Brennan Report - Department of Health and Children

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Report of the Commission on Financial Management and Control Systems in the Health Serviceyears. The speciality costing system has as its output a set of costs for each speciality areawithin a hospital. It distinguishes between the direct costs of treating a patient and the indirectcost associated with patient care.In 1993 the Department of Health, for the first time incorporated a casemix adjustmentwithin its budgetary allocation to a group of fifteen hospitals. Wiley (1997) 4 summarises theessentials of this casemix adjustment as follows:‘hospitals are stratified according to teaching or non-teaching status; activity data fromthe relevant hospitals are assigned to Diagnosis Related Groups and a case mix adjustedcost is estimated for the individual hospital and hospital group; a budget allocation rate isthen determined on the basis of a ‘blend’ of the hospital’s case mix adjusted case cost andthat estimated for the relevant hospital group.’Casemix analysis was used to make small adjustments to 5% of the in-patient budgets; theremaining 95% was based on the hospital’s historical allocation.This mechanism was introducedon a budget neutral basis, with the inefficient hospitals losing funding and the efficient hospitalsgaining additional funding.This process was extended to 21 hospitals in 1994, 23 hospitals in 1995 and 26 hospitals in 1996(Fitzgerald et al, 1998) 5 . It has since been extended to all public acute hospitals discharging morethan 5,000 patients per annum, 32 in total. These 32 hospitals account for 74% of all acutehospital activity in Ireland. Casemix has also been extended to day cases.The casemix adjustment for 2002 for the 32 hospitals are shown in Figure Ax.1. This showsthat one hospital lost approximately ¤ 1million, while one hospital gained approximately¤ 800,000.4Wiley, M.M., Financing the Irish Health Services, Chapter 15; Robins, Joseph, (ed), Reflections on Health: Commemorating Fifty Years ofthe Department of Health, 1947-1997 (Dublin, Department of Health, 1997) pp 210-221.5Fitzgerald,A, and Lynch, F., Casemix Measurement:Assessing the Impact in Irish Acute Hospitals,Administration (Spring 1998) 46 pp29-54.176
Appendix 5Figure: Ax.1 Casemix Adjustment 2002(1,000,000) (800,000) (600,000) (400,000) (200,000) 0 200,000 400,000 600,000 800,000 1,000,000Graph depicts actual Casemix Budget outturns by hospital (names deleted) from anegative outturn of ¤ 1m to a positive outturn of ¤ 800,000The casemix budgetary mechanism was designed to improve hospital efficiency. Hospitals areinformed, by the Department of Health and Children, of their ranking relative to others withintheir group.Although the adjustments are small in the context of the overall hospital budget, itdoes provide an incentive for hospitals to improve productivity so as not to lose funding.The rate of adjustment to hospital budgets (known as the blend rate) has increased over timeto 20% of the hospital in-patient budget and to 10% for day cases.The Department of Healthand Children has indicated that it plans to extend this blend rate in the future. It has beenrecognised, however, that some improvements need to be made to the speciality costing systemto ensure uniformity of cost data across hospitals. Once this has been achieved, the blend ratemay be extended. Figure Ax.2 shows the development of casemix over time.177
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Commission onFinancial Managementan
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TABLE OF CONTENTSEXECUTIVE SUMMARY
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6.4 COMMUNITY DRUG SCHEMES 80Medica
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Executive SummaryEXECUTIVE SUMMARYT
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Executive SummaryWe do not underest
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Executive Summary"demand-led" schem
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Terms of ReferenceTERMS OF REFERENC
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GlossaryEstimates for Public Servic
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Chapter 1 Introduction and Backgrou
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Chapter 1 Introduction and Backgrou
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Chapter 2 Overview and Issues2.2 OR
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Chapter 2 Overview and IssuesAppend
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Chapter 2 Overview and IssuesFigure
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Chapter 2 Overview and Issuesother
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Chapter 2 Overview and IssuesTable
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Chapter 2 Overview and IssuesFigure
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Chapter 2 Overview and IssuesIn 200
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Chapter 2 Overview and IssuesThe an
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Chapter 2 Overview and IssuesTable
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Chapter 2 Overview and IssuesProble
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Chapter 3 Managing the Health Servi
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Chapter 4 Service Planning, Budgeti
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Chapter 5 Accountability - Hospital
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Chapter 6 Accountability - General
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Chapter 7 Accountability - Employme
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Chapter 8 Audit ReformCHAPTER 8AUDI
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Page 107 and 108: Chapter 8 Audit Reformaudit reports
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Page 113 and 114: Chapter 9 External Reporting Proced
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Page 121 and 122: Chapter 10 Information SystemsRecom
Page 123 and 124: Chapter 11 ImplementationRecommenda
Page 125 and 126: Chapter 11 Implementationbeing brou
Page 127 and 128: Appendix 1Appendix 1COMMISSION MEMB
Page 129 and 130: Appendix 1He has held this position
Page 131 and 132: Appendix 2SIPTU*South Eastern Healt
Page 133 and 134: Appendix 3Name of AgencyBord na Rad
Page 135 and 136: Appendix 3Name of AgencyIrish Blood
Page 137 and 138: Appendix 3Name of AgencyWomen’s H
Page 139 and 140: Appendix 4Department of Health and
Page 141 and 142: Appendix 4collated and assessed by
Page 143 and 144: Appendix 4The most detailed element
Page 145 and 146: Appendix 4Ratifying and Submitting
Page 147 and 148: Appendix 4changes to the Service Pl
Page 149 and 150: Appendix 4advised of their existenc
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Page 153: Appendix 5Appendix 5DIAGNOSIS RELAT
Page 157 and 158: Appendix 6Appendix 6AUDIT OF STRUCT
Page 159 and 160: Appendix 7(vii)(viii)(ix)participat
Page 161 and 162: Appendix 8Appendix 8 - Integrated M
Page 163 and 164: ADDENDUMNumber Recommendation IT Ti
Page 165 and 166: Number Recommendation IT TimeframeR
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Brennan Report - Department of Health and Children

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