Accommodating different and divergent interests is not an easy task. Utilizing classification systems that fail to meet basic medical concepts, in terms of which disease and illness are understood, makes this task even more difficult. This can be seen in the article by Drs Iezzoni and Moskowitz1 in this issue of The Journal.
The goal of any classification system is to ensure that homogeneity is inherent in each category classified. An optimal classification system allows the prognosis and resource needs to be compared for individuals with "similar illnesses." The problem is the definition of "similar illness." Even though there may be biological similarities, there will be social differences that will affect patient care. Patient expectations and demands will also vary and will influence the effectiveness of the care given. Thus, case mix classification is an exercise in how best to pretend that what is in fact heterogeneous is homogeneous. The
Gonnella JS. Case Mix Classification: The Need to Reduce Inappropriate Homogeneity. JAMA. 1986;255(7):941–942. doi:10.1001/jama.1986.03370070095035
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