Fundación Valle del Lili Departamento de Medicina Interna, Cali, Valle del Cauca, Colombia.
Universidad Icesi, Cali, Colombia.
BMJ Open Respir Res. 2024 Apr 5;11(1):e002097. doi: 10.1136/bmjresp-2023-002097.
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.
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.
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.
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.
本研究旨在探讨 COVID-19 大流行对哥伦比亚卫生系统的财务影响，重点关注住院费用的报销率是否充足。该研究基于疾病成本分析，旨在评估报销方案的有效性，并确定卫生系统内可能存在的经济损失。
研究方案规定了纳入标准为年龄>18 岁、确诊 COVID-19 感染且病情为中度至重度的患者。纳入 2020 年 6 月至 2021 年 6 月期间至少住院 24 小时的患者。排除标准包括孕妇和最初因非 COVID-19 住院的患者。
本研究纳入了 781 名患者，共涉及 790 例住院病例。对患者的人口统计学和临床特征进行了分析，其中危重症是最常见的类别（61%）。总死亡率为 20.3%，主要发生在危重症患者中。在中度病例的普通病房中，报销率从 2020 年的 3237 美元大幅增加到 2021 年的 6760 美元，超过了中位数资源利用。然而，对于中级护理病房的重度病例，报销率下降，表明费用覆盖不足。在重症病例的重症监护病房中，尽管报销率有所提高，但中位数资源利用仍超过 2021 年的水平，表明报销率存在资金不足。
我们的研究强调了先前的报销系统在应对 COVID-19 住院治疗中不同资源利用和成本方面的不足。我们的分析显示，估计成本与实际资源利用之间存在显著差异，特别是在重度和危重症病例中。我们主张政府在修订报销篮子方面具有灵活性，同时支持进行试点研究以评估效果。使用真实世界证据为调整报销水平提供了重要基础，以应对未来的大流行。这种积极主动的方法确保了报销政策与实际相关成本之间的一致性。
