საპენსიო ასაკის პირების ფინანსური ხელმისაწვდომობა გადაუდებელ ონკო-ჰემატოლოგიურ მომსახურებაზე DRG-მოდელის დანერგვის შემდეგ

ჰელსი2

ნებისმიერი სახელმწიფოს ჯანდაცვის სისტემის უმნიშვნელოვანესი ამოცანაა მოსახლეობისთვის სამედიცინო მომსახურებაზე ფინანსური ხელმისაწვდომობის გაზრდა. 2022 წელს საქართველოში ამოქმედდა დიაგნოზთან შეჭიდული ჯგუფებით (DRG) დაფინანსების მოდელი გეგმური და გადაუდებელი სტაციონარული მომსახურებებისთვის, რომლის მთავარი ამოცანა ჯანდაცვის სამედიცინო სერვისებზე ხელმისაწვდომობისა და მომსახურების ხარისხის გაუმჯობესებაა. DRG-მოდელის დანერგვის მიუხედავად, ონკო-ჰემატოლოგიურ პაციენტებს, მათ შორის საპენსიო ასაკის პირებს, უხდებათ გარკვეული საფასურის გადახდა ისეთ სერვისებში, რომლებსაც აქამდე სრულიად უფასოდ იღებდნენ. დიაგნოზთან შეჭიდული ჯგუფების მოდელის დანერგვის შემდეგ ონკო-ჰემატოლოგიურ სერვისებზე დაწესებული თანაგადახდის ზემო ზღვარი საპენსიო ასაკის პირებისათვის საკმაოდ დიდ თანხას წარმოადგენს, რაც ამცირებს ფინანსურ ხელმისაწვდომობას. მიზანშეწონილია აღნიშნულ სერვისებზე დაწესებული თანაგადახდების გადახედვა.

***

სამედიცინო მომსახურებაზე ფინანსური ხელმისაწვდომობის პრობლემა უარყოფითად აისახება ჯანმრთელობის მდგომარეობაზე. სახელმწიფოს უმნიშვნელოვანესი ამოცანაა მოსახლეობისათვის სამედიცინო მომსახურებაზე ფინანსურად თანაბრად ხელმისაწვდომობის უზრუნველყოფა. აღნიშნულის მიღწევის ერთ-ერთ მექანიზმს წარმოადგენს სამედიცინო მომსახურების დიაგნოზთან შეჭიდული ჯგუფებით (DRG) დაფინანსების მოდელი, რომელიც მსოფლიოს მრავალ ქვეყანაშია დანერგილი.

დიაგნოზთან შეჭიდული ჯგუფებით დაფინანსების მეთოდი საქართველოში 2022 წლის პირველი ნოემბრიდან ამოქმედდა, რომლის მიხედვით, საყოველთაო ჯანდაცვის პროგრამაში ჩართულ ყველა კლინიკაში, ერთსა და იმავე მომსახურებას აქვს ერთი ტარიფი. სამედიცინო მომსახურების მიღებისას, პაციენტს დამატებითი ხარჯების გაწევა აღარ მოუწევს და იხდის მხოლოდ საყოველთაო ჯანდაცვის პროგრამით განსაზღვრულ თანაგადახდის წილს (0-დან 30%-მდე).

