Case mix
Encyclopedia
The term Casemix refers to the type or mix of patients treated by a hospital or unit. The term is often used to describe the billing system of the hospital or unit, since the "cost per item" of healthcare is based on the casemix.
In the Netherlands, the casemix system is called a "DBC" (Dutch:Diagnosebehandelcombinatie), and can be defined as a predefined average care package, which is applied with a fixed price when a specific diagnosis occurs.
Casemix is a system that measures hospital performance, aiming to reward initiatives that increase efficiency in hospitals. It also serves as an information tool that allows policy makers understand the nature and complexity of health care
delivery.
Diagnosis Related Groups
(DRGs) is the best-known classification system that is used in this funding model. It classifies acute inpatient episodes into a number of manageable categories based on clinical condition and resource consumption. A single acute episode of inpatient care is allocated to one DRG using coded clinical information derived from the patient’s medical record. This information is coded by the Health Information Managers in order to allocate a DRG. Each DRG is allocated a ‘weight’, which is dependent on the average cost of inputs (e.g. nursing, diagnostic services, procedures) required to achieve the appropriate patient outcome. The facility is reimbursed a predetermined amount for each patient episode.
. This will eventually allow the billing processes to become more aligned in their classification schemes with the electronic patient record.
Background
Casemix based funding is the key funding model currently used in Australian health care services for reimbursement of the cost of patient care.In the Netherlands, the casemix system is called a "DBC" (Dutch:Diagnosebehandelcombinatie), and can be defined as a predefined average care package, which is applied with a fixed price when a specific diagnosis occurs.
Casemix is a system that measures hospital performance, aiming to reward initiatives that increase efficiency in hospitals. It also serves as an information tool that allows policy makers understand the nature and complexity of health care
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
delivery.
Diagnosis Related Groups
Diagnosis-related group
Diagnosis-related group is a system to classify hospital cases into one of originally 467 groups. The 467th was "Ungroupable." The system of classification was developed as a collaborative project by Robert B Fetter, PhD of the Yale School of Management, and John D Thompson, MPH of the Yale...
(DRGs) is the best-known classification system that is used in this funding model. It classifies acute inpatient episodes into a number of manageable categories based on clinical condition and resource consumption. A single acute episode of inpatient care is allocated to one DRG using coded clinical information derived from the patient’s medical record. This information is coded by the Health Information Managers in order to allocate a DRG. Each DRG is allocated a ‘weight’, which is dependent on the average cost of inputs (e.g. nursing, diagnostic services, procedures) required to achieve the appropriate patient outcome. The facility is reimbursed a predetermined amount for each patient episode.
Classification systems
The strength of such a system compared to traditional billing models is obvious, since the casemix system introduces a kind of Activity Based Costing to the health profession. However the complexities of the system (in the Netherlands, over 100,000 DBC's can be theoretically charged) has led new initiatives to link billable activities directly to international standards, such as the ICD-10ICD-10
The International Statistical Classification of Diseases and Related Health Problems, 10th Revision is a medical classification list for the coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases, as maintained by the...
. This will eventually allow the billing processes to become more aligned in their classification schemes with the electronic patient record.