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Finance and Policy
Introduction
—What features are highly desirable in a private sector payment model?
—The ‘old’ per diem payment model of the 1980s and 1990s
—Do current private sector case-payment models meet the criteria?
—EPMTM
—Classification system
—Step down points
—Relative weights
—Costs not bundled into relative weights
—Financial effect of LOS reduction
—Relative cost weights derivation
—Payment based on EPMTM units
—DRGs as the basis of per diem payment
—Discussion
—Advantages for hospitals
—Advantages for health funds
—Disadvantages
—Implementation
—Conclusion
—Competing interests
—References
—Author details
The many types of payment models used in the Australian private sector are reviewed. Their features are compared and contrasted to those desirable in an optimal private sector payment model. The EPMTM (Equitable Payment Model) is discussed and its consistency with the desirable features of an optimal private sector payment model outlined. These include being based on a robust classification system, nationally benchmarked length of stay (LOS) results, nationally benchmarked relative cost and encouraging continual improvement in efficiency to the benefit of both health funds and private hospitals. The advantages in the context of the private sector of EPMTM being a per diem model, albeit very different to current per diem models, are discussed. The advantages of EPMTM for hospitals and health funds are outlined.
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Brian WT Hanning, MB, ChB, FRACMA, FAFPHM, Medical Director
Australian Health Service Alliance, Camberwell, VIC.
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©Aust Health Rev 2005 www.aushealthreview.com.au PRINT ISSN: 0156-5788 ONLINE ISSN: 1449-8944