ჯანდაცვის სამინისტრომ 2023 წლის 25 აპრილს დიაგნოზთან შეჭიდული ჯგუფების მოდელის მიმდინარეობასთან დაკავშირებით გარკვეული ცვლილებები შეიტანა სამედიცინო მომსახურებისთვის გადასახდელი თანხის ოდენობაში. ცვლილების შეტანის მიზეზი გახდა ზოგიერთ სამეცდიცინო მომსახურებაზე თანაგადახდის მოცულობის გაზრდილი რაოდენობა და ურგენტულ შემთხვევებზე დამატებითი გადასახადის დაწესება. საყოველთაო ჯანდაცვის პროგრამით სამედიცინო მომსახურებაზე პაციენტისათვის დაწესებულ თანაგადახდის წილზე ზედა ზღვარი დაწესდა. დიაგნოზთან შეჭიდული ჯგუფებით დაფინანსების მოდელის ფარგლებში პაციენტებს მოეხსნათ სხვა დამატებითი გადასახადი, ანუ თანაგადახდის ზედა ზღვარზე მეტის გადახდა პაციენტს არ მოუწევს. საპენსიო ასაკის ადამიანებისთვის თანაგადახდის წილი დაწესდა – 10% – მაგრამ არაუმეტეს 500 ლარისა. მაგალითად, თუ მომსახურების სრული ღირებულების 10% აღემატება 500 ლარს, პაციენტი იხდის მხოლოდ 500 ლარს, დარჩენილ თანხას კი სრულად აფინანსებს სახელმწიფო. 0-5 წლის ბავშვებისთვის, შშმ ბავშვებისთვის, მკვეთრად გამოხატული შშმ პირებისა და სტუდენტებისთვის – 20% – არაუმეტეს 1000 ლარისა; მაგალითად, თუ მომსახურების სრული ღირებულების 20% აღემატება 1000 ლარს, პაციენტი იხდის მხოლოდ 1000 ლარს, დარჩენილ თანხას კი სრულად აფინანსებს სახელმწიფო. საბაზისო პაკეტის მოსარგებლეებისთვის – 30% – არაუმეტეს 1500 ლარისა. მაგალითად, თუ მომსახურების სრული ღირებულების 30% აღემატება 1500 ლარს, პაციენტი იხდის მხოლოდ 1500 ლარს, დარჩენილ თანხას კი სრულად აფინანსებს სახელმწიფო.

დიაგნოზთან შეჭიდული ჯგუფებით დაფინანსების მოდელის დანერგვის შემდეგ გადაუდებელ ონკო-ჰემატოლოგიურ პაციენტებს მომსახურებაში, რომელიც აქამდე სრულიად უფასო იყო, გარკვეული თანხის გადახდა უხდებათ. საყურადღებოა, რომ ონკო-ჰემატოლოგიური დაავადებები ხშირია საპენსიო ასაკის პირებში. გადაუდებელი ონკო-ჰემატოლოგიური საპენსიო ასაკის პაციენტებისათვის თანაგადახდის წილი 445-235 ლარს შეადგენს. გასათვალისწინებელია ის ფაქტი, რომ საქართველო განვითარებადი ქვეყანაა და საპენსიო პირთა სახელმწიფო პენსია 295-365 ლარია.

კვლევის მიზანს წარმოადგენდა დიაგნოზთან შეჭიდული ჯგუფების მეთოდის შემოღების შემდგომ, გადაუდებელ ონკო-ჰემატოლოგიურ მომსახურებაზე საპენსიო ასაკის პირთა ფინანსური ხელმისაწვდომობის შესწავლა. გამოიკითხა თბილისის ერთ-ერთი კლინიკის ონკო-ჰემატოლოგიური საპენსიო ასაკის პაციენტები, რომლებიც ურგენტული შემთხვევებით განთავსდნენ ქიმიოთერაპიისა და ონკო-ჰემატოლოგიის დეპარტამენტში და ამავე დეპარტამენტების მენეჯერები.

კვლევამ აჩვენა, რომ საპენსიო ასაკის პირების მიერ ონკო-ჰემატოლოგიური სტაციონარული მომსახურებით სარგებლობის შემთხვევები საკმაოდ ხშირია. სტაციონარში საპენსიო ასაკის პირის მოხვედრის სიხშირე დამოკიდებულია დიაგნოზზე, რადგან სხვადასხვა ტიპის ონკო-ჰემატოლოგიური დაავადებებით ჰოსპიტალიზაციის სიხშირე განსხვავებულია. რკინადეფიციტური და B12 დეფიციტური ანემიის მქონე საპენსიო ასაკის პაციენტის ჰოსპიტალიზაცია შესაძლოა წლის განმავლობაში 2-3-ჯერ გახდეს საჭირო, ჰემოლიზური ანემიის დიაგნოზის მქონე პაციენტები წელიწადში დაახლოებით 3-4-ჯერ ხვდებიან სტაციონარულ დაწესებულებაში, ხოლო სიმსივნური ანემიების შემთხვევაში, სტაციონარში განთავსების აუცილებლობა შესაძლოა თვეში ერთხელაც კი გახდეს საჭირო, განსაკუთრებით, თუ პაციენტი პალიატიურია ან ვერ/არ იტარებს შესაბამის მკურნალობას.

