Experience of revision physician in evaluating the extent of compensation of biological therapy in specialized care centers

Summary

It is necessary and useful to follow the provision of costly biological therapy by a revision physician. The specialized care centers in collaboration with the attending physician represent professional controlling and revision opportunity to follow the quality of the provided care, the therapeutic effect as well as the aspect of financial compensation and purposeful allocation of financial remedies of public health insurance. The conclusions reached in collaboration with professional representatives of the center made it clear that there is a discrepancy in the level of real financial compensations of the health insurance company and the requirements of the medical institution to increase the established limit of the compensations of “center drugs” in the observed period of time. In connection with the application of biological therapy and provision of professional nursing and medical care it has become obvious that the participation in keeping the records of medical documentation in certain insured individuals was insufficient. In connection with the demonstrated regression and subsequent remission of the disease there is a medical-ethical as well as economic problem to be solved. It is associated with increasing financial cost influenced by purposeful duration of biological therapy as well as the number of therapeutic doses applied, frequency of their repetition in connection with securing a long-term effect of therapy and especially the quality of life of the insured individual. At the same time there is a connection of the decision of the attending physician when and under which conditions to end the therapy “lege artis” with proved clinical effect in favor of the patient and the economic aspect of purposefulness.

Key words:
control – revision physician – care provider – biological therapy – specialized care center – effect of therapy – therapeutic drug compensation – limit of compensation of center drugs – expensive therapy – medical-ethical and economic problem – purposeful therapy – quality of life