Abstract:
Historically, the definition of a case mix system is a system that classifies individuals into groups that are homogeneous in the use of resources within the healthcare setting. A good case mix system also makes clinical sense by providing and generating meaningful clinical descriptions of individuals in a group. Therefore, case mix systems are designed to provide a comprehensive picture from both the clinical and administrative perspectives. To date, the application of case mix is broad within hospital settings, it provides the basis not only for reimbursement, but also for comparing the populations within programs and as a staff planning tool, such as Diagnosis Related Groups (DRGs). However, there is limited use of case mix within primary care settings. The purpose of this thesis investigates how to implement case mix systems within primary care settings. Specifically, the aims of this thesis are, first, whether case mix systems could be implemented within primary care settings. Second, how case mix systems can be implemented within primary care settings. Third, why case mix systems use for primary care. In doing so, this thesis develops a conceptualised model in order to illustrate the function of case mix systems as a filter to help service providers filter clients’ needs. Three theoretical perspectives are relevant for this conceptualised model which are respectively market segmentation, Service Dominant (S-D) Logic, Resource Based View (RBV). In order to test each element of the conceptualised model, this thesis used a qualitative research method by conducting interviews. From the main findings of qualitative data four themes emerged, Theme 1 identified the scope and range of primary care. Theme 2 identified the scope and range of primary health care. Theme 3 summarised current service provision of primary care within New Zealand. Theme 4 evaluated advantages and challenges from both clinical and administrative perspectives during the implementation of case mix systems for primary care. Overall, this thesis contributes to the literature of case mix systems for primary care as well as developing a conceptualised model for illustrating the function of case mix systems. The conclusion draw from this thesis is that case mix could be implemented within primary care settings, using level of needs as a basis, and would be much more appropriate than diagnosis under traditional case mix systems.