კვლევამ აჩვენა, რომ ურგენტული სტაციონარული ონკო-ჰემატოლოგიური განყოფილების დატვირთვა დიაგნოზთან შეჭიდული ჯგუფების მეთოდის დანერგვის შემდეგ შემცირდა. აღნიშნულის ძირითად მიზეზად მენეჯერების მიერ დასახელდა ფინანსური სირთულეები და გაწეულ მომსახურებაზე თანხის გადაუხდელობის პრობლემები. ზოგ შემთხვევაში, საპენსიო ასაკის პაციენტები ფინანსური პრობლემების გამო უარს აცხადებენ სტაციონარულ სამედიცინო მომსახურების მიღებაზე.

კლინიკების მენეჯერებმა აღნიშნეს, რომ სტაციონარში მოხვედრილი საპენსიო ასაკის პაციენტების უმეტესობა ხშირად გამოთქვამს უკმაყოფილებას, რაც დაკავშირებულია DRG-მეთოდის დანერგვის შემდეგ ონკო-ჰემატოლოგიურ სერვისებზე თანაგადახდის (235-დან 445 ლარამდე)  შემოღებასთან, რომელიც მათი პენსიის თითქმის 75%-ია.

მენეჯერების მტკიცებით, მიუხედავად თანაგადახდისა, პაციენტების მხრიდან მკურნალობაზე უარის თქმის შემთხვევები თითქმის არ ფიქსირდება, რაც განპირობებულია ორი ძირითადი მიზეზით. პირველი უკავშირდება სტაციონარში შესული საპენსიო ასაკის პირის ჯანმრთელობის მძიმე მდგომარეობას, რის გამოც პაციენტს არ შეუძლია მკურნალობაზე უარის თქმა. მეორე მნიშვნელოვანი ფაქტორია ოჯახის წევრების მხარდაჭერა, რადგან ფინანსური პრობლემების მიუხედავად, პაციენტის ახლობლები მაინც ცდილობენ თანხების მოძიებას პაციენტის ჯანმრთელობის მდგომარეობის შემსუბუქების მიზნით, რათა ფინანსური სირთულეები არ გახდეს მკურნალობაზე უარის თქმისა და მდგომარეობის გაუარესების მიზეზი. მიუხედავად ამისა, არის გარკვეული შემთხვევები, როცა გადაუდებელ განყოფილებაში შესულ პაციენტს ფინანსების არქონის გამო უწევს სამედიცინო მომსახურების მიღებაზე უარის თქმა.

საპენსიო ასაკის პაციენტებში არცთუ ისე ხშირია სამედიცინო მომსახურების მიღების შემდეგ საავადმყოფოს ხელწერილის საფუძველზე დატოვების შემთხვევები, რადგან ხშირად საპენსიო ასაკის პირების მკურნალობა ოჯახის წევრების მხარდაჭერით ფინანსდება. თუმცა არის გარკვეული შემთხვევები, როდესაც პაციენტებს უწევთ ხელწერილის  საფუძველზე კლინიკის დატოვება.

კლინიკების მენეჯერების აზრით, საპენსიო ასაკის პირების ფინანსური ხელმისაწვდომობა ურგენტულ ონკო-ჰემატოლოგიურ მომსახურებაზე დაფინანსების ახალი DRG-მოდელის დანერგვის შემდგომ შემცირდა, რაც გამოწვეულია მანამდე უფასო მომსახურებებზე თანაგადახდის წილის შემოღებით, რომელიც საპენსიო ასაკის პირების ერთადერთი შემოსავლის წყაროს, ასაკობრივი პენსიის ძირითად ნაწილს შეადგენს.

დაფინანსების DRG-მეთოდის დანერგვის შემდგომ კლინიკებისა და ონკო-ჰემატოლოგიური განყოფილებების დატვირთვა მინიმალურად შეიცვალა, უმეტეს შემთხვევაში დარჩა იგივე, რაც განპირობებულია საპენსიო ასაკის პირების ოჯახის წევრებზე ფინანსურად დამოკიდებულებით, თუმცა შეინიშნება შემცირებაც, რაც თანაგადახდის წილის შემოღებამ და ფინანსურმა სირთულეებმა გამოიწვია. საყურადღებოა, რომ რესპონდენტთა აზრით, ონკო-ჰემატოლოგიური სტაციონარული შემთხვევების დაახლოებით 30% გადახარჯვით სრულდება. შესაბამისად, DRG-მეთოდის შემოღება ფინანსურად ნაკლებად სარგებლიანი აღმოჩნდა ონკო-ჰემატოლოგიური განყოფილებებისთვის.

