Anne O E van den Bulck1, Maud H de Korte2, Arianne M J Elissen3, Silke F Metzelthin4, Misja C Mikkers5, Dirk Ruwaard6. 1. Maastricht University, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Department of Health Services Research, P.O. Box 616 6200 MD, Maastricht, the Netherlands. Electronic address: a.vandenbulck@maastrichtuniversity.nl. 2. Tilburg University, Department of Economics, P.O. Box 90153 5037 AB, Tilburg, the Netherlands; Dutch Healthcare Authority (NZa), P.O. Box 3017 3502 GA, Utrecht, the Netherlands. Electronic address: mkorte@nza.nl. 3. Maastricht University, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Department of Health Services Research, P.O. Box 616 6200 MD, Maastricht, the Netherlands. Electronic address: a.elissen@maastrichtuniversity.nl. 4. Maastricht University, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Department of Health Services Research, P.O. Box 616 6200 MD, Maastricht, the Netherlands. Electronic address: s.metzelthin@maastrichtuniversity.nl. 5. Tilburg University, Department of Economics, P.O. Box 90153 5037 AB, Tilburg, the Netherlands; Dutch Healthcare Authority (NZa), P.O. Box 3017 3502 GA, Utrecht, the Netherlands; Tilburg University, Tilburg Law and Economics Center (TILEC), P.O. Box 90153 5000 LE, Tilburg, the Netherlands. Electronic address: mmikkers@nza.nl. 6. Maastricht University, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Department of Health Services Research, P.O. Box 616 6200 MD, Maastricht, the Netherlands. Electronic address: d.ruwaard@maastrichtuniversity.nl.
Abstract
BACKGROUND: Case-mix based payment of health care services offers potential to contain expenditure growth and simultaneously support needs-based care provision. However, limited evidence exists on its application in home health care (HHC). Therefore, this study aimed to synthesize available international literature on existing case-mix models for HHC payment. METHODS: We performed a systematic review of scientific literature, supplemented with grey literature. We searched for literature using six scientific databases, reference lists, expert consultation, and targeted websites. Data on study design, case-mix model attributes, and conclusions were extracted narratively. RESULTS: Of 3303 references found, 22 scientific studies and 27 grey documents met eligibility criteria. Eight case-mix models for HHC were identified, from the US, Canada, New Zealand, Australia, and Germany. Three countries have implemented a case-mix model as part of a HHC payment system. Different combinations of in total 127 unique case-mix predictors are included across models to predict HHC use. Case-mix models also differ in targeted services, operationalization, and outcome measures and predictive power. CONCLUSIONS: Case-mix based payment is not yet widely used within HHC. Multiple varieties were found between HHC case-mix models, and no one best form of a model seems to exist. Even though varieties are partly inevitable due to country-specific contexts, developing a shared vision in case-mix model attributes would be key to achieving efficient, needs-based HHC.
BACKGROUND: Case-mix based payment of health care services offers potential to contain expenditure growth and simultaneously support needs-based care provision. However, limited evidence exists on its application in home health care (HHC). Therefore, this study aimed to synthesize available international literature on existing case-mix models for HHC payment. METHODS: We performed a systematic review of scientific literature, supplemented with grey literature. We searched for literature using six scientific databases, reference lists, expert consultation, and targeted websites. Data on study design, case-mix model attributes, and conclusions were extracted narratively. RESULTS: Of 3303 references found, 22 scientific studies and 27 grey documents met eligibility criteria. Eight case-mix models for HHC were identified, from the US, Canada, New Zealand, Australia, and Germany. Three countries have implemented a case-mix model as part of a HHC payment system. Different combinations of in total 127 unique case-mix predictors are included across models to predict HHC use. Case-mix models also differ in targeted services, operationalization, and outcome measures and predictive power. CONCLUSIONS: Case-mix based payment is not yet widely used within HHC. Multiple varieties were found between HHC case-mix models, and no one best form of a model seems to exist. Even though varieties are partly inevitable due to country-specific contexts, developing a shared vision in case-mix model attributes would be key to achieving efficient, needs-based HHC.
Authors: Anne O E van den Bulck; Arianne M J Elissen; Silke F Metzelthin; Maud H de Korte; Gertjan S Verhoeven; Teuntje A T de Witte-Breure; Lieuwe C van der Weij; Misja C Mikkers; Dirk Ruwaard Journal: BMC Health Serv Res Date: 2022-03-25 Impact factor: 2.655