Raziskava stroškov zdravljenja z zdravili v času hospitalizacije na Kliniki Golnik

Pirc, Meta (author), Kos, Mitja (mentor), Morgan, Tina (co-mentor)

Zdravstveno zavarovanje v Sloveniji je v domeni Zavoda za zdravstveno zavarovanje Slovenije. V njegovi pristojnosti je financiranje tako zdravil iz javnih sredstev, kot tudi bolnišničnih obravnav in drugih zdravstvenih dejavnosti. Zdravila, ki jih osebe prejmejo v času hospitalizacije, so financirana v okviru povračila za Skupino primerljivih primerov (SPP), ki pripada tej hospitalizaciji. Iz takega načina financiranja ne moremo vedeti, koliko Zavod za zdravstveno zavarovanje Slovenije dejansko plačuje za bolnišnična zdravila, ter kolikšen delež povračila za posamezen SPP ta predstavljajo. V nalogi smo raziskali stroške, ki jih je predstavljalo zdravljenje z zdravili hospitaliziranih oseb na Kliniki Golnik v letu 2019 in kakšni so ti stroški v relaciji do povračila za SPP, ki je bil posamezni hospitalizaciji šifriran. To smo storili s popisom vseh odmerkov vseh zdravil, ki so jih pacienti prejeli v času hospitalizacije in nadaljnjo obdelavo pridobljenih podatkov. Naredili smo retrospektivno raziskavo na 414 hospitalizacijah in ugotovili, da je bil povprečni strošek zdravil v času hospitalizacije 136,05 EUR, kar je v povprečju predstavljalo 4,9% povračila za SPP. Stroški zdravil so znašali od 0,00 EUR do 4.774,29 EUR, deleži od povračila za SPP pa od 0,0% do kar 122,0%. Najvišje stroške na hospitalizacijo, kot tudi najvišje deleže od povračila za SPP, so predstavljala zdravila iz skupine ATC L – Zdravila z delovanjem na novotvorbe in imunomodulatorji, najvišje skupne stroške pa so predstavljala zdravila iz skupine ATC J - Zdravila za sistemsko zdravljenje infekcij. SPP, pri katerem so zdravila predstavljala najvišji povprečni strošek, je bil A06Z - Traheostomija vse starosti, vsa stanja, SPP z najvišjim deležem stroškov zdravil glede na povračilo za SPP pa G66B - Bolečina v trebuhu ali mezenterijski adenitis brez spremljajočih bolezenskih stanj ali zapletov. Ugotovili smo tudi, da 80% aplikacij najcenejših zdravil, opredeljenih s ceno na enoto, predstavlja le 15% celokupnega stroška vseh zdravil.

• Language: Slovenian
• Keywords: Financiranje, skupine primerljivih primerov, hospitalizacija, stroški zdravil
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2023
• PID: 20.500.12556/RUL-151824
• Publication date in RUL: 21.10.2023

Secondary language

• Language: English
• Title: Research of medication costs during hospitalization at Klinika Golnik

Abstract

The health insurance provider in Slovenia is The Health Insurance Institute of Slovenia. It oversees financing of both the medication that is financed from the public fund as well as hospital stays and other health care services. Medication that a person is given during their hospitalization is financed as a part of the Diagnosis-related Group (DRG) that befalls that hospitalization. That’s why we don’t know exactly how much The Health Insurance Institute of Slovenia pays for medication used in hospitals and what share of the reimbursement for each individual DRG their cost represents. Our objective was to research medication costs that occurred during hospitalization at Klinika Golnik in 2019 and to find out what share of the reimbursement for each individual DRG they represented. We did that by recording every unit of every medication that the patients were given during their hospitalization and analysing the obtained data. We did a retrospective research on 414 hospitalizations and found that the mean medication cost per hospitalization was 136,05 EUR, which in average represents 4,9% of the reimbursement for DRG. Medication costs ranged from 0,0 EUR to 4.774,29 EUR, while shares of the reimbursement for DRG varied between 0,0% and 122,0%. ATC group with the highest average cost of medication per hospitalization as well as highest average share of the reimbursement for DRG was group L – Antineoplastic and immunomodulating agents, while the group with highest combined costs of medication was group J – Antiinfectives for systemic use. DRG with the highest average medication cost was A06Z – Tracheostomy, while DRG with the highest share of the reimbursement for DRG was G66B - Abdominal Pain or Mesenteric Adenitis without complications or comorbidity. We also found that 80% of applications of the cheapest medication, defined by price per unit, only accounted for 15% of total medication cost.

• Keywords: Financing, diagnosis-related group, hospitalization, medication cost