title: Capturing patients' needs in casemix: a systematic literature review on the value of adding functioning information in reimbursement systems.
abstract: BACKGROUND
  Contemporary casemix systems for health services need to ensure that payment rates adequately account for actual resource consumption based on patients' needs for services. It has been argued that functioning information, as one important determinant of health service provision and resource use, should be taken into account when developing casemix systems. However, there has to date been little systematic collation of the evidence on the extent to which the addition of functioning information into existing casemix systems adds value to those systems with regard to the predictive power and resource variation explained by the groupings of these systems. Thus, the objective of this research was to examine the value of adding functioning information into casemix systems with respect to the prediction of resource use as measured by costs and length of stay.
  
  
  METHODS
  A systematic literature review was performed. Peer-reviewed studies, published before May 2014 were retrieved from CINAHL, EconLit, Embase, JSTOR, PubMed and Sociological Abstracts using keywords related to functioning ('Functioning', 'Functional status', 'Function*, 'ICF', 'International Classification of Functioning, Disability and Health', 'Activities of Daily Living' or 'ADL') and casemix systems ('Casemix', 'case mix', 'Diagnosis Related Groups', 'Function Related Groups', 'Resource Utilization Groups' or 'AN-SNAP'). In addition, a hand search of reference lists of included articles was conducted. Information about study aims, design, country, setting, methods, outcome variables, study results, and information regarding the authors' discussion of results, study limitations and implications was extracted.
  
  
  RESULTS
  Ten included studies provided evidence demonstrating that adding functioning information into casemix systems improves predictive ability and fosters homogeneity in casemix groups with regard to costs and length of stay. Collection and integration of functioning information varied across studies. Results suggest that, in particular, DRG casemix systems can be improved in predicting resource use and capturing outcomes for frail elderly or severely functioning-impaired patients.
  
  
  CONCLUSIONS
  Further exploration of the value of adding functioning information into casemix systems is one promising approach to improve casemix systems ability to adequately capture the differences in patient's needs for services and to better predict resource use.
authors: Swiss Paraplegic Research, 6207, Nottwil, Switzerland. maren.hopfe@paraplegie.ch.|Department of Health Sciences & Health Policy, University of Lucerne, 6002, Lucerne, Switzerland. maren.hopfe@paraplegie.ch.
authors: Maren
authors: M
authors: Hopfe
authors: Swiss Paraplegic Research, 6207, Nottwil, Switzerland.|Department of Health Sciences & Health Policy, University of Lucerne, 6002, Lucerne, Switzerland.
authors: Gerold
authors: G
authors: Stucki
authors: National Centre for Classification in Health, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, 2141, Australia.
authors: Ric
authors: R
authors: Marshall
authors: Faculty of Social and Human Sciences, School of Psychology, University of Southampton, Southampton, SO17 1BJ, UK.
authors: Conal D
authors: CD
authors: Twomey
authors: World Health Organization, Classifications, Terminologies and Standards, 1211, Geneva, 27, Switzerland.
authors: T Bedirhan
authors: TB
authors: Üstün
authors: Swiss Paraplegic Research, 6207, Nottwil, Switzerland.|Department of Health Sciences & Health Policy, University of Lucerne, 6002, Lucerne, Switzerland.
authors: Birgit
authors: B
authors: Prodinger
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D003695:Delivery of Health Care / Q000191:economics; D003953:Diagnosis-Related Groups / Q000191:economics; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D012051:Reimbursement Mechanisms