Tuesday, 27 January 2004

Questions (95)

Ciarán Cuffe

Question:

209 Mr. Cuffe asked the Minister for Health and Children the reason for the difference in performance between hospitals under the casemix scheme; if he accepts that accident and emergency admissions have a major bearing on results; and if he will make a statement on the matter. [2029/04]

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Written answers (Question to Minister for Health and Children)

The rationale for the use of casemix systems as part of the budgetary process is the wish to base funding on measured costs and activity, rather than on less objective systems of resource allocation, and to fund hospitals based on their "mix" of cases. In other words a hospital should be funded for the patients they actually treat.

The reason hospitals fare differently under the programme is that each hospital's cost per case is compared with that of its peers, for example, the cost of a tonsillectomy in one teaching hospital versus another. The peer group sets the mean for each type of case treated, not my Department. Those whose cost per case is higher than the mean have some of their funding redistributed to those whose cost per case is lower.

The programme is operated in an open and transparent fashion, and full details of the clinical and financial information on which casemix budget adjustments are based is provided to all participating hospitals.

Admissions through accident and emergency do not have a bearing on results as the complexity of cases admitted as emergencies is fully taken into account. Issues such as excessive length of stay and severe complexity are all considered. Hospitals are not given a profile of patients that they must treat but rather they are judged on their relative efficiency in treating their cases versus their peers.

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 the types of cases treated, in the hope that it would assist hospitals to define their products, measure their productivity, and assess quality.

The key benefit of casemix measurement is the extent to which it provides a common language for service planning, management and development that is meaningful to both clinicians and managers, and facilitates cost comparison, clinical audit, strategic services planning and the collection of meaningful epidemiological data. It is the only model capable of dealing with the complexities of resource allocation within the hospital service. I am committed to the expansion of the programme as a central pillar in the budgetary process.

A comprehensive review of the entire national casemix programme has been carried out by the casemix unit of my Department. This review has taken place in an open, inclusive manner and included consultation with all the stakeholders in the process, including hospital managers and clinicians.

The intention of the review was to ensure that the system is fair and accurate, and robust enough to incorporate all the strategic developments being proposed in the medium-term. A report on the matter is presently being prepared which will make recommendations for the enhancement of the model. This will result in Ireland having one of the most advanced casemix systems in the world, while still being an "Irish" system for Irish patients.

Question No. 210 answered with QuestionNo. 142.
Question No. 211 answered with QuestionNo. 148.