Modeling Health Utilization of Medicaid Children

医疗补助儿童的健康利用建模

• 批准号: 6554906
• 负责人: David B Rein
• 金额: $ 2.96万
• 依托单位: GEORGIA STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-09-30 至 2004-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6554906
• 关键词: Medicare /Medicaid; child with disability; children; clinical research; cost effectiveness; developmental disease /disorder; health behavior; health care cost /financing; health care model; health care policy; health care quality; health care service organization; health care service utilization; health services research tag; human data; model design /development

DESCRIPTION (provided by applicant): Insurers, public health officials, providers, and health management professionals are interested in predicting who uses health care and why. The ability to predict who will use services is important for several practical applications, such as health care financing and targeting health promotion initiatives. Recent research suggests that better predictive estimates of individual level health care utilization are now possible. This research seeks to build a better model to predict the use of health services. Specifically, it seeks to predict the health care expenses for the full population of Georgia Medicaid children in 1999. This dissertation research combines the strengths of two leading cost forecasting models in order to address three primary goals: First, to build a better predictive model of health service utilization; Second, to address a particular health policy area, that of children with special health care needs (CSHCN), by providing information to help in their definition and categorization. Third, to build upon previous theory in health service utilization, such as the behavioral model of health service utilization and the principal agent model, using knowledge gained from new methodological approaches. To achieve these goals, a two-part model will be developed, with each portion of the model being treated as a finite mixture of at least two sub-populations. The model is estimated using maximum likelihood estimation, through use of the estimation/maximization (EM) algorithm. The new model is compared to published models to determine improvements in predictive power, using the BIC and the GOF criteria. Information from the new model can be used to design health care financing strategies for children in Medicaid; to identify different groups of CSHCN; and to expand the theory about who uses health services and why. The methodologies used to build this predictive model are directly applicable to several other areas of health services research.

描述(由申请人提供)：保险公司、公共卫生官员、提供者和健康管理专业人员对预测谁使用医疗保健以及为什么使用医疗保健感兴趣。预测谁将使用服务的能力对于几个实际应用非常重要，例如卫生保健融资和有针对性的健康促进倡议。最近的研究表明，现在有可能对个人水平的卫生保健利用率进行更好的预测性估计。 这项研究试图建立一个更好的模型来预测卫生服务的使用情况。具体地说，它试图预测1999年佐治亚州医疗补助计划儿童的全部人口的医疗费用。本文的研究结合了两种主要的成本预测模型的优点，以解决三个主要目标：第一，建立更好的卫生服务利用预测模型；第二，通过提供信息来帮助定义和分类特定的卫生政策领域，即有特殊卫生保健需要的儿童(CSHCN)。第三，利用从新的方法论方法中获得的知识，在卫生服务利用的行为模型和委托代理模型等卫生服务利用的先前理论的基础上进行发展。 为了实现这些目标，将开发一个由两部分组成的模型，将模型的每一部分视为至少两个子总体的有限混合。通过使用估计/最大化(EM)算法，使用最大似然估计对模型进行估计。使用BIC和GOF标准，将新模型与已发表的模型进行比较，以确定预测能力的改进。 来自新模型的信息可用于为医疗补助中的儿童设计医疗保健融资战略；识别CSHCN的不同群体；并扩展关于谁使用医疗服务以及为什么使用医疗服务的理论。用于建立这一预测模型的方法直接适用于卫生服务研究的其他几个领域。

项目成果

A matter of classes: stratifying health care populations to produce better estimates of inpatient costs.

类别问题：对医疗保健人群进行分层，以更好地估计住院费用。

• DOI: 10.1111/j.1475-6773.2005.00393.x
• 发表时间: 2005
• 期刊: Health services research
• 影响因子: 3.4
• 作者: Rein,DavidB