Diagnosis-Based Risk Adjustment for Medicare Capitation Payments
Diagnosis-Based Risk Adjustment for Medicare Capitation Payments
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基于诊断的医疗保险按人头付款风险调整
作者：
R. Ellis;G. Pope;L. Iezzoni;J. Ayanian;D. Bates;H. Burstin;A. Ash
使用1991-92年的数据为5%的医疗保险样本，我们开发，估计和评估风险调整模型，利用诊断信息从住院和门诊索赔，以调整支付老年人和残疾人的医疗保险参保者。分层共存条件（HCC）模型通过考虑多种共存的医疗条件，实现了比诊断成本组（DCG）模型更大的解释能力。前瞻性模型预测慢性病患者的平均成本几乎和并发模型一样。所有模型对医疗费用的预测都比当前的健康维护组织（HMO）支付公式准确得多。
Using 1991-92 data for a 5-percent Medicare sample, we develop, estimate, and evaluate risk-adjustment models that utilize diagnostic information from both inpatient and ambulatory claims to adjust payments for aged and disabled Medicare enrollees. Hierarchical coexisting conditions (HCC) models achieve greater explanatory power than diagnostic cost group (DCG) models by taking account of multiple coexisting medical conditions. Prospective models predict average costs of individuals with chronic conditions nearly as well as concurrent models. All models predict medical costs far more accurately than the current health maintenance organization (HMO) payment formula.
利用慢性病风险因素来调整医疗保险按人头付费。
影响因子：
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作者：
Schauffler,HH;Howland,J;Cobb,J
通讯作者：
Cobb,J