Phil Hogan (Carlow-Kilkenny, Fine Gael)
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Question 146: To ask the Tánaiste and Minister for Health and Children her views on the casemix system; and if she will make a statement on the matter. [3007/06]

Phil Hogan (Carlow-Kilkenny, Fine Gael)
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Question 241: To ask the Tánaiste and Minister for Health and Children her plans to review the casemix system; and if she will make a statement on the matter. [3006/06]

Mary Harney (Dublin Mid West, Progressive Democrats)
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I propose to take Questions Nos. 146 and 241 together.

In an era of evidence based medicine, we must also have evidence based management. It is widely agreed that the most developed system for assessing comparative efficiency and for creating incentives within the acute hospital sector, and for encouraging good performance, is casemix. It assists hospital managers to define their workload, measure their productivity and assess quality. It is accepted that it is the only system capable of dealing with the complexities of acute hospital management.

Casemix is now an international system, used in most countries with a developed health care system. It is constantly evolving to keep pace with changing clinical and management practice. A casemix programme was initiated here in 1991 and it is open and inclusive, with all stakeholders actively encouraged to participate in and contribute to the process. My Department works with hospitals to implement suggested improvements in a manner that enhances the consistency and accuracy of the system. At local level, hospitals are encouraged to establish structures encompassing both management and clinicians and advise on the operation and implementation of the programme.

Here, casemix is used as part of the budgetary process in order that hospitals are fully funded for the patients they actually treat. Full account is taken of patient complexity and all unique local issues, such as long-stay patients that cannot be discharged, high cost cases, specialist hospitals versus general hospitals, teaching hospitals versus non-teaching, urban versus rural, etc. All benchmarks within the system, including cost-per-case, are generated by direct reference to each hospital's peer group. The programme in Ireland is unique in that it is budget-neutral, with all funding deducted going back into the acute hospital system.

Many hospitals that lose funding under the programme review their management of patient services and go on to provide better services to more patients and consequently gain funding in the following years. The benefit of casemix is that hospitals can receive recognition and funding for all their patients, taking into account their cost and clinical complexity. The only loser in this process is inefficiency.

A major review of the entire national casemix programme has taken place in consultation with all stakeholders and is actively being implemented. This review led to a complete modernisation of the system.

I am committed to rewarding good performance and as casemix is the most internationally accepted performance related acute hospital activity programme, it is agreed between my Department and the Health Service Executive that casemix will be used as a central pillar in acute hospital funding policy.