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Does case-mix based reimbursement stimulate the development of process-oriented care delivery?
Leti Vos1, Michel L A Dückers, Cordula Wagner
1NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, The Netherlands. l.vos@lumc.nl
Health Policy (Amsterdam, Netherlands)
|July 8, 2010
Summary
Case-mix reimbursement stimulates hospitals to create care programs. However, it has not yet shifted focus from independent activities to integrated care processes, indicating a need for further research on care coordination improvements.
Area of Science:
- Healthcare Management
- Health Economics
- Quality Improvement
Background:
- Case-mix reimbursement aims to improve efficiency and care quality by focusing on total patient care during acute episodes.
- While efficiency gains are documented, the impact of case-mix reimbursement on care coordination remains unclear.
Purpose of the Study:
- To investigate if case-mix reimbursement encourages the development of care coordination through care programs and a process-oriented approach.
- To explore the relationship between reimbursement models and the implementation of structured care pathways.
Main Methods:
- A survey of all Dutch hospitals was conducted in the winter of 2007/2008.
- Descriptive and structural equation modeling (SEM) analyses were employed to analyze the data.
Main Results:
- SEM analysis indicated that case-mix reimbursement adoption within hospital budgeting stimulates the establishment of care programs using process-oriented performance measures.
- The implementation of these care programs has not yet resulted in a shift in focus from functional, independent care activities to a process-oriented, interconnected chain of care delivery.
Conclusions:
- Hospital management can effectively stimulate the development of care programs by integrating case-mix reimbursement into budgeting processes.
- Further research is recommended to validate these findings and assess if care programs eventually foster a more process-oriented perspective among healthcare professionals.
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