The organisational change implications of casemix-based hospital management

The 1970s and 80s have witnessed increasing concern about the efficiency and effectiveness of hospitals as core units of the health care system. In recent times, the solutions offered for improving hospitals have centred on the promotion of a more output and finance-driven approach to hospital-based service provision, strengthening managerial authority and more recently, incorporating clinicians into the day-to-day management of hospitals. The purpose of this paper is to examine the background to these developments, how they are being made manifest within hospitals and to foreshadow their implications for the work of clinician-managers.