SLIDE 3 3
1995 Reforms
- Private sector encouraged to contact with private hospitals using Casemix
and within a few years all health insurance benefit structures for private hospital treatment were paid either directly or indirectly through contractual arrangements.
- Private sector Casemix unit set up to examine the various types of
Casemix that could be used.
- The conclusion was that current mixture of per diem and cost centre based
benefits were a form of Casemix but that the structure was continually evolving and that for some well defined services episodic payments were
- appropriate. For many in-hospital services the existing structure was more
appropriate as it was more flexible and hence provided better certainty for hospitals.
- To illustrate the gaming possibilities of a pure DRG based episodic benefit
structure the Private Sector Casemix Unit provided many examples of DRGs that covered a wide range of possible resource utilisations.
- One DRG covered operative services of such a diverse nature that 8 out of
the then 12 operating theatre benefits were payable under the current system with theatre fee benefits ranging from around $200 to well over $2000.
Increased Sophistication of Private Sector Hospital Benefits - 2004
- Per diem benefits highly differentiated by patient
classification and length of inpatient treatment.
- Theatre fee benefits now at 14 levels
- Labour ward benefits at 2 or 3 levels
- ICU and CCU benefits differentiated and often at
different levels depending on stay and complexity of care
- Prosthesis appliance list of benefits grew from 3 pages in
1987 to currently about 80 pages. (Cost has increased by around 25% per annum since inception)
- Episodic payments used for some DRGs but more often
defined by the Medicare Medical Benefit Schedule (MBBS) item number that was used for the indicative service.
