Stoelwinder J U
Monash Medical Centre, Clayton, Vic.
Med J Aust. 1994 Sep 5;161(S1):S15-8. doi: 10.5694/j.1326-5377.1994.tb138383.x.
The Victorian casemix funding initiative has achieved initial success in implementing massive budget cuts while increasing hospital throughput and reducing waiting lists. For hospitals to survive, the relationship between casemix and resource use must be managed and this can only be achieved by the involvement of clinicians. With effective information systems and accommodating clinicians, games to maximise casemix, and hence revenue, will undoubtedly emerge. Side effects may include reduced access to "unprofitable" services, increasing pressure on "unprofitable" clinicians and the wooing of "profitable" ones, increasing difficulty in delivering continuity of care and the politicisation of the diagnosis-related groups pricing system. In the end, State governments will be left with a complex control system without resolving the fundamental dilemma inherent in being both the provider of hospital care and the payer.
维多利亚州病例组合资金计划在实施大幅预算削减的同时，提高了医院的诊疗量并减少了候诊名单，已取得初步成功。为使医院生存下去，必须管理病例组合与资源使用之间的关系，而这只有通过临床医生的参与才能实现。有了有效的信息系统和通情达理的临床医生，为使病例组合最大化从而增加收入的博弈无疑将会出现。副作用可能包括获得“无利可图”服务的机会减少、给“无利可图”的临床医生带来更大压力以及对“有利可图”的临床医生的拉拢、提供连续护理的难度增加以及诊断相关分组定价系统的政治化。最终，州政府将面临一个复杂的控制系统，却无法解决身为医院护理提供者和付款方所固有的根本困境。
