‘Bipolarity’ in bipolar disorder: Distribution of manic and depressive symptoms in a treated population

SummaryCross-sectional analysis of 441 individuals with bipolar disorder treated at a US health maintenance organisation investigated the distribution of manic and depressive symptoms in that illness. Clinically significant depressive symptoms occurred in 94.1% of those with (hypo)mania, while70.1% inadepressive episode had clinically significant manic symptoms. DSM-unrecognised depression-plus-hypomania was over twice as prevalent as DSM-recognised mixed episodes. Depressive symptoms were unimodally distributed in (hypo)mania. Depressive and manic symptoms were positively, not inversely correlated, and their co-occurrence was associated with worse quality of life. Implications for the DSM and ICD nosological systems are discussed.

Funding issues for Victorian hospitals:the risk-adjusted vision beyond casemix funding

This paper discusses casemix funding issues in Victoria impacting on teaching hospitals. For casemix payments to beacceptable, the average price and cost weights must be set at an appropriate standard. The average price is based ona normative, policy basis rather than benchmarking. The 'averaging principle' inherent in cost weights has resulted insome AN-DRG weights being too low for teaching hospitals that are key State-wide providers of high complexityservices such as neurosurgery and trauma. Casemix data have been analysed using international risk adjustmentmethodologies to successfully negotiate with the Victorian State Government for specified grants for several highcomplexity AN-DRGs. A risk-adjusted capitation funding model has also been developed for cystic fibrosis patientstreated by The Alfred, called an Australian Health Maintenance Organisation (AHMO). This will facilitate thedevelopment of similar models by both the Victorian and Federal governments.