Joan Burton (Dublin West, Labour)
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Question 229: To ask the Tánaiste and Minister for Health and Children her views on the penalty and rewards system to encourage efficiency in hospitals here and that hospitals offering excellent care are being penalised; her further views on whether the criteria for judging needs to be refined and developed; if best practice in hospitals should be encouraged; if her Department recognises that sometimes best practice costs money; and if she will make a statement on the matter. [3029/06]

Mary Harney (Dublin Mid West, Progressive Democrats)
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All the international data suggests that good hospital management usually results in both effective financial control and high quality patient care. There is no evidence that poor patient care has resulted in financial gains. In fact, the reverse usually occurs.

I agree that quality of care is an issue of concern to all of those who use the health services and quality is as important as value for money. I see no reason we cannot have both.

The national case mix programme reviews all patient encounters, apart from outpatients, that occur in the 37 hospitals in the programme. The case mix programme operates four separate budget models and hospitals may win or lose in any one of them as they may have excellent management of one area, but less so in another. The models are inpatient, day cases, accident and emergency, and what is termed the "split-year" workload adjustment which incorporates the most up-to-date data available, for which finalised financial accounts are not yet available. Obviously, the press focuses on the overall adjustment. I am aware that some hospitals which we would all consider excellent institutions suffered some financial loss within case mix. However, if one examines the individual programmes, one sees that they were rewarded for good performance in some areas while losing in others.

Case mix collects data on the procedures and diagnoses pertaining to individual patients and the cost of treating them. While its primary focus is the budgetary process, it also provides data which allows others within the health service to focus on quality related issues. Many indicators already exist outside of case mix and the data collected as part of both the national HIPE programme and case mix programme can assist towards developing quality indicators. Some of these are used as performance indicators within the service planning process.

It is possible to broaden the programme, as some other countries have done, to encompass issues such as re-admission rates, death rates and other quality related indicators, and this will be considered. At present, the focus is on broadening the programme and encouraging its use as a management tool and data set. This year the programme will be broadened by commencing an Irish cost weights programme which will result in Irish patient level cost data driving the reimbursement rates, including new areas such as dialysis and radiotherapy treatments performed on a day case basis, reviewing and refining the accident and emergency model, continuing to refine the day case model to reflect changing clinical practice, strengthening the national structures in order that work can commence on including more hospitals within the programme and commencing a review of outpatient departments so that they too may be included, at which point every patient encounter with the hospitals will be subject to case mix. When these matters have been concluded, a review of whether various quality of care indicators can be included as part of the programme will be initiated.