Linking care bands to resource allocation for home support and long-term residential care. An evidence review

Many different reimbursement systems exist for providers offering healthcare to service users in their homes or residential settings. Under case mix classification systems, service users are sorted into “care bands”, which group together service users with similar levels of care needs. Funding and resources are then allocated to providers based on the care bands of their service users, rather than on a fee-per-hour basis or by a flat rate. This allows funding to be better matched to levels of care needs, and it can reduce incentives to provide unnecessary care. 

Ireland’s Department of Health is currently developing a new statutory scheme for financing and regulating home support services, which will include a model based on case mix classification and resource allocation. It is important that the new scheme for home support matches the scheme for residential care, so that service users can transition smoothly from one system to the other if needed. This review was carried out to support the Department of Health in designing the new model for Ireland, by providing an evidence base and a comprehensive understanding of existing systems of case mix classification and their effects. 

In the first part of the review, country case studies are presented for Australia, Canada, Germany, the Netherlands, New Zealand, and the USA. The case studies provide a comprehensive overview of the care-banding systems and how they are used to allocate funding and resources in each country.  In the second part, a systematic review was carried out to present evidence on the impact of these systems on outcomes for service users, healthcare systems, and costs. Searches of five electronic databases were supplemented with Google searches and reference and citation chasing, yielding a total of 46 studies that met inclusion criteria. We found that in some countries, costs for case mix reimbursement increased over time and tended to be higher than other reimbursement systems. Across countries, there was little impact on equity, service user outcomes, or quality of care.