Case-mix system for hospitals, move to manage healthcare resources

From next year, government hospitals will introduce a "case-mix system", which classifies patients in accordance with type of diseases, costs and outcome of treatment.
Director-General of Health Datuk Dr Ismail Merican said the system, to be implemented in phases, will initially begin with 25 hospitals. An important element will be coding and disease classification.
"Case-mix is a crucial tool that will help us manage our healthcare resources effectively and thus be affordable," he said.
He said it was a fairer means of allocating resources as it takes into account the wide spectrum of disease conditions, their varying degrees of severity and significant patient variables such as age and gender.
Dr Ismail said changing needs and disease patterns were well thought-out under the system.
At present hospitals are given their annual grants based on "historical allocation" and it is difficult to ascertain whether each hospital has received an appropriate amount.
Under the new system, patients will be sent for tests that are only absolutely necessary as the practice of some doctors of sending patients for a host of tests, some of which are unnecessary, has ballooned hospital costs.
Studies by Hospital Universiti Kebangsaan Malaysia indicate that if the system is implemented correctly, the Government can save between RM800 million and RM1 billion a year in health costs.
HUKM, which implemented the system, managed to save RM15 million since 2002. Hospital operational costs have increased from RM64 million in 1998 to RM253 million in 2003.
HUKM Professor of Health Economics and Head of the Community Health Department, Professor Syed Mohamed Aljunid, said: "This system can be used to gauge the usage of resources needed to provide healthcare service in a hospital according to patients’ conditions."
He said it was appropriate, especially in justifying the usage of optimum resources in tertiary care hospitals which admit more severe cases.
At present, the allocation of resources is based on the number of beds and previous resource utilisation without considering efficiency and thus, Prof Syed Mohamed said, it did not contribute to the improvement of hospital efficiency.
He said allocating hospital resources using the case-mix system according to workload would ensure funds are used efficiently and produce better quality care.
HUKM was the first hospital to implement the system in Malaysia, with the objective of improving efficiency and quality of patient care.
Prof Syed Mohamed said the demand for healthcare and medical costs had recently escalated tremendously while the ability of the Government to bear this increment was limited.
Dr Ismail stressed that the implementation of case-mix was not a way to cut the health budget and neither was it a way of discharging patients from hospitals prematurely.
Source