The MHIF has prepared a mechanism for assessing the quality of treatment for patients with hepatitis C

The Federal Compulsory Medical Insurance Fund (FFOMS) sent to the regions a checklist with an algorithm for the treatment of chronic viral hepatitis C (CVHC) in a day hospital. This document will be used by insurance companies and territorial compulsory medical insurance funds when checking the quality of medical care, as well as by the medical organizations themselves for internal control. Regulators thus continue to formulate a list of measures to reduce mortality from hepatitis C – such an order was given by President Vladimir Putin back in 2021. The patient community notes the importance of a clear algorithm for patient management from screening to treatment. But they are afraid that patients who are not included in the checklist, especially those with the initial stages of hepatitis C, may be left without treatment.

The Federal Compulsory Medical Insurance Fund sent the form of an individual checklist “Quality control of medical care for the provision of medical care to patients with chronic viral hepatitis C in a day hospital” to the regions on September 11. The letter from the chairman of the FFOMS, Ilya Balanin, clarifies that the algorithm was developed “in order to organize the implementation of the “Action Plan to Combat Chronic Viral Hepatitis C in the Russian Federation until 2030,” approved by order of the Russian government.”

Let us recall that back in April 2021, Vladimir Putin instructed the Ministry of Health of the Russian Federation to formulate a list of measures to reduce mortality from several diseases, including chronic viral hepatitis C. In December 2021, the chief infectious disease specialist of the Ministry of Health, Vladimir Chulanov, presented a draft passport for the federal program to combat chronic hepatitis C. On In the first stage, in 2023–2025, it is expected to cure more than 50% of patients – 343 thousand people already registered at the dispensary (with priority coverage of patients at the late stage of liver fibrosis). At the second stage, until 2030, it is planned to identify and treat all patients who are not yet under dispensary observation. At the same time, analysts from the Zdravresurs expert group pointed out that in 2022, only about 4% of registered patients and only 1% of the estimated number of people living with chronic hepatitis C in Russia were covered by treatment.

The checklist contains information about the patient: prescriptions and examinations performed, experience of previous antiviral therapy, signs of chronic hepatitis C with outcome in liver cirrhosis, fibrosis and relapse after liver transplantation; information about vaccinations against hepatitis A and B. Let us remind you that infection with the hepatitis C virus occurs through blood. The virus can also be transmitted sexually and from an infected mother to a child (in utero or during childbirth).

Assessing the quality of medical care using individual checklists includes “monitoring the violated rights of the patient to adequate quality and availability of comprehensive medical care,” the letter says. This data is expected to be used by insurance companies and the Federal Compulsory Compulsory Medical Insurance Fund when conducting inspections. In addition, medical organizations themselves will use the form for internal quality control and safety of medical activities.

Chairman of the Board of the interregional public organization “Together against Hepatitis” Nikita Kovalenko says that the appearance of such a checklist is associated with updating the standards of treatment for hepatitis C. According to him, the document is “generally good”, as it gives the doctor a clear algorithm for managing the patient from screening to cure. However, Mr. Kovalenko “still has a few questions.” “First of all, why do we need another piece of paper, even if it’s in electronic form? By the end of the year, within the framework of EGAIS (Unified State Automated Information System.— “Kommersant”) the patient registry should be operational. From there, you can arrange for downloading of all the necessary information so that the doctor does not have to enter 10-digit numbers several times,” comments Nikita Kovalenko. “Secondly, unfortunately, the checklist strengthens the position of the 70th order of the Ministry of Health as a document regulating the treatment of hepatitis In general, within the framework of compulsory medical insurance.”

“Kommersant” previously told about the order of the Ministry of Health of the Russian Federation No. 70 on the criteria for providing medical care to patients with hepatitis C in a hospital, which was agreed upon by the Ministry of Justice at the end of March. Patients and public organizations asked the department to finalize it. From the document it followed that only patients in the later stages of fibrosis and with cirrhosis of the liver can count on treatment at the expense of compulsory medical insurance. The patient community asked to review the order “towards expanding access to therapy.” They mentioned in particular patients with moderate fibrosis; people on the waiting list for internal organ transplants; patients with concomitant cancer diseases; observed for chronic viral hepatitis C in a specialized medical institution for more than a year; women of childbearing age, including those undergoing or planning an IVF procedure. As a result, the Ministry of Health took into account only one of 23 proposals, the Treatment Preparedness Coalition (ITPC) told Kommersant: patients with a risk of rapid development of liver disease due to concomitant diseases were added to the list.

Nikita Kovalenko clarifies that the patient community “understands and supports” the need for this order as a tool to control the growth of expenses of the Federal Compulsory Medical Insurance Fund for the treatment of hepatitis C. “But now we are receiving another document that violates the norms of the law “On Compulsory Health Insurance in the Russian Federation,” according to which insurance companies will have the official opportunity not to pay for the treatment of patients who are not included in the checklist. And there are already such cases: the Federal Compulsory Medical Insurance Fund of the Komi Republic refuses to pay for the treatment of nine patients, which began before the 70th order came into force,” says Mr. Kovalenko.

Against this background, he continues, another problem seems “very insignificant”: the authors of the checklist suggest performing liver elastometry (an ultrasound test that evaluates the elasticity and stiffness of tissues) only in patients with suspected cirrhosis. “On the one hand, it is clear: in the vast majority of cases, you can do without elastometry, but sometimes it is still needed, and not only if cirrhosis is suspected. And the doctor does not have the opportunity to prescribe it within the framework of compulsory medical insurance – a checklist without options. As a result, the patient will again go to work for his own money, and this is a violation of his rights,” concludes Nikita Kovalenko.

The chief infectious disease specialist at the Ministry of Health, Vladimir Chulanov, previously told Kommersant that the establishment of criteria for the provision of medical care to patients with hepatitis C provides an opportunity to more than fivefold increase treatment coverage, especially for patients with a high risk of developing life-threatening conditions. He emphasized that the new criteria apply only to inpatient care, which, as a rule, is needed by patients who have complications of the underlying disease or concomitant ones, while the possibilities for outpatient treatment of patients with hepatitis C are fully preserved.

Natalia Kostarnova