利用慢性病风险因素调整人头费：一项初步研究。
Adjusting capitation using chronic disease risk factors: a preliminary study.
作者信息
Howland J, Stokes J, Crane S C, Belanger A J
出版信息
Health Care Financ Rev. 1987 Winter;9(2):15-23.
Abstract
Researchers have sought ways to modify Medicare's capitation formula, the adjusted average per capita cost (AAPCC), by including measures of individual health status. The present study assesses the value of risk factors for disease as predictors of hospitalization for Framingham Heart Study participants (1,210 males and 1,496 females) 60-65 years of age. Regression models including several common physiologic measures and prior hospitalizations yielded adjusted R2s of 9.69 percent for males and 3.61 percent for females. The contributions of the risk factors and prior hospitalization were about equal and independent. These results confirm the potential utility of disease risk factors for adjusting the AAPCC.
摘要
研究人员一直在寻找方法，通过纳入个体健康状况指标来调整医疗保险的人头计算公式，即调整后的人均成本（AAPCC）。本研究评估了疾病风险因素作为弗雷明汉心脏研究中60至65岁参与者（1210名男性和1496名女性）住院预测指标的价值。包含几种常见生理指标和既往住院情况的回归模型得出，男性的调整后R²为9.69%，女性为3.61%。风险因素和既往住院情况的贡献大致相等且相互独立。这些结果证实了疾病风险因素在调整AAPCC方面的潜在效用。
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本文引用的文献
1
Functional health measure for adjusting health maintenance organization capitation rates.用于调整健康维护组织按人头付费率的功能健康指标。
Health Care Financ Rev. 1986 Spring;7(3):85-95.
2
Using prior utilization to determine payments for Medicare enrollees in health maintenance organizations.利用既往医疗服务利用率来确定健康维护组织中医疗保险参保人的支付金额。
Health Care Financ Rev. 1985 Spring;6(3):27-38.
3
Variations in medical care among small areas.小区域间医疗服务的差异。
Sci Am. 1982 Apr;246(4):120-34. doi: 10.1038/scientificamerican0482-120.
4
On the research status of risk-adjusted capitation rates.关于风险调整后的人头费率的研究现状。
Inquiry. 1984 Fall;21(3):205-13.
5
Increasing Medicare enrollment in HMOs: the need for capitation rates adjusted for health status.增加医疗保险组织中医疗保险的参保人数：需要根据健康状况调整人头费率。
Inquiry. 1983 Fall;20(3):227-39.
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Medicare turns to HMOs.医疗保险转向健康维护组织。
N Engl J Med. 1985 Jan 10;312(2):132-6. doi: 10.1056/NEJM198501103120237.
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