4.2.1 RationaleAustralia's investment in developing a casemix classification for mental health services was initiated in the mid 1990s, culminating in a 'first generation' classification (MH-CASC) that was foreshadowed for further development. Further research and development to improve the classification was suspended over the 1998-2003 period, while States and Territories implemented arrangements for the collection and national reporting of the required data.
As that work nears completion, Australia is in a position to recommence its planning for a casemix classification, building on the work completed in the 1990s. The original rationale for commencing on the path to develop a casemix for mental health remains as relevant today as it was then.
Casemix is often seen as solely concerned with the funding of health services, and as such, has been viewed with concern by the mental health community. However, its original purpose was to provide a basis for quality assurance. In Australia, casemix was introduced initially as a management information system to assist in improving efficiency, standards and patient outcomes, not as a basis for determining payments. This role of a casemix classification is often lost in discussions about its potential in the mental health field, a barrier that remains to be crossed.
Casemix classifications provide a standardised method for describing the activities of health services in terms of the types of patients treated, their treatment episodes and associated resource use. They add an important dimension to value for money assessments because they provide tools that distinguish variation between health services attributable to patients (ie. casemix) from those that are caused by provider factors. Separating these two sources of variation in health service data is an essential step in developing benchmarks to compare services on costs, outcomes and quality.
Casemix classifications are inherently evolutionary and require an ongoing investment in research and development. Casemix classes need to be modified with experience, cost weights adjusted based on changing patterns of care, and so forth. Compared with the acute health field, where such work has been in progress for more than 20 years, the mental health sector is only at the beginning of this cycle.Top of page
4.2.2 Consolidation activities
Completing the implementation of the MH-CASC collection requirementsMost States and Territories have further work to ensure comprehensive coverage of services in their data collection and reporting arrangements.
Promoting the understanding and application of casemix in mental health servicesConsiderable misunderstanding exists in the mental health workforce about the purpose of casemix and its value as a tool in quality improvement activities. In the years ahead, a range of information and training resources will be developed through AMHOCN that are designed to promote a more informed workforce.
4.2.3 New initiatives
Trialing and refinement of the classificationAs data of sufficient quality become available, a range of analyses will be undertaken to further develop the casemix classification produced by the Mental Health Classification and Service Costs (MH-CASC) Project. This will include addressing issues identified in the 1999 'first edition' of national information priorities such as:
- testing the classification based on its performance in explaining service utilisation (as proxy measures for cost);
- implementing desirable clinical modifications to improve its utility in quality assurance and other clinical applications;
- identifying cost weight refinements and possible future costing studies; and
- addressing the need to rationalise classifications in the field of aged care.