Russian DRG manual for hospital and day case care in 2017

In Russia, hospital care is reimbursed via two separate mechanisms:

• Advanced (high-end) medical care is reimbursed via fixed tariff payments for entire episode of hospitalization. Clinical indications (including ICD-10 codes), type of care covered (according to the Russian Nomenclature of Medical Services) and reimbursement tariff is determined annually by the Government of Russian Federation
• Routine hospital and day case care is reimbursed via socalled “Clinico-Statistical Groups” or “Clinico-Profile Groups”, which are Russian version of diagnosis-related groups. Structure of DRG system and DRG cost coefficients are determined by the Federal Fund for Mandatory Medical Insurance at national level. Each region determines base DRG tariff, which is used to determine tariff by multiplication of base tariff by cost coefficient

Current version of the DRG manual for hospital and day case care was approved in December 2016 by the Russian Federal Fund for Mandatory Medical Insurance (FFOMS).

Since then, there were two updates of DRG manual: in February and May 2017. Updates have introduced only minor changes to the system, including:

• use of organizational (reducing tariff) coefficients for DRGs in oncology,
• criteria for DRG for infections of upper respiratory tracts (linked to verification of influenza virus),
• change of definitions of frostbite.

See the list of Orders of the Federal Fund for Mandatory Medical Insurance in relation to DRG system (in Russian) here.

Don’t hesitate to contact us, if you need support with understanding Russian reimbursement system.

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