A systematic review of case-mix models for home health care payment: Making sense of variation

Anne O. E. van den Bulck*, Maud H. de Korte, Arianne M. J. Elissen, Silke F. Metzelthin, Misja C. Mikkers, Dirk Ruwaard

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review


Background: Case-mix based payment of health care services offers potential to contain expenditure growth and simultaneously support needs-based care provision. However, limited evidence exists on its application in home health care (HHC). Therefore, this study aimed to synthesize available international literature on existing case-mix models for HHC payment.

Methods: We performed a systematic review of scientific literature, supplemented with grey literature. We searched for literature using six scientific databases, reference lists, expert consultation, and targeted websites. Data on study design, case-mix model attributes, and conclusions were extracted narratively.

Results: Of 3303 references found, 22 scientific studies and 27 grey documents met eligibility criteria. Eight case-mix models for HHC were identified, from the US, Canada, New Zealand, Australia, and Germany. Three countries have implemented a case-mix model as part of a HHC payment system. Different combinations of in total 127 unique case-mix predictors are included across models to predict HHC use. Case-mix models also differ in targeted services, operationalization, and outcome measures and predictive power.

Conclusions: Case-mix based payment is not yet widely used within HHC. Multiple varieties were found between HHC case-mix models, and no one best form of a model seems to exist. Even though varieties are partly inevitable due to country-specific contexts, developing a shared vision in case-mix model attributes would be key to achieving efficient, needs-based HHC. (C) 2020 The Authors. Published by Elsevier B.V.

Original languageEnglish
Pages (from-to)121-132
Number of pages12
JournalHealth Policy
Issue number2
Publication statusPublished - Feb 2020


  • Casemix
  • Home care services
  • Classification
  • Prospective payment system
  • Systematic review

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