Problems in counting and paying for multidisciplinary outpatient clinics

Abstract

Policy-makers have always found it problematic to formulate fair and consistent counting rules for public hospital outpatient activities. In the context of output-based funding, such rules have consequences which can affect patient care. This paper reviews the rationale for organising multidisciplinary clinics and reports on a series of focus groups convened in four Melbourne teaching hospitals to consider funding policy for such clinics. It discusses issues of targeting outpatient services, along with implications for payment policy. It evaluates counting rules in terms of intended and unintended consequences in the context of Victoria's introduction of output-based funding for outpatient services.

Hospital outpatient and emergencyservices in rural Victoria

“…Here, a number of studies have been undertaken including development of casemix measures to describe hospital outpatient activity (e.g. Jackson and Sevil, 1997;Cleary 1998). There have also been studies of the importance of metropolitan hospital outpatient departments in terms of their relative role for lower socio-economic groups (Hill 1989).…”

Funding Victoria's public hospitals: The casemix policy of 2000-2001

“…A clinical panel has been established to monitor VACS. In addition to reviewing weights, the panel assigns clinics to VACS categories avoiding hospital-specific idiosyncratic naming policies (Jackson and Sevil 1997). Clinic schedules for each provider are established annually by the VACS Clinical Panel who must be informed of any changes in clinic schedules.…”