Explanatory ability of the ACG system regarding the utilization and expenditure of the National Health Insurance population in Taiwan - A 5-year analysis
Explanatory ability of the ACG system regarding the utilization and expenditure of the National Health Insurance population in Taiwan - A 5-year analysis
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DOI：
10.1016/s1726-4901(08)70103-5
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发表时间：
2008-04-01
影响因子：
3
通讯作者：
Huang, Tong-Po
中科院分区：
文献类型：
--
作者：
Lee, Wui-Chiang;Huang, Tong-Po
背景：调整临床组（ACG）是一种基于诊断的病例组合调整系统，已在台湾以外的多个国家进行了广泛评估。本研究的目的是评估 ACG 系统在台湾国民健康保险 (NHI) 人群中的表现。方法：我们使用 2000 年至 2004 年随机抽样的 1% 国民健康保险参保者的索赔数据进行纵向数据分析。使用 ACG 软件分别根据 2000 年至 2004 年每年的年龄、性别和汇总诊断将每个人分配到 1 个 ACG 类别。研究了 ACG 分配模式及其与支出的关系。通过每年的多元回归模型检查 ACG 系统调整 R 2 测量的当年和下一年门诊和住院费用的解释能力。结果：NHI 索赔数据的质量令人满意，98.1％的人口可以分配到 ACG 类别，人口的 ACG 模式基本一致，但在 5 年内分布不均匀。百分之八十的 NHI 支出花在了分配到 21 个 ACG 的人员身上。个人ACG及其组成部分对同年和次年99%截断就诊的方差、门诊费用、住院费用和国民健康保险总费用的解释能力在各年之间相当一致，并且优于年龄和性别。门诊支出的解释性能优于住院支出，并且与其他国家的统计数据相当。结论：ACG 系统多年来在台湾门诊和支出方面效果良好。卫生保健当局可以引入 ACG 系统来量化人口的发病负担和医疗需求。
Background: The adjusted clinical group (ACG) is a diagnosis-based case-mix adjustment system, which has been widely evaluated in several countries other than Taiwan. The aim of this study was to assess the performance of the ACG system on the National Health Insurance (NHI) population in Taiwan.Methods: We conducted longitudinal data analysis using the claims data of 1% of randomly sampled NHI enrollees from 2000 to 2004. The ACG software was used to assign each individual to 1 ACG category based on age, gender and aggregating diagnoses in each year from 2000 to 2004, respectively. The ACG distribution patterns and their relationships to expenditure were examined. Explanatory ability as measured by adjusted R 2 of the ACG system for same-year and next-year ambulatory and inpatient expenditure were examined by multivariate regression models for each year.Results: The quality of NHI claim data was satisfactory in that 98.1% of the population could be assigned to ACG categories, The population's ACG patterns were substantially consistent but unequally distributed across the 5 years. Eighty percent of NHI expenditure were spent on people assigned to 21 ACGs. The explanatory abilities of individual's ACG and its components with respect to the variance of same-year and next-year 99% truncated visits, ambulatory expenditure, inpatient expenditure, and total NHI expenditure were quite consistent across years and were superior to age and gender. The explanatory performance was better for ambulatory than inpatient expenditure and was comparable to the statistics demonstrated in other countries.Conclusion: The ACG system worked well for Taiwanese ambulatory visits and expenditure across years. Health care authorities can introduce the ACG system to quantify the population's morbidity burdens and medical needs.