Case-Mix System as a Boundary Object: The Case of Home Care Services

Abstract

A B S T R A C TGovernments worldwide face the challenges of an ageing population. New models of health services are being established to support older people to continue living in their homes with timely access to quality health services. Health care provision for older people, however, involves multiple stakeholders, who represent different views on health care, while working towards a common goal. This study presents an actionoriented collaborative process between funders, service providers and clinicians that showcases the development of a client classification (case-mix) system for home-based support service provision in New Zealand. In doing so, this study draws on the concept of boundary objects and develops a unique framework that explicitly showcases the process of aligning diverse stakeholder interests to reach a consensus. This study demonstrates how different manifestations of a single boundary concept-object can effectively bridge all knowledge boundaries and thus develops a new way of using boundary objects for creating effective collaborations.

Developing and utilising a new funding model for home-care services in New Zealand

“…Furthermore, New Zealand clinical opinion on provision of home‐care services did not support adoption of the current RUG‐III/HC system, preferring to focus on differentiation around carer stress, disability and cognitive impairment as described by Sajtos et al. (). A focus on such groups allows health services to develop targeted responses aligned to client needs.…”

“…On completion of the development of the classification system, expert clinicians assigned clinically appropriate responses to the Casemix groups, the methods of which are reported elsewhere (Sajtos, Rouse, Harrison, & Parsons, ), but the final pathways are presented here.…”

“…Mean hours per week of homecare services were used in the analysis as the dependent variable (similar to Calver et al 2004). Independent variables comprised responses from the two assessment tools.On completion of the development of the classification system, expert clinicians assigned clinically appropriate responses to the Casemix groups, the methods of which are reported elsewhere(Sajtos, Rouse, Harrison, & Parsons, 2014), but the final pathways are presented here.…”

Case-mix accounting beyond the hospital

“…Management accountants have studied the use of the case-mix as a decision-support and performance measurement tool to manage hospital effectiveness and efficiency (Abernethy et al, 2006;Abernethy, 1996). Coordination is a key role of case-mix, helping align disparate stakeholder interests such as physicians who prioritise care, funders who consider cost and resource utilisation and managers who require information to mediate financial and medical pressures (Sajtos et al, 2014).…”

“…We interviewed a small group of academics and practitioners engaged in case-mix for primary healthcare to provide cutting-edge perspectives, balancing these with other viewpoints from those in clinical, administrative, policy and research backgrounds. These supply-side perspectives provide a foundation to support further patient collaboration (Sajtos et al, 2014). Results indicate that an SDL focus will benefit the case-mix for primary healthcare, contrasting with traditional goods-dominant views of the case-mix.…”