Publication Details
Abstract
The article presents methodological and applied results of building a system of clinical cost groups based on the analysis of step-down costing in institutions of the phthisiological profile of the Republic of Uzbekistan. The study was carried out as part of the reform of healthcare financing and the transition to a payment model for a treated case in the context of the introduction of public health insurance. The analysis covered 59 institutions, including a pilot sample of 13 hospitals. Aggregated data from the UzASBO-2 accounting system, statistical reporting (form 066/y), as well as cost allocation parameters for responsibility centers were used. It was found that clinical costs account for an average of 72% of total costs, auxiliary costs — 18%, administrative costs — 10%, with pronounced variability between institutions. A statistically significant inverse relationship was found between the share of administrative costs and the volume of treated cases (p = -0.72; p = 0.006). The average cost of a case varies significantly depending on the form of tuberculosis and drug resistance: from 85 082 rubles. for HP-TB up to 211 085 rubles. in XDR-TB in adult patients. A model of 10 enlarged CCGs has been developed, reflecting the clinical and economic stratification of cases and allowing for the formation of a reasonable pricing system. The results obtained confirm the applicability of the step-down costing method for the formation of a financially stable payment model in a specialized phthisiological service.