Differences that matter: Understanding case-mix and quality for prospective payment of home care

A suitable payment system is necessary to provide efficient, high-quality care at home. Therefore, in 2017, the Dutch Healthcare Authority initiated a project to develop a new home care payment system based on client profiles. This means a budget per client is determined beforehand, which suits a client’s expected care use. To do so, insight is needed on which client characteristics can predict the expected home care use. This was studied in this dissertation, by asking district nurses and by studying scientific literature. Among others, client characteristics related to a client’s functioning in daily life – for example if a client is independent in showering or using medication – were considered as relevant predictors of home care use. Subsequently, with this knowledge the Case-Mix Short Form was developed, tested and implemented, together with district nurses, home care providers and healthcare insurers, to collect data on relevant predictive client characteristics in a standardized manner. Finally, this dissertation provides an exploration of suitable outcomes for quality measurement in home care.