Policy Issues in Medical Computing. Health Care Economics and Medical Computing: Applying Case-Mix Methods to Ambulatory Care

Case-mix based prospective reimbursement methods are being adopted for inpatient care. No similar methods exist for ambulatory care, due to the lack of an accepted outpatient case-mix methodology. Two approaches to ambulatory care case-mix are described. The first is based on classifying patients by their primary problem and their mix of problems treated during a patient-year. The second is based on classifying each visit by primary problem addressed. The adoption of case-mix methods will require the development of many new medical information systems. The use of such systems to describe and analyze ambulatory care over time is discussed. Inpatient and ambulatory care are functionally linked. The development of ambulatory care case-mix systems and their integration with inpatient case-mix systems will allow a major step towards the development of a capitation approach to describing total healthcare costs, by case, for a given population.