Proposal for social health insurance financing of effective drug therapy of healthcare and ventilation associated pneumonia in Hungary

Abstract

Healthcare- and ventilator-associated infections (HAI) are one of the most common threats to patient safety, causing significant morbidity, mortality and economic burden, primarily for patients, families and ultimately the entire healthcare system. More than two thirds of these infections are caused by pathogens of bacterial origin. Multidrug-resistant pathogens, which have been spreading at an alarming rate in recent decades at various settings and levels of healthcare, further complicate the effective and rapid management of these pathologies.

Despite significant advances in understanding the causes and prevention, the effective treatment of nosocomial pneumonia remains a major medical challenge both nationally and internationally.

In this article, we developed a proposal for the inclusion of targeted and modern drug treatment of health-
care associated and ventilator-associated pneumonia caused by Pseudomonas aeruginosa and other Gram-negative bacteria in public funding. The funding scheme would focus on the creation of an additional Diagnosis Related Group - DRG that would promote the targeted and adequate use of high-cost anti-infective products for the appr. 1000 cases anually. The requirements on this new entitled DRG would be a compulsory microbiology histological examination based on a deep respiratory sample (optionally including PCR testing), consultation by an infectologist, continuous monitoring of clinical symptoms, at institutional level having a regularly upgraded intsitutional protocol on anti-infective therapy. The proposed tariff per case would be between 3-4 thousand EUR, with a 7-14 minimum to normative days. Once implemented, these above listed funding conditions of healthcare institutions and university clinics will play a key role in the care of these serious infections. It also would be systematically improved through the targeted, transparent and controlled use of resources in a professional order defined in accordance with a modern infectious disease approach (updated institutional guidelines on the use of anti-infective agents and infection control strategies, an infectious disease advisory board, antibiotic stewardship, Infection Control and Antibiotic Committee supervision).