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Frequently Asked Questions

What is Casemix?
Casemix provides a means for standardising data collected on activity and costs within acute hospitals so that meaning comparisions can be made between different areas of activity and different hospitals.

Where does Casemix operate?
• In Ireland: In 38 public hospitals
• In the majority of OECD countries

What is Casemix used for?
The Casemix system is used for a range of applications, including
• hospital budgeting and funding;
• service planning (national strategies, local developments, new units, trends) and;
• epidemiological research.

How long has the Irish Casemix Programme been running?
The HIPE programme started in the late 1960's and the Casemix programme stated in 1991 with the first financial adjustments being applied for the 1993 financial allocation. 

Is Casemix an Irish system for Irish patients?
Yes.  Although the system in use is based on an international framework, it is adapted for Irish hospital systems, cost and patient activity.

Are the hospitals represented in the decision making process?
Yes.  Every effort is made to increase stakeholder participation in the process.  Educational seminar’s; lectures/talks and an national conference are held annual which are all geared towards making the process as open and transparent as possible.

Are the HSE using Casemix to save money?
No.  The process is what is called “budget neutral” - that is any funding taken from hospitals is redistributed to other hosptials who have demonstrated that such funding will be used efficiently and effectively.  The system  is aimed at rewarding good performance.

Does the HSE penalise hospitals for keeping patients too long?
No. There are many reasons why hospitals lose in Casemix. The Casemix Budget Model actually gives hospitals credit for long stay patients. The average length of stay which emerges from the Casemix process is arrived at on the basis of clinical practice in hospitals throughout the country. Casemix does not dictate or lay down arbitrary parameters regarding length of stay for patients in public hospitals. The clinicians remain responsible for admitting and discharging patients.

What is the justification for a negative adjustment?
Accountability is one of the cornerstones of public policy. For every hospital that is penalised, one is rewarded. The system highlights variances in performance, both between hospitals and within hospitals themselves. This assists management to establish which issues need to be addressed. In fact, it is the Casemix data itself that facilitates hospitals to address funding issues for particular services.

Does Casemix take into account that every hospital is different?
Yes, the Casemix system takes this into account, by comparing "like with like." This is done by dividing the workload into 698 Diagnosis Related Groups (DRG) and each hospital's activity in each DRG (if any) is compared with the mean for that AR DRG.

Do we assist hospitals in the National Casemix programme?
Yes, ongoing assistance is available to all hospitals wishing to develop their Casemix skills. An annual Casemix seminar has a significant role in providing education on the Casemix programme.

Do we take account of “special” circumstances?
Yes, any area of activity that cannot be accurately compared with other sites is omitted or amended.

What’s the future of Casemix?
The system is being constantly refined and expanded. Every patient encounter with a hospital will soon come under the scope of the Casemix Budget Model.  

What about other aspects of Casemix?
Every aspect of the Casemix system is kept under review. Hospitals are kept fully up to date of developments.

Each hospital represented in the programme has a HIPE / Casemix Co-ordinator, all of whom have direct contact with the National Casemix Programe in the HSE.

What is a Specialty Costing Section?
The Specialty Costing Section of the National Casemix Programme collects the cost of treating a patient by Specialty in participating hospitals. The costs are derived from the Annual Accounts of the hospital and are allocated by the hospitals under headings such as salaries, radiology, labs, drugs, etc. 

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