Quality of care under casemix

The introduction of casemix funding in some States has led to concerns that hospitals, faced with budgetary problems, may be tempted to discharge patients prematurely after inadequate treatment — the “quicker and sicker syndrome”. There are no significant Australian data on quality of care before and after casemix funding, but a large study in the United States found that, in general, there was no evidence of a deterioration in care. Contrary to expectation, readmission rates were unaltered. There was, however, some evidence of an increase in discharge of patients in an unstable state and more were transferred to nursing homes. There are significant reasons why these conclusions can not be readily transported to the Australian environment, and there is a need to monitor the discharge status of patients, particularly the frail elderly, with casemix funding in Australia.