Kronick R, Dreyfus T, Lee L, Zhou Z
Department of Family and Preventative Medicine, University of California, San Diego 92093, USA.
Health Care Financ Rev. 1996 Spring;17(3):7-33.
This article describes a system of diagnostic categories that Medicaid programs can use for adjusting capitation payments to health plans that enroll people with disability. Medicaid claims from Colorado, Michigan, Missouri, New York, and Ohio are analyzed to demonstrate that the greater predictability of costs among people with disabilities makes risk adjustment more feasible than for a general population and more critical to creating health systems for people with disability. The application of our diagnostic categories to State claims data is described, including estimated effects on subsequent-year costs of various diagnoses. The challenges of implementing adjustment by diagnosis are explored.
本文介绍了一种诊断分类系统，医疗补助计划可利用该系统来调整向招收残疾人士的健康计划支付的人头费。对来自科罗拉多州、密歇根州、密苏里州、纽约州和俄亥俄州的医疗补助索赔进行了分析，以证明残疾人群体成本的更高可预测性使得风险调整比对普通人群更可行，并且对于为残疾人士建立卫生系统更为关键。描述了我们的诊断分类在州索赔数据中的应用，包括各种诊断对次年成本的估计影响。探讨了按诊断进行调整所面临的挑战。
