Improving the Access to Radionuclide Therapy for Prostate Cancer within Compulsory Health Insurance System at the Regional Level: Experience of the Kemerovo Region

Abstract

The article discusses issues of antineoplastic radiation, particularly radionuclide, therapy payment through compulsory health insurance system. Healthcare organization faces several problems in this field when introducing new treatment methods. Regulatory and infrastructural aspects of the radionuclide therapy provision are brought up. The article discusses the problem raised by the average payment for the diagnostic-related groups (DRG) at the federal level, which makes it difficult to use selected medical services with the cost above the average DRG tariff. As an example, the article describes the experience of Kemerovo region on tariff correction using subgroup split-off method for DRG that includes systemic radionuclide therapy with radium-223. Splitting the federal DRG for sub-groups gave the possibility of providing therapy to patients with prostate cancer in the region. Besides, the authors discuss the relevance and practical aspects of interregional payments in the compulsory healthcare insurance system with respect to the radionuclide therapy in order to improve the quality of medical care for patients with cancer, regardless of infrastructural restrictions and the patients’ residence.