ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138378.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

The introduction of casemix payment systems into Australia's public hospitals is an inevitability which the Australian Medical Association has now begun to address. A greater involvement of clinicians in the design and implementation of casemix can add substantial quality to these systems. However, there is concern that a proliferation of separate casemix systems may be contrary to overall health policy developments and that governments will not understand the limits of casemix. Recent attempts to include medical payments within a casemix payment system in the private sector faced our united opposition. Finally, special care needs to be taken to ensure that the introduction of a casemix payment system does not further disadvantage access to high quality health care for Aborigines.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138379.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

The Australian Casemix Clinical Committee coordinated the clinical evaluation of inpatient casemix classifications leading to the development of Australian national diagnosis‐related groups 1, 2 and 3. It has provided and will continue to provide advice on clinical matters associated with casemix activities to the Commonwealth and State health authorities, public and private hospital associations, insurers and the clinical professions. In future, all clinicians will be expected to understand casemix, diagnosis‐related groups and cost weights, especially those relevant to their speciality.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138380.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

The diagnosis‐related group (DRG) classification has been the centre of Commonwealth and various State initiatives to modify significantly the basis for funding of public hospitals in Australia. The classification has been extensively criticised by Australian clinicians as being out of date and inappropriate for several areas of medicine. Developments in Australia to improve the DRGs classification have led to the Australian national version, AN‐DRGs. The differentiating features of AN‐DRGs are summarised and priority areas for further development are suggested. Further substantial improvement in the classification can be obtained only if new approaches to classification design are considered and if it is supplemented by measures of severity of illness.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138381.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

Although a number of concerns remain, casemix ‐based funding is seen by clinicians in Victoria to be a more equitable way of determining public hospital inpatient budgets than historical allocation, and will provide a valuable source of data for service provision planning. The concerns in particular are the inadequacy of the current Australian national diagnosis‐related groups 2 system to classify modern clinical practice and describe complex patients; the absence of adequate baseline data to allow an accurate assessment of the impact of casemix‐based funding on quality of care; the lack of direct recognition within diagnosis‐related groups of the training, research and development roles of public hospitals; and the instability of a funding system which is in evolution.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138382.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

The Victorian casemix funding initiative has achieved initial success in implementing massive budget cuts while increasing hospital throughput and reducing waiting lists. For hospitals to survive, the relationship between casemix and resource use must be managed and this can only be achieved by the involvement of clinicians. With effective information systems and accommodating clinicians, games to maximise casemix, and hence revenue, will undoubtedly emerge. Side effects may include reduced access to “unprofitable” services, increasing pressure on “unprofitable” clinicians and the wooing of “profitable” ones, increasing difficulty in delivering continuity of care and the politicisation of the diagnosis‐related groups pricing system. In the end, State governments will be left with a complex control system without resolving the fundamental dilemma inherent in being both the provider of hospital care and the payer.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138383.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

The introduction of casemix funding in some States has led to concerns that hospitals, faced with budgetary problems, may be tempted to discharge patients prematurely after inadequate treatment — the “quicker and sicker syndrome”. There are no significant Australian data on quality of care before and after casemix funding, but a large study in the United States found that, in general, there was no evidence of a deterioration in care. Contrary to expectation, readmission rates were unaltered. There was, however, some evidence of an increase in discharge of patients in an unstable state and more were transferred to nursing homes. There are significant reasons why these conclusions can not be readily transported to the Australian environment, and there is a need to monitor the discharge status of patients, particularly the frail elderly, with casemix funding in Australia.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138384.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

Devolved clinical management aims at greater medical and nursing involvement in the management of health resources and focuses on achieving measurable improvements in patient care through better use of resources. It permits the major drivers of the health care system (doctors), in collaboration with the major direct care providers (nurses), to be not only effective at allocating resources but also effective resource users. Casemix is a classification of patient care episodes based principally on resource use and can assist in the process of managing health services. We discuss the relationship between devolved clinical management and casemix systems. Health care organisations must move towards devolved clinical management, with a greater focus on the patient and a greater emphasis on accountability among all clinical disciplines.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138385.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

The Australian national diagnosis‐related groups (AN‐DRGs) patient classification has highlighted the distinction between different categories of inpatient care and ambulatory care, and the need for an explicit definition of boundaries of associated categories. A nationally consistent definition of these patient care categories, and of episodes of care according to illness acuity, will facilitate the design of additional casemix classifications to supplement AN‐DRGs. Specific features of the AN‐DRGs classification will have a major impact on health care of the elderly through incentives created by funding arrangements based on this classification. The use of age as an AN‐DRG classification criterion, as a surrogate for definitive secondary diagnoses, should be regarded as an interim measure pending improvement in medical record documentation, further analysis of the relationship of age partitions to these secondary diagnoses, and ongoing improvement of AN‐DRG design. The complex process of development of casemix classifications for subacute and ambulatory care has commenced, and will also have a profound impact on health care of the elderly and on all specialities concerned with both acute and chronic illness, again because of financial incentives in the classification design. Funding for development and refinement of each of these casemix classifications will be required if the anticipated benefits are to occur.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138386.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

There are many advantages in the use of casemix measures for financing acute hospitals, but there are deficiencies in the diagnosis‐related groups (DRGs) classification for paediatrics. Some, such as poor measurement of severity, inability to classify appropriately some operating room procedures and an inappropriate mix of uncommon complex paediatric procedures and common straightforward adult procedures in the one DRG, are intrinsic to the system and not easy to change. Costing studies must be sufficiently sophisticated to determine the increased costs of nursing a child in hospital if cost weights are not to disadvantage children.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138387.x

出版商:Wiley    

年代:1994

数据来源: WILEY