Outpatient costing and classification: are we any closer to a national standard for ambulatory classification systems?

The Outpatient Costing and Classification Study was commissioned by the Dep artment of Health and Family Services to evaluate the suitability of the De velopmental Ambulatory Classification System (DACS). Data on the full range of ambulatory services (outpatient clinics, emergenc y departments and allied health services) were collected prospectively from a stratified sample of 28 public hospitals. Patient encounters captured in the study represent 1% of the total ambulatory encounters in Australia in one year. Costing per encounter included time spent with the patient, cost of procedu res, indirect costs (salaries and consumables), overhead costs and diagnost ic costs. The most significant variable explaining cost variation was hospital type, followed by outpatient clinic type. Visit type and presence or absence of a procedure major splits for the proposed DACS - did not produce splits that were consistent across all hospital strata. The study found that DACS is n ot an appropriate classification for hospital ambulatory services. A clinic-based structure for outpatients and allied health departments is r ecommended for classifying and funding ambulatory services in Australia.