საპენსიო ასაკის პაციენტების გამოკითხვით, ასევე გამოვლინდა DRG-მოდელის დანერგვის შემდგომ ხელმისაწვდომობით უკმაყოფილება. კლინიკების ურგენტული ონკო-ჰემატოლოგიური განყოფილებების მენეჯერების თქმით, საპენსიო ასაკის პაციენტების უმეტესობა ხშირად გამოთქვამს უკმაყოფილებას, რაც სერვისებზე თანაგადახდის შემოღებამ განაპირობა. კერძოდ, საპენსიო ასაკის პაციენტებისთვის თანაგადახდის მინიმალური ოდენობა 234,27 ლარს შეადგენს, რაც ასაკობრივი პენსიის თითქმის 75%-ია.

გამოკითხული პაციენტების უმრავლესობა თვლის, რომ დაფინანსების ახალი DRG-მოდელის შემოღების შემდეგ მათი ხელმისაწვდომობა ურგენტულ ონკო-ჰემატოლოგიურ სერვისებზე შემცირდა. ამასთან გასათვალისწინებელია, რომ გამოკითხული საპენსიო ასაკის პაციენტების უმრავლესობა არ არის ფინანსურად დამოუკიდებელი. შესაბამისად, რესპონდენტების უმრავლესობას (79%) შეექმნა ფინანსური სირთულეები გადაუდებელ ონკო-ჰემატოლოგიურ მომსახურებაში თანხის გადახდის გამო.

ონკო-ჰემატოლოგიურ სტაციონარში შემოსულ პაციენტებს კონკრეტული დიაგნოზიდან გამომდინარე, უწევთ განსხვავებული რაოდენობის თანხის გადახდა. ანემიური კოდების შემთხვევაში საპენსიო ასაკის პაციენტებს უწევთ სრული ღირებულების 10%-ის გადახდა, რაც დაახლოებით 235 ლარს შეადგენს, ხოლო კოაგულაციური კოდების შემთხვევაში, გაწეული მომსახურების 10% შეადგენს 445 ლარს. რესპონდენტების უმრავლესობას სტაციონარის დატოვების შემდეგ მოუხდა 235 ლარის გადახდა.

გაწეულ მომსახურებაში ფინანსური სირთულეებით გამოწვეული თანხის გადაუხდელობის შემთხვევაში, პაციენტს აქვს უფლება, გამოიყენოს კლინიკასთან იურიდიული ხელშეკრულების დადების შესაძლებლობა, რომელიც მას აკისრებს საფასურის წინასწარ დადგენილ ვადებში გადახდის ვალდებულებას. რესპონდენტების უმრავლესობას არ ჰქონია სტაციონარის ხელწერილით დატოვების საჭიროება, ხოლო რესპონდენტთა 25%-მა ფინანსური პრობლემების გამო გამოიყენა სტაციონარის ხელწერილით დატოვების უფლება. რესპონდენტების უმრავლესობას შეექმნა ფინანსური სირთულეები გადაუდებელ ონკო-ჰემატოლოგიურ მომსახურებაში თანხის გადახდის გამო. რესპონდენტების უმრავლესობის აზრით, დაფინანსების DRG-მოდელის დანერგვის შემდგომ ურგენტული ონკო-ჰემატოლოგიური მომსახურების ხარისხი და ხელმისაწვდომობა შემცირდა.

ამგვარად, შეიძლება ითქვას, რომ დიაგნოზთან შეჭიდული ჯგუფების მოდელის დანერგვის შემდეგ ონკო-ჰემატოლოგიურ სერვისებზე დაწესებული თანაგადახდის ზემო ზღვარი საპენსიო ასაკის პირებისათვის საკმაოდ დიდ თანხას წარმოადგენს. გადაუდებელ ონკო-ჰემატოლოგიურ მომსახურებაზე საპენსიო ასაკის პირებისათვის ხელმისაწვდომობის შემცირების გამო მიზანშეწონილია აღნიშნულ სერვისებზე დაწესებული თანაგადახდების გადახედვა. დიაგნოზთან შეჭიდული ჯგუფების მოდელი იძლევა შესაძლებლობას, მოერგოს ქვეყნის გამოწვევებსა და მოთხოვნებს.

გააზიარე

206 კომენტარი

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  65. Today, I went to the beachfront with my kids.
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