Casemix perspectives for clinicians in the private sector.
All private hospitals and clinics must now supply deidentified data, using AN-DRG classification, on all admitted patients to the Private Hospitals Data Bureau. Contracts between health funds and hospitals must also be described on the basis of AN-DRGs, which will enable funds to undertake hospital variance analysis. These data provide the foundation for nationally developed clinical pathways and utilisation reviews which could modify clinical practice, improve standards and reduce health costs. Clinicians must understand and participate in these changes, and adequate safeguards are needed to protect them against loss of their clinical integrity, and against inappropriate discretionary control by private hospitals, healthcare corporations and health insurers.
Maxwell
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Australian Casemix Clinical Committee, Melbourne, VIC. cmaxwell@tnh.vic.gov.au
D001315:Australia; D019091:Critical Pathways; D003953:Diagnosis-Related Groups / Q000191:economics*; D017048:Health Care Costs; D016304:Hospitals, Private / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D010820:Physicians / Q000191:economics; D017149:Private Sector / Q000191:economics*; D014600:Utilization Review