利用慢性病风险因素调整医疗保险按人头付费。
Using chronic disease risk factors to adjust Medicare capitation payments.
作者信息
Schauffler H H, Howland J, Cobb J
机构信息
School of Public Health, University of California, Berkeley 94720.
出版信息
Health Care Financ Rev. 1992 Fall;14(1):79-90.
This study evaluates the use of risk factors for chronic disease as health status adjusters for Medicare's capitation formula, the average adjusted per capita costs (AAPCC). Risk factor data for the surviving members of the Framingham Study cohort who were examined in 1982-83 were merged with 100 percent Medicare payment data for 1984 and 1985, matching on Social Security number and sex. Seven different AAPCC models were estimated to assess the independent contributions of risk factors and measures of prior utilization and disability in increasing the explanatory power of AAPCC. The findings suggest that inclusion of risk factors for chronic disease as health status adjusters can improve substantially the predictive accuracy of AAPCC.
本研究评估了将慢性病风险因素用作医疗保险人头费公式（即平均调整后人均成本，AAPCC）的健康状况调整因子的情况。将1982 - 1983年接受检查的弗雷明汉研究队列幸存成员的风险因素数据与1984年和1985年100%的医疗保险支付数据进行合并，依据社会保险号和性别进行匹配。估计了七种不同的AAPCC模型，以评估风险因素以及先前利用情况和残疾指标在提高AAPCC解释力方面的独立贡献。研究结果表明，纳入慢性病风险因素作为健康状况调整因子可大幅提高AAPCC的预测准确性。
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