Strengths, weaknesses, opportunities and threats with the new system of radiotherapy remuneration in Brazil: a critical appraisal

ABSTRACT

Objectives: To evaluate the economic impact of the new form of radiotherapy remuneration published by the Ministry of Health. Methods: We design a simulated group of seventy patients from a database of a public institution. We compare the remuneration from SUS old payment methodology (SOPM), with the new form entitled of the diagnosis-related groups (DRG). A comparison between the DRG with the SOPM corrected by four economic indexes was also performed. We tested if hypofractionation replace or equilibrate the absence of readjustment according to the economic indexes. A p-value <0.05 significant. Results: The remuneration of sixty CIDs using the SOPM and the DRG were done to simulate the group of patients. Evaluating the sixty CIDs, the DRG had a mean readjustment of 33.2% (-29.5% to 258%). However, evaluating the readjustment in the group, the ten most frequent tumor sites responsible per 85% of the remuneration had a readjustment < 5% (0.4-4.5%). The total of remuneration by the DRG or by the old table had a difference of R$18.700,00 (p=0.821). The difference was influenced by the breast cancer readjustment, and when breast cancer was the second or third most frequent, SOPM remunerated better than DRG. All indexes had a significant difference for the remuneration by DRG (p<0.0001). The hypofractionation improved the remuneration per fraction (p=0.001). The number need to treat with a hypofractionated schedule to equilibrate the difference for the economic indexes would be 31.2, 32, 60, and 58, for IPCA, IGPM, Dollar and minimum wage. Conclusion: The remuneration by DRG produced a non-significant difference compared with SOPM; the correction was < 5% for the most frequent tumors. The hypofractionation improves the ticket per fraction, but it does not exclude the need of a readjustment.

RESUMO

Objetivos: Avaliar o impacto econômico da nova forma de remuneração em radioterapia publicada pelo Ministério da Saúde. Métodos: Nós planejamos um grupo simulado de setenta pacientes a partir de um banco de dados de uma instituição pública. Comparamos a remuneração da metodologia de pagamento antigo do SUS (SOPM), com o novo formulário intitulado dos grupos relacionados ao diagnóstico (DRG). Também foi realizada uma comparação entre o DRG e o SOPM corrigido por quatro índices econômicos. Testamos se a hipofracionamento substitui ou equilibra a ausência de reajuste de acordo com os índices econômicos. A valor p<0,05 significativo. Resultados: A remuneração de sessenta CIDs utilizando o SOPM e o DRG foi realizada para simular o grupo de pacientes. Avaliando os sessenta CIDs, o DRG teve um reajuste médio de 33,2% (-29,5% a 258%). Entretanto, avaliando o reajuste no grupo, os dez locais de tumores mais frequentes, responsáveis por 85% da remuneração apresentaram reajuste < 5% (0,4-4,5%). O total de remuneração pelo DRG ou pela tabela antiga teve uma diferença de R$18.700,00 (p=0,821). A diferença foi influenciada pelo reajuste do câncer de mama e, quando o segundo ou o terceiro foi o mais frequente, o SOPM remunerou melhor que o DRG. Todos os índices tiveram uma diferença significativa para a remuneração por DRG (p<0,0001). O hipofracionamento melhorou a remuneração por fração (p=0,001). O número necessário para tratar com um cronograma hipofracionado para equilibrar a diferença dos índices econômicos seria 31,2, 32, 60 e 58, para IPCA, IGPM, dólar e salário mínimo. Conclusão: A remuneração do DRG produziu uma diferença não significativa em relação ao SOPM, a correção foi < 5% para os tumores mais frequentes. O hipofracionamento melhora o ticket por fração, mas não exclui a necessidade de um reajuste.

Keywords:

Radiotherapy - Remuneration - Unified Health System

Descritores:

Radioterapia - Remuneração - Sistema Unificado de Saúde

AUTHOR'S CONTRIBUTION

Gustavo Viani Arruda: Collection and assembly of data, Conception and design, Data analysis and interpretation, Final approval of manuscript, Manuscript writing, Provision of study materials or patient

Publication History

Received: 13 March 2019

Accepted: 16 April 2020

Article published online:
10 June 2020

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