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Macroeconomic policy impact on oncology-related public expenditure in an emerging European market: Signs of early recovery
Uticaj makroekonomske politike na javna izdvajanja za onkologiju na rastućem evropskom tržištu - znaci ranog oporavka
aClinical Center Kragujevac, Center for Oncology and Radiology, Serbia
bUniversity of Kragujevac, Faculty of Medical Sciences, Serbia
cUniversity of Kragujevac, Faculty of Medical Sciences, Department of Pharmacology and Toxicology, Serbia
Project: Medical costs structure and budget impact analysis regarding most prevalent and/or most expensive diseases and cost/effectiveness/utility coefficient determination of common medical interventions (MESTD - 175014)
Abstract
Healthcare financing in Serbia has faced many challenges over the past few decades. One of the most severe challenges is a global macroeconomic recession whose far-reaching consequences deserve particular attention from policymakers in cases of the most demanding major prosperity diseases, such as cancer. The objective of the study was to assess the precise cost matrix of oncology medical care and its chronological evolution during the key years of the macroeconomic recessionary period during 2010-2013. A retrospective database of hospital discharge invoices was analysed, encompassing 37, 978 hospital admissions and 12, 505 patients during a four-year period. Insight into microeconomic patterns of consumption across groups of medical services was provided. A payer's perspective and one-year time horizon have been adopted. Total hospital direct medical costs of cancer diagnostics and treatment in the observed tertiary care facility decreased from €7, 411, 446 in 2010 to €5, 715, 884 in 2012 and then increased to an extraordinary €8, 536, 364 in 2013. The costs of oncology nursing care, imaging diagnostics and radiotherapy have increased considerably while those of pharmaceuticals and surgery have decreased radically - completely transforming the resource allocation landscape of public cancer care. The financial burden of cancer in Serbia is considerable and, unfortunately, expected to increase further in the coming years. Worldwide economic recession and consecutive domestic policy constraints of reimbursement limitations have heavily affected the affordability of cancer treatment for ordinary citizens. Promising signs of market recovery are clearly visible in 2013, which will likely improve both access and equity of medical care in Serbian oncology clinics.
Sažetak
Cilj studije je analiza trendova u javnim izdvajanjima za onkološku zdravstvenu zaštitu u godinama duboke ekonomske recesije u svetu i na Balkanu. Ostali ciljevi su utvrditi finu strukturu troškova u ovoj kliničkoj disciplini kao i eventualno prisustvo korelacije obima potrošnje na dijagnostiku i lečenje malignih neoplazmi sa makroekonomskim kretanjima i zdravstvenom politikom u Srbiji. Primenjena je retrospektivna studija slučaja, kojom je obuhvaćen period od četiri godine (2010-2013.) iz perspektive finansijera zdravstvene zaštite i sa usvojenim vremenskim horizontom od godinu dana. Studija je izvedena na osnovu izvoda baze podataka o 37 978 epizoda bolničkog lečenja i 12 505 pacijenata sa klinički potvrđenim kancerom pri regionalnom Centru za onkologiju i radioterapiju Kliničkog Centra Kragujevac. Ukupni direktni medicinski troskovi dijagnostike i lečenja kancera u posmatranom tercijernom centru su pali sa €7, 411, 446 u 2010 na €5, 715, 884 u 2012 i iznova snažno skočili na €8, 536, 364 u 2013. Glavni domeni troškova koji su najviše doprineli ukupnom obimu potrošnje su bili onkološka medicinska nega, radioterapija i lekovi. Finansijski teret kancera u Srbiji je ogroman i nažalost izgledno je da ce nastaviti da raste zahvaljujući nizu činilaca poput starenja populacije, boljeg preživljavanja, naraslih očekivanja građanstva o pravu na pristup naprednim metodama lečenja kao i dugoročno izvesnog rasta pokrivenosti stanovništva zdravstvenom zaštitom. Posebno masivni faktori su širenje dostupnosti metoda radioterapije i refundacija skupih bioloških lekova. Obećavajući znaci oporavka nacionalnog tržista će se, nadamo se, pretočiti u napore na poboljšanju pristupa i priuštivosti onkološke nege običnom građaninu.
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