Capitation Adjustment for Children with Special Health Care Needs

尽管风险调整后的按人头支付通常由公众和 在私营保险公司中，几乎没有专门针对儿童的风险调整模型。 越来越依赖成本控制机制，如管理式医疗和按人头计价 无论是私人市场还是针对儿童的公共项目，都需要设置足够的 儿童的人均占有率更加紧迫。这项研究通过开发风险来满足这一需求 儿童，特别是有特殊保健需要的儿童(CSHCN)的调整模式， 在目前由以下因素主导的医疗保险市场中，他们尤其脆弱 管理型医疗计划。拟议项目的目标是为以下三个方面的政策制定提供信息 儿童保健筹资的重要问题：(1)。风险调整模型能做得多好 估计是专门为儿童表演的？(2)。健康计划是多少钱？风险的激励因素 儿童在不同风险调整模式下的选择减少？和(3)。一辆车能卖多少钱 风险调整后的资本计入和风险分担的混合制度(即由 赞助商)减少选拔激励？ 这项研究有四个具体目标： 具体目标1：评估CSHCN和 CSHCN状态的持久性。 具体目标2：首先使用关于CSHCN的信息估计风险调整模型，以及 然后通过与基于诊断的模型的比较来评估其预测性能。 具体目标3：模拟健康计划？不同风险下风险选择的潜在收益 调整器。 具体目标4：调查健康计划？两者兼而有之的混合制度下的潜在利润 风险调整后的资本比率和风险分担。我们将研究两种类型的风险分担， 包括对高成本儿童的离群值风险分担和针对具体情况的风险分担。 这项研究符合医疗研究和质量机构(AHRQ)的优先计划 确定改进获取、促进适当使用和减少 尤其是，它将使用AHRQ的医疗支出小组 调查(MEP)，以评估财务安排的变化如何影响获得护理的机会 CSHCN，AHRQ特别关注的弱势群体。

Although risk-adjusted capitation payments have commonly been implemented by public and private insurers, few risk adjustment models have been estimated specifically for children. Increasing reliance on cost containment mechanisms, such as managed care and capitation in both private markets and public programs targeting children, makes the need to set adequate capitation rates for children more urgent. This study addresses this need by developing risk adjustment models for children, especially children with special health care needs (CSHCN), who are particularly vulnerable in the current health insurance marketplace dominated by managed care plans. The goal of the proposed project is to inform policy-making on three important issues of health care financing for children: (1). How well can risk adjustment models estimated specifically for children perform? (2). How much are health plans? incentives for risk selection reduced under different risk adjustment models for children? and (3). How much can a mixed system of both risk-adjusted capitation and risk-sharing (i.e. reinsurance funded by the sponsor) reduce selection incentives? This study has four specific aims: Specific Aim 1: To assess the persistence of high expenditures among CSHCN and the persistence of CSHCN status. Specific Aim 2: First to estimate a risk adjustment model using information about CSHCN, and then to assess its predictive performance through comparison with the diagnosis-based models. Specific Aim 3: To simulate health plans? potential profits from risk selection under different risk adjusters. Specific Aim 4: To investigate health plans? potential profit under the mixed system that has both risk-adjusted capitation rates and risk-sharing. Two types of risk-sharing will be examined, including outliers risk-sharing for high-cost children and condition-specific risk-sharing. This study fits in the Agency of Healthcare Research and Quality's (AHRQ) priority program area of "Identifying Strategies to Improve Access, Foster Appropriate Use, and Reduce Unnecessary Expenditures." In particular, it will use the AHRQ's Medical Expenditure Panel Survey (MEPS) to assess how changes in financial arrangements affect access to care by CSHCN, a vulnerable population of special interest to the AHRQ.