医疗保险风险调整的实施。
Implementation of risk adjustment for Medicare.
作者信息
Ingber M J
机构信息
Office of Strategic Planning, Health Care Financing Administration, Baltimore, MD 21244-1850, USA.
出版信息
Health Care Financ Rev. 2000 Spring;21(3):119-26.
The Health Care Financing Administration (HCFA) implemented risk adjustment for Medicare capitated organizations January 2000. The risk adjustment system used, the Principal Inpatient Diagnostic Cost Group (PIPDCG) method, had to be incorporated into the payment structure mandated by the Balanced Budget Act of 1997 (BBA). This article describes how risk adjustment was integrated into the payment system within the rules of the BBA, and how fee-for-service (FFS) and health maintenance organization (HMO) data are collected and used in the determination of payment.
医疗保健财务管理局（HCFA）于2000年1月对医疗保险按人头付费组织实施了风险调整。所采用的风险调整系统，即主要住院诊断成本分组（PIPDCG）方法，必须纳入1997年《平衡预算法案》（BBA）规定的支付结构中。本文描述了风险调整是如何在BBA的规则范围内纳入支付系统的，以及如何收集和使用按服务收费（FFS）和健康维护组织（HMO）的数据来确定支付金额。
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