Casemix Funding of Hospitals: Objectives and Objections

Abstract

Reform of the funding of hospitals and other health services has been one of the most important health policy initiatives undertaken by governments in recent years. A number of countries have adopted the casemix approach to payment, or are currently exploring the feasibility of its introduction. Under casemix arrangements hospitals are funded on the basis of the numbers and types of patients they treat. This paper analyses, and finds inadequate, various objections to casemix funding, including those which appeal to considerations of ethics and equity.

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

“…Case-mix (Zbylot et al, 1995; Palmer, 1996) is a system that classifies clients into groups that are homogeneous in both clinical condition and resource use. Originating in the Yale cost model, the case-mix methodology was designed to fund hospitals by measuring their productivity and aimed to reward initiatives that increased efficiency.…”

“…The development of case-mix systems within the community context has wide international interest and early work has already been undertaken in Australia (Calver et al, 2004) and the US (Palmer, 1996; Cambell et al, 1997; Levine et al, 2003). Since the completion of this research, the developed case-mix system for home based support services has been adopted by many DHBs around New Zealand for classifying clients.…”