev D.V.

Center for Expertise and Quality Control of Medical Care;
Russian Medical Academy of Continuous Professional Education;
Research Financial Institute

ORCID: 0000-0001-8977-5934

Seryapina Yu.V.

Center for Expertise and Quality Control of Medical Care

Scopus AuthorID: 57373554500
ORCID: 0000-0003-2607-8765

Received:

22.12.2020

Accepted:

14.01.2021

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