|
|
Casemix: moving forward
Key elements of inpatient funding policies, 1997-98, by State*| Element | Victoria |
| Funding model | Standard price by hospital group, capped, fixed and variable model with minor purchasing price competitive elements |
| Prices for different hospital groups | Variable payment constant. Fixed payment varies for five hospital groups, with payment declining as size increases |
| Relative weights | Derived from clinical costing data provided by 15 Victorian hospitals (updated annually) |
| Volume flexibility method | Base volume target set for each metropolitan area and rural region, then distributed as a capped budget to hospitals. Throughput, up to 2% above base, funded at discounted rate. Additional throughput at differential rates offered at start of financial year |
| Trim points** | L3H3 No cost trim point |
| Outlier and exceptional case payment policy | Outliers converted into "inlier equivalents" by adding a discounted payment for all days above the high trim point; or by discounting the normal inlier payment if length of stay is below the low trim point |
| Critical care supplement | No |
| Payment for public and private patients | Differential payment for public and private patients. Same weights for both groups |
| Element | Queensland |
| Funding model | Standard price by hospital group, capped, fixed and variable model |
| Prices for different hospital groups | Prices based on five hospital groups (base payment price increases with size). Weights differ for different groups |
| Relative weights | National public hospital weights from 1995 national cost modelling study adjusted by deducting allocated overhead, medical pathology and critical care components |
| Volume flexibility method | Volume caps at district (multi-hospital) level. Districts distribute the capped budget to hospitals |
| Trim points** | L3H3 plus "extra high" trim point at five times average length of stay. No explicit cost trim point |
| Outlier and exceptional case payment policy | Discounted per diem price paid for short stay outliers Additional per diem rate for long stay outliers. Extra long stay outliers paid twice inlier payment plus per diem payment for days above extra high boundary point. Special case can be made for high cost ouliers |
| Critical care supplement | Taken into account in identifying hospital categories and relevant payment weights |
| Payment for public and private patients | Separate medical cost weights used for medical payments for public patients |
| Element | Western Australia |
| Funding model | Standard price capped, full price model |
| Prices for different hospital groups | Two groups for payments: hospitals with Trendstar clinical costing system and those without (the latter, generally smaller, receive a lower payment). Access subsidy for rural and remote hospitals |
| Relative weights | Derived from clinical costing data provided by four major hospitals comprising seven sites (updated annually) |
| Volume flexibility method | Volume target set for each hospital |
| Trim points** | L3H3 High cost trim point at $75 000 |
| Outlier and exceptional case payment policy | An Exceptional Episodes Insurance Pool funds "exceptional DRGs" (DRGs with low volume or unpredictability in costs); cases with length of stay >91 days; cases with length of stay <91 days but cost >$75 000; short stay outliers and 35% of the payment for long stay outliers. 65% funding of long stay outliers folded back into "central episodes" (inliers) |
| Critical care supplement | Block intensive care unit payment based on historical expenditure |
| Payment for public and private patients | Block medical payment based on historical expenditure |
| Element | South Australia |
| Funding model | Standard price, capped, full price model. If activity targets not reached, funding discounted by 65% of full price |
| Prices for different hospital groups | Metropolitan teaching hospitals have 6% loading; metropolitan non-teaching and country regional have 2% loading. Access subsidy for very small hospitals |
| Relative weights | National public hospital weights derived from 1995 national cost modelling study adjusted by deducting critical care component. State-developed paediatric weights for paediatric services at Women's and Children's Hospital and Flinders Medical Centre |
| Volume flexibility method | Volume target set for each hospital |
| Trim points** | H3 Short stay trim 3 SD below mean in those DRGs in which average length of stay is >4 days. High cost trim at $60 000 above AN-DRG reimbursement |
| Outlier and exceptional case payment policy | Additional per diem rate for long stay outliers at two rates - up to 90 days higher than longer stays. Pool for high cost outliers established |
| Critical care supplement | Intensive care units funded separately on a per diem basis |
| Payment for public and private patients | No distinction |
| Element | Tasmania |
| Funding model | Standard price, capped, full price model. |
| Prices for different hospital groups | Casemix funding only applies to the State's three major hospitals |
| Relative weights | National public hospital weights from 1995 national cost modelling study |
| Volume flexibility method | Volume target set for each hospital |
| Trim points** | L3H3 No cost trim points |
| Outlier and exceptional case payment policy | Long stay outliers paid $200 per DRG weighted day for days above trim point. Discounted payment (on a per diem basis) for short stay outliers. Discretionary pool established for high cost outliers |
| Critical care supplement | No |
| Payment for public and private patients | No distinction |
| * | New South Wales does not fund hospitals on a casemix basis. |
| ** | L3H3 indicates a long stay trim point three times average length of stay of DRG, and a short stay trim point one third of the average length of stay of DRG. |
Back to article . . .
<URL: http://www.mja.com.au/> © 1998 Medical Journal of Australia.