Dudley R A, Rennie D J, Luft H S
Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, USA.
Inquiry. 1999 Summer;36(2):200-11.
This paper shows that risk adjustment models based on demographic and employment variables are not easily transferable from one population to the next, and that administrative variables are not useful in predicting medical expenditures. We found statistically significant differences between models built on populations of employees from a single employer enrolled in two different health plans, and between models built on populations of enrollees from a single health plan employed at two different companies. Employment-based variables (e.g., length of employment) had little predictive power in any of these risk models. We conclude that policymakers should be careful in applying risk models across populations, and that future versions of risk models for use within large employers need not include employment-based variables.
本文表明，基于人口统计学和就业变量的风险调整模型不易从一个人群转移到另一个人群，且行政变量在预测医疗支出方面并无用处。我们发现，基于参加两种不同健康计划的单一雇主的员工人群构建的模型之间，以及基于在两家不同公司工作的单一健康计划参保人群构建的模型之间，存在统计学上的显著差异。基于就业的变量（如就业时长）在任何这些风险模型中几乎没有预测能力。我们得出结论，政策制定者在跨人群应用风险模型时应谨慎，且大型雇主内部使用的风险模型的未来版本无需纳入基于就业的变量。
