BOOKS OF RtfiDIfGS - PAHO/WHO

;.'.
'Vol. XVIII. No. 2. Siupplement
- 73 -
¡mlore sopltisticated and include process
and ontcoanit nita miires.
5. The cost of providing care to the different
types of patients must be reasonable.
The i..formation fromi projets such as the
Ntew Jersey prospective reiml)ursemnent
experinment can establish the cost of providing
care to eacli patient type iu eavh hospital.
If a hospital proves extremely cost ineffecvtie
in providing care to vertain types of
patibts. llthe the pliannúing process sii.st
consir er : ther a iore c(ust-efll'ctive alternative
exists.
TlIiIs, the basict hospital rcgional planning
problem can be describedl as a system
of hospitais with the capacity to treat
specitied nunibers and types of patients. In
addition, there aure a set of basic cquality and
access constraints that must be met. However,
given that the capacity boiunds and
access and quality constraints can be met
by a number of alternative cotigurattiotns
of case mix, the alternative requiring the
least cx)st is likely to be the preferred alternative.
Such a probleni can be analyzed
nsing linear programming techniques. The
DRC can provide the basis for establishing
hospital case mix. A case mix-based linear
progranming model of the regional plan-
.ning probleim should prove to have many
CASE MIX APPROACH TO PLANNING
iminmediate practical applications. For
example, suptpose a proposal to close a particular
hospital had been made. The regional
planning model could be used to
suygest the most cost-effective means of
¡tistributing the closed hospital's case mix
to the other hospitais in the region while
still maintaining adequate access and quality
andl not exceeding the capacities of any
hlospital. Alternatively, if there were an
existing recommendation for the distribution
of the closed hospital's case mix, then
the model could he used simply to siminlate
the impact oft'the case mix changes un
the other hospitals and describe that impact
in terms of various hospital parameters,
such as occiupancy rates and reinmbursement
levels. There are many other
examples of the use of such a m¡odel. If
there were significant changes in the composition
of case types projected becvaise of
a new cure or an outbreak of an inflctious
disease, then the modeliould be usedl to
evaluate the impact on the hospitais in the
region. Thus, while a case mix regional
planning model is only in it's early stagesxf
development, it does hold the potential to
be a powerful tool for the hospital planning
process.