Casemix Budget Adjustments
The Annual Casemix Budget Outturns for December 2005 are attached below. The figures relate to 2004 activity and costs and will now form part of the 2006 acute hospital financial allocations of the 37 hospitals involved in the programme this year.
Casemix is the comparison of activity and costs between hospitals by analysing each hospitals ‘mix’ of patients (their ‘case-mix’) into discrete ‘Diagnoses Related Groups’ (or DRGs) which are clinically meaningful and consume similar levels of resources. Casemix was introduced in an effort to collect, categorise and interpret hospital patient data related to the type of cases treated to assist managers define their services, measure their productivity and assess quality. Casemix contributes towards equity, efficiency and transparency by classifying and categorising hospital throughput. By allowing Peer Group comparison it creates an incentive for better performance.
Casemix data is not merely used as part of the budgetary process, but as it is the only audited dataset of activity and costs nationally, provides data in a meaningful and manageable way that assists towards hospital, regional and national planning.
The National Casemix Programme has been operating in Ireland since 1993 and the 37 hospitals who presently participate in the programme now account for €3.5 billion of health expenditure and almost 1.7 million patient encounters annually. The programme aims to fund hospitals for the patients they actually treat, at a cost per case which is determined by their own peers.
The Tánaiste and Minister for Health and Children, Mary Harney T.D. remains committed to the usage of performance related funding, and Casemix is the most internationally accepted ‘performance related’ acute hospital activity programme.
The Health Service Executive are also committed to developing Casemix as a management and funding tool and will implement the Casemix adjustments by including them in the 2006 acute hospital financial allocations of the 37 hospitals who presently participate in the programme.
As can be seen from the attached table, Ireland operates a unique ‘budget-neutral’ policy which rewards efficiency by rebalancing funding based on a Casemix review of the actual patient workload of the hospital – overall acute hospital funding nationally is not affected by the programme.
Individual hospitals are invited to participate at a national level in the National Casemix Programme. The programme takes account of each hospital’s ‘unique’ issues and ‘unique’ patients. Hospitals are not penalised for long-stay patients, nor are they rewarded for discharging patients too early.
The Department’s Statement of Strategy 2005-2007 includes provision for the incremental broadening of the programme each year. This year 30% of the Casemix budgets were ‘Peer Group Performance Related’ (up from 20% the previous year). This will increase to 40% in 2006 (in relation to 2005 costs and activity) and 50% in 2007. The programme is being developed in partnership with, and with the active assistance of, the Health Service Executive.
|Total Negative Adjustment||Total Positive Adjustment|
|Cork University Hospital||1,935,482|
|Waterford Regional Hospital||1,212,266|
|Longford Westmeath General Hospital||895,120|
|Merlin Park Hospital, Galway||867,490|
|Wexford General Hospital||853,453|
|Letterkenny General Hospital, Co. Donegal||701,204|
|South Infirmary-Victoria Hospital, Cork||627,652|
|Mater Misericordiae Hospital, Eccles Street||620,674|
|Louth County Hospital||467,419|
|Our Lady of Lourdes Hospital, Drogheda||369,656|
|Mercy Hospital, Cork||345,032|
|Tralee General Hospital, Kerry||308,346|
|Coombe Women’s Hospital, Dublin||132,778|
|Portiuncula Hospital, Ballinasloe, Galway||32,896|
|Mallow General Hospital, Cork||-14,565|
|National Maternity Hospital, Holles Street||-14,799|
|St. Columcille’s Hospital, Loughlinstown||-45,453|
|St. Vincent’s Hospital, Elm Park||-98,031|
|St. Luke’s County Hospital, Kilkenny||-117,369|
|Rotunda Hospital, Dublin 1||-117,979|
|St. James’s Hospital, Dublin 8.||-146,515|
|New General Hospital, Cavan.||-220,563|
|Monaghan General Hospital||-257,217|
|St. Nessan’s Regional Orthopaedic Hospital, Limerick||-297,526|
|Beaumont Hospital, Dublin 9||-312,564|
|University College Hospital, Galway||-366,692|
|Sligo General Hospital||-488,360|
|St. Mary’s Orthopaedic Hospital Gurranebraher,||-497,315|
|Portlaoise General Hospital, Co. Laois||-553,928|
|James Connolly Memorial Hospital, Blanchardstown||-711,432|
|Tullamore General Hospital, Co. Offaly||-851,866|
|A.M. & NCH Tallaght||-920,920|
|Limerick Regional Hospital||-1,028,324|
|Our Lady’s Hospital, Navan||-1,063,164|
|Mayo General Hospital||-1,244,883|