title: Healthcare tariffs for specialist inpatient neurorehabilitation services: rationale and development of a UK casemix and costing methodology.
abstract: OBJECTIVE
  To describe the rationale and development of a casemix model and costing methodology for tariff development for specialist neurorehabilitation services in the UK.
  Patients with complex needs incur higher treatment costs. Fair payment should be weighted in proportion to costs of providing treatment, and should allow for variation over time CASEMIX MODEL AND BAND-WEIGHTING: Case complexity is measured by the Rehabilitation Complexity Scale (RCS). Cases are divided into five bands of complexity, based on the total RCS score. The principal determinant of costs in rehabilitation is staff time. Total staff hours/week (estimated from the Northwick Park Nursing and Therapy Dependency Scales) are analysed within each complexity band, through cross-sectional analysis of parallel ratings. A 'band-weighting' factor is derived from the relative proportions of staff time within each of the five bands.
  Total unit treatment costs are obtained from retrospective analysis of provider hospitals' budget and accounting statements. Mean bed-day costs (total unit cost/occupied bed days) are divided broadly into 'variable' and 'non-variable' components. In the weighted costing model, the band-weighting factor is applied to the variable portion of the bed-day cost to derive a banded cost, and thence a set of cost-multipliers. Preliminary data from one unit are presented to illustrate how this weighted costing model will be applied to derive a multilevel banded payment model, based on serial complexity ratings, to allow for change over time.
authors.affiliation: King's College London School of Medicine, Department of Palliative Care, Policy and Rehabilitation, London, UK.
authors.forename: Lynne
authors.initials: L
authors.lastname: Turner-Stokes
authors.forename: Stephen
authors.initials: S
authors.lastname: Sutch
authors.forename: Robert
authors.initials: R
authors.lastname: Dredge
mesh_terms: D003362:Cost-Benefit Analysis; D003953:Diagnosis-Related Groups / Q000191:economics*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D018803:Models, Economic; D009422:Nervous System Diseases / Q000175:diagnosis / Q000534:rehabilitation*; D012047:Rehabilitation Centers / Q000191:economics / Q000706:statistics & numerical data; D013038:Specialization / Q000191:economics*; D013222:State Medicine / Q000191:economics*; D006113:United Kingdom