Unveiling the truth: is COVID-19 reimbursement in Colombia a flawed design? A cost-of-illness analysis for moderate, severe and critical infections

IF 3.6 3区 医学 Q1 RESPIRATORY SYSTEM BMJ Open Respiratory Research Pub Date : 2024-04-01 DOI:10.1136/bmjresp-2023-002097
Liliana Fernandez-Trujillo, Saveria Sangiovanni, Ana Isabel Castrillon, Lina Hincapie-Zapata, Lina Maria Góez-Mogollón, Marcela Brun Vergara, Sergio I Prada
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Abstract

Purpose This study examines the financial impact of the COVID-19 pandemic on the Colombian Health System, focusing on the adequacy of reimbursement rates for inpatient stays. The study, based on a cost of illness analysis, aims to evaluate the effectiveness of the reimbursement scheme and identify potential economic losses within the health system. Patients and methods The study protocol outlines the inclusion criteria for patients >18 years with confirmed COVID-19 infection and moderate to critical disease. Patients hospitalised between June 2020 and June 2021 for at least 24 hours were included. Exclusion criteria involved pregnant patients and those initially hospitalised for non-COVID-19. Results The study included 781 patients contributing to 790 hospitalisations. Demographic and clinical characteristics were analysed, with critical illness being the most prevalent category (61%). The overall mortality rate was 20.3%, primarily observed in critically ill patients. In the general ward for moderate cases, the reimbursement rate saw a substantial increase from US$3237 in 2020 to US$6760 in 2021, surpassing median resource utilisation. However, for severe cases in the intermediate care unit, reimbursement rates decreased, indicating potential insufficiency in covering costs. In the intensive care unit for critical cases, despite improved reimbursement rates, median resource utilisation still exceeds the 2021 rate, suggesting financial insufficiency in reimbursement rates. Conclusion Our study underscores the inadequacies of the previous reimbursement system in addressing the varying resource utilisation and costs associated with COVID-19 inpatient care. Our analysis reveals substantial discrepancies between estimated costs and actual resource utilisation, particularly for severe and critical cases. We advocate for government flexibility in revising reimbursement baskets, supported by pilot studies to assess effectiveness. The use of real-world evidence forms a crucial basis for informed adjustments to reimbursement levels in preparation for future pandemics. This proactive approach ensures alignment between reimbursement policies and the actual costs associated. Data are available on reasonable request.
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揭开真相:哥伦比亚 COVID-19 的报销设计是否存在缺陷?中度、重度和危重感染的疾病成本分析
目的 本研究探讨了 COVID-19 大流行对哥伦比亚卫生系统的财务影响,重点是住院病人的报销比例是否适当。该研究以疾病成本分析为基础,旨在评估报销计划的有效性,并确定卫生系统内潜在的经济损失。患者和方法 研究方案概述了纳入标准,即年龄大于 18 岁、确诊感染 COVID-19 并患有中重度疾病的患者。研究对象包括 2020 年 6 月至 2021 年 6 月期间住院至少 24 小时的患者。排除标准包括怀孕患者和最初因非 COVID-19 感染住院的患者。结果 研究纳入了 781 名患者,其中 790 人次住院。对人口统计学和临床特征进行了分析,危重病是最常见的病种(61%)。总死亡率为 20.3%,主要是危重病人。在中度病例的普通病房,报销比例从 2020 年的 3237 美元大幅增加到 2021 年的 6760 美元,超过了资源利用中位数。然而,对于中度护理病房的重症病例,报销率却有所下降,表明可能不足以支付费用。在重症监护室的危重病例中,尽管报销率有所提高,但资源利用率的中位数仍然超过了 2021 年的报销率,这表明报销率存在资金不足的问题。结论 我们的研究强调了以前的报销制度在解决与 COVID-19 住院护理相关的不同资源利用率和成本方面的不足。我们的分析表明,估计成本与实际资源利用率之间存在巨大差异,尤其是重症和危重病例。我们主张政府灵活修订报销篮子,并辅以试点研究来评估其有效性。使用真实世界的证据是在知情的基础上调整报销水平的重要依据,以便为未来的大流行病做好准备。这种积极主动的方法可确保补偿政策与相关实际成本保持一致。如有合理要求,可提供相关数据。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMJ Open Respiratory Research
BMJ Open Respiratory Research RESPIRATORY SYSTEM-
CiteScore
6.60
自引率
2.40%
发文量
95
审稿时长
12 weeks
期刊介绍: BMJ Open Respiratory Research is a peer-reviewed, open access journal publishing respiratory and critical care medicine. It is the sister journal to Thorax and co-owned by the British Thoracic Society and BMJ. The journal focuses on robustness of methodology and scientific rigour with less emphasis on novelty or perceived impact. BMJ Open Respiratory Research operates a rapid review process, with continuous publication online, ensuring timely, up-to-date research is available worldwide. The journal publishes review articles and all research study types: Basic science including laboratory based experiments and animal models, Pilot studies or proof of concept, Observational studies, Study protocols, Registries, Clinical trials from phase I to multicentre randomised clinical trials, Systematic reviews and meta-analyses.
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