Liam Twomey (Wexford, Fine Gael)
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Question 189: To ask the Tánaiste and Minister for Health and Children if the Health Service Executive or former health boards had direct involvement in the management of hospitals that were penalised for failing to reach targets under the case mix system; and if she will make a statement on the matter. [6313/06]

Mary Harney (Dublin Mid West, Progressive Democrats)
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Case mix analyses the mix of patients hospitals treat by collecting data on the diagnoses and procedures relating to individual patients and the cost of treating them and categorising them into diagnoses related groups. Case mix is used as part of the budgetary process in order that funding is based on measured costs and activity and to fund hospitals for the patients actually treated. In calculating these costs, account is taken of each hospital's unique issues and unique patients.

The case mix programme does not set hospital targets. Case mix hospitals are divided into four peer groups of similar hospitals. This is to allow fair clinical and cost comparison of like with like and take full account of each hospital's different mix of cases. Benchmarks such as cost per case, are generated by direct reference to both the national data and each hospital's peer group of hospitals, that is, the hospital's data sets the benchmarks used. A percentage of each hospital's budget is adjusted based on its peer group case mix performance. The consequence of this is that some hospitals may lose funding while others may gain.

As case mix quantifies the mix of cases each hospital treats, it is a hospital rather than a health board programme. However, the programme is managed with the active participation of all stakeholders, including individual hospitals and their respective hospital networks, the national hospitals office and the Health Service Executive. All stakeholders are actively encouraged to participate in the process. They are also encouraged to establish structures to advise on the operation and implementation of the programme.

As case mix allows for the collection, categorisation and interpretation of hospital patient data related to the types of cases treated to assist hospitals to define their products, measure their productivity and assess quality, a central tenet of the programme is that all data collected from individual hospitals is shared among all participating hospitals, the national hospitals office and the Health Service Executive. This ensures that the value-added benefit that accrues from such a comprehensive database of hospital data can be fully utilised.

There are 37 hospitals within the national case mix programme, comprising both voluntary and former health board, now HSE hospitals. The Health Service Executive has responsibility for the funding of all 37 hospitals. Former health board hospitals come under the direct management of the HSE while voluntary hospitals have their own management structures. It is a matter for each hospital to review its case mix outturns in consultation with the HSE, as funder, and to take whatever action deemed appropriate.

I remain committed to rewarding good performance and, as case mix is the most internationally accepted performance related acute hospital activity programme, it is agreed between my Department and the Health Service Executive that case mix will be used as a central pillar in acute hospital funding policy.