Press Release

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.

TABLE A – CASEMIX ADJUSTMENTS FORMING PART OF 2006 ALLOCATION
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
Temple Street 1,484
OLHSC Crumlin -1,484
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