Health-Based Risk Adjustment
Improving the Pharmacy-Based Cost Group Model by Adding Diagnostic Cost Groups
Bibliographic Data
| ID | 13774798 |
|---|---|
| Authors | Femmeke J Prinsze (0000-0002-7849-0092, corresponding author), René C J A Van Vliet (Erasmus University Rotterdam) |
| Year | 2007 |
| Volume | 44 |
| Issue | 4 |
| Pages | 469-480 |
| Publication date | 2007-11-01 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | INQUIRY The Journal of Health Care Organization Provision and Financing (JOURNAL) |
| Journal identifiers | ISSN: 0046-9580 • E-ISSN: 1945-7243 |
| Publisher | SAGE Publishing (PUBLISHER • US) |
| DOI | 10.5034/inquiryjrnl_44.4.469 |
| PMID | 18338519 |
| OpenAlex | W2001165132 |
| Language | EN |
| Citations received | 7 |
| References cited | 9 |
Since 1991, risk-adjusted premium subsidies have existed in the Dutch social health insurance sector, which covered about two-thirds of the population until 2006. In 2002, pharmacy-based cost groups (PCGs) were included in the demographic risk adjustment model, which improved the goodness-of-fit, as measured by the R2, to 11.5%. The model's R2 reached 22.8% in 2004, when inpatient diagnostic information was added in the form of diagnostic cost groups (DCGs). PCGs and DCGs appear to be complementary in their ability to predict future costs. PCGs particularly improve the R2 for outpatient expenses, whereas DCGs improve the R2 for inpatient expenses. In 2006, this system of risk-adjusted premium subsidies was extended to cover the entire population
Actuarial science · Business · Economics · Environmental health · Family medicine · Goodness of fit · Operations management · Population · Statistics · Subsidy · Health Systems, Economic Evaluations, Quality of Life · Healthcare cost, quality, practices · Healthcare Policy and Management · Mathematics · Medicine · Pharmacy
Prior Use of Durable Medical Equipment as a Risk Adjuster for Health-Based Capitation
Profiling Individual Physicians Using Administrative Data From a Single Insurer
Predicting Healthcare Utilization Using a Pharmacy-based Metric With the WHO’s Anatomic Therapeutic Chemical Algorithm
Improving Risk Equalization Using Multiple-year High Cost as a Health Indicator
Diagnosis-based Cost Groups in the Dutch Risk-equalization Model
Risk Adjustment in Health Insurance Markets
Diagnostic, Pharmacy-Based, and Self-Reported Health Measures in Risk Equalization Models
| Citations per year | 0.44 |
|---|---|
| Citation span | 2010 - 2024 (15) |
| Highly cited | No |