23rd December, 2009
Promoting Evidence Based Hospital Management
The Health Service Executive (HSE) has released the Casemix Budget Outturns for 2009. The National Casemix Programme has been in operation since 1993 and there are currently 39 acute hospitals in the Programme which account for almost €4.9 billion of health spending and 92% of acute hospital activity. Two additional hospitals entered the Casemix programme in 2009.
Casemix is the comparison of activity and costs between hospitals by categorising hospital throughput into Diagnoses Related Groups (DRG's. Casemix is an internationally accepted management system for the monitoring and evaluation of health services which allows for the collection, categorisation and interpretation of hospital patient data, related to cases treated, in order to assist hospitals define their products, measure their productivity assess quality.
The process also contributes towards equity, efficiency and transparency by using common and consistent criteria to classify and categorise hospital performance. Casemix in Ireland operates a "budget neutral policy" i.e. no funding is taken out of the system, which rewards efficiency by redirecting funds to hospitals who have demonstrated that additional funding will result in real benefits.
The data in the attached Table A provides details of the 2009 Casemix Budget Adjustments (comprising of 2008/9 activity and cost data) for inclusion in the 2010 financial allocations. These budget adjustments are a reflection of each hospital's true performance against their peers taking account of each hospital's unique mix of cases and differing complexities.
Hospitals are not penalised for long stay patients, neither are they rewarded for discharging patients too early. The system is designed to take account of each hospital's "unique" issues and "unique" patients. As the HSE moves forward with plans for ever more evidence based management, it is expected that Casemix will play more of a central role in acute hospital funding and management practices.