Medicare Risk-Adjusted Capitation Payments: From Research to Implementation
Medicare Risk-Adjusted Capitation Payments: From Research to Implementation
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医疗保险风险调整按人头付费：从研究到实施
DOI：
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发表时间：
2000
影响因子：
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通讯作者：
L. Greenwald
中科院分区：
文献类型：
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作者：
L. Greenwald
在本期《卫生保健筹资评论》中，我们重点讨论风险调整。风险调整是当前医疗保健术语中一个非常流行的部分，它实际上可以指一些相互关联的概念。例如，风险调整有时描述了一种解释不同研究人群健康状况差异的方法；这也被称为病例组合调整。风险调整也可用于衡量和/或预测个人或群体的卫生保健支出，并具体作为支付系统的一部分加以应用。这一术语的后一种应用是本问题的焦点。
In this issue of the Health Care Financing Review, we focus on risk adjustment. A now-popular part of current health care jargon, risk adjustment can actually refer to a number of interrelated concepts. For example, risk adjustment sometimes describes a way of accounting for differences in health status among various study populations; this is also referred to as case-mix adjustment. Risk adjustment can also be used for the purpose of measuring and/or predicting the health care expenditures of individuals or groups, and applied specifically as part of a payment system. It is this latter application of the term that is the focus of this issue.
In part, this issue updates some of the research that was previously published in the 1996 issue of the Review Volume 17, Number 3 on risk adjustment. While much has changed regarding the policy applications of risk adjustment—risk-adjusted capitated payments are now a reality in the Medicare program, as well as in many State Medicaid programs—recent research on risk adjustment continues to focus on model development and improvement. However, because the real world of risk-adjusted payment systems are far more common than in 1996, some of the newest work in risk adjustment is related to policy applications. This issue presents articles that touch both on recent model development work and on policy applications.