Casemix Systems

Casemix has transformed the way hospitals are financed worldwide. Originally developed as Diagnosis Related Groups (DRGs) in the United States during the 1980s, casemix has since spread across Europe, Australia, and Asia. Today, it underpins major health financing reforms, shaping efficiency, transparency, and accountability in healthcare delivery.
This comprehensive volume explores the principles, practice, and policy dimensions of casemix systems, with a special focus on Indonesia’s INA-CBG and its integration into the Jaminan Kesehatan Nasional (JKN). Drawing on international comparisons, case studies, and future scenarios, the book provides readers with both the conceptual foundations and the practical applications of casemix.
Key highlights include:

A clear explanation of casemix concepts, from relative weights and tariffs to Case Mix Index (CMI).
Historical evolution of DRGs and their adaptation into CBGs across high-, middle-, and low-income countries.
Insights into hospital management using casemix dashboards for budgeting, resource allocation, and quality monitoring.
Discussion of policy challenges such as equity, rural adaptation, coding quality, and governance.
Exploration of digital health and AI innovations that are reshaping casemix implementation in the 21st century.
Case studies from Indonesia, Thailand, the Philippines, Kenya, and Nigeria-highlighting both successes and barriers.
Forward-looking scenarios for 2030-2040, including outcome-based payments and globally harmonized casemix systems.

Accessible yet rigorous, this book serves multiple audiences:

Students and educators in health informatics, hospital administration, and health policy.
Hospital managers and financial officers seeking practical tools to improve efficiency and equity.
Policymakers and reformers aiming to strengthen universal health coverage (UHC) through evidence-based payment models.
Researchers interested in healthcare financing, data systems, and comparative health policy.

By weaving together theory, evidence, and practice, Casemix Systems underscores that financing reform is not merely technical-it is deeply political, ethical, and social. The message is clear: efficiency must always be balanced with quality and equity, ensuring that healthcare reforms truly serve patients and communities.