In this paper we consider the progress made in using casemix in Australia. We argue that while the casemix infrastructure has been highly developed and the casemix-based funding systems of some states are mature, there is still more development needed to use the data for clinical questions such as quality improvement activities. Further research is needed to establish what is needed to describe the impact of casemix on clinicians and hospitals in a context of increasing accountability and transparency and where questions of efficiency cannot be ignored.