Does case-mix based reimbursement stimulate the development of process-oriented care delivery?
OBJECTIVE
Reimbursement based on the total care of a patient during an acute episode of illness is believed to stimulate management and clinicians to reduce quality problems like waiting times and poor coordination of care delivery. Although many studies already show that this kind of case-mix based reimbursement leads to more efficiency, it remains unclear whether care coordination improved as well. This study aims to explore whether case-mix based reimbursement stimulates development of care coordination by the use of care programmes, and a process-oriented way of working.


METHODS
Data for this study were gathered during the winter of 2007/2008 in a survey involving all Dutch hospitals. Descriptive and structural equation modelling (SEM) analyses were conducted.


RESULTS
SEM reveals that adoption of the case-mix reimbursement within hospitals' budgeting processes stimulates hospitals to establish care programmes by the use of process-oriented performance measures. However, the implementation of care programmes is not (yet) accompanied by a change in focus from function (the delivery of independent care activities) to process (the delivery of care activities as being connected to a chain of interdependent care activities).


CONCLUSIONS
This study demonstrates that hospital management can stimulate the development of care programmes by the adoption of case-mix reimbursement within hospitals' budgeting processes. Future research is recommended to confirm this finding and to determine whether the establishment of care programmes will in time indeed lead to a more process-oriented view of professionals.
Vos
Leti
L
NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, The Netherlands. l.vos@lumc.nl
Dückers
Michel L A
ML
Wagner
Cordula
C
van Merode
Godefridus G
GG
D002017:Budgets; D003695:Delivery of Health Care / Q000458:organization & administration*; D003953:Diagnosis-Related Groups; D004469:Economics, Hospital; D019538:Health Care Surveys; D006801:Humans; D008962:Models, Theoretical; D009426:Netherlands; D010346:Patient Care Management / Q000191:economics*; D011787:Quality of Health Care; D012051:Reimbursement Mechanisms / Q000458:organization & administration*