Case-Mix System for Hospitals

KUALA LUMPUR, Wed. – 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 said the implementation of case-mix was not a way to cut the

health budget nor a way of discharging patients from hospitals

prematurely.