A guide for clinical staff, clinical coders, service managers, and other sector participants in understanding the casemix based funding system, the importance of clinical coding, and how it is applied in the funding of inpatient hospital admissions in New Zealand.
This publication provides an overview of the New Zealand Casemix System – how it works and how it is used. It is intended to help clinical staff, clinical coders, service managers, and others in the health sector in understanding the casemix system, the importance of coding, and how it is applied in funding inpatient hospital admissions.
Casemix concerns the mix of patients treated, as described by a system which aggregates information about patients and treatments into groups based on the health condition or type of procedure. Casemix systems are used for a variety of purposes including hospital planning, clinical reviews, funding, monitoring, benchmarking and management. Internationally they have been implemented in a variety of settings including acute, sub-acute and non-acute care.
In New Zealand casemix based funding between the DHB funders and the provider of hospital services applies mainly to medical, surgical, obstetric, and neonatal inpatient services. Other services, most notably outpatient services, emergency department, mental health, rehabilitation, disability support and health of older people, are funded by different methods. However, casemix based funding accounts for a significant proportion of all DHB funding, varying between 28% and 29%. It underpins the National Minimum Data Set (NMDS) collection.
This publication is in three parts: the first sketches how casemix arose; the second concerns the casemix concept in general including standard facets of the classifications in use in New Zealand; and the third part describes casemix based funding in New Zealand for public hospital inpatient admissions.