A discordancy test approach is proposed to identify outliers of inpati
ent length of stay. This has implications not only for benchmarking se
rvice delivery but also for linking budget allocation procedures to ef
ficiency of health service provisions. The effects of shifting trim po
int thresholds on hospital payments are assessed in a case study of a
group of obstetrical patients. (C) 1998 John Wiley & Sons, Ltd.