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一个针对成本的临床详细风险信息系统。

A clinically detailed risk information system for cost.

作者信息

Carter G M, Bell R M, Dubois R W, Goldberg G A, Keeler E B, McAlearney J S, Post E P, Rumpel J D

机构信息

RAND, Santa Monica, CA 90407-2138, USA.

出版信息

Health Care Financ Rev. 2000 Spring;21(3):65-91.

PMID:11481768
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4194682/
Abstract

The authors discuss a system that describes the resources needed to treat different subgroups of the population under age 65, based on burden of disease. It is based on 173 conditions, each with up to 3 severity levels, and contains models that combine prospective diagnoses with retrospectively determined elements. We used data from four different payers and standardized the cost of most services. Analyses showed that the models are replicable, are reasonably accurate, explain costs across payers, and reduce rewards for biased selection. A prospective model with additional payments for birth episodes and for serious problems in newborns would be an effective risk adjuster for Medicaid programs.

摘要

作者们讨论了一种基于疾病负担来描述治疗65岁以下不同人群亚组所需资源的系统。它基于173种病症，每种病症有多达3个严重程度级别，并包含将前瞻性诊断与回顾性确定的因素相结合的模型。我们使用了来自四个不同付款方的数据，并对大多数服务的成本进行了标准化。分析表明，这些模型具有可复制性，相当准确，能解释不同付款方的成本情况，并且减少了对有偏差选择的奖励。一个针对出生情况和新生儿严重问题有额外支付的前瞻性模型将是医疗补助计划的有效风险调整工具。

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本文引用的文献

1
Adjusting capitation rates using objective health measures and prior utilization.
Health Care Financ Rev. 1989 Spring;10(3):41-54.
2
The demand for episodes of treatment in the Health Insurance Experiment.
J Health Econ. 1988 Dec;7(4):337-67. doi: 10.1016/0167-6296(88)90020-3.
3
Insurance aspects of DRG outlier payments.
J Health Econ. 1988 Sep;7(3):193-214. doi: 10.1016/0167-6296(88)90025-2.
4
Rate adjusters for Medicare under capitation.
Health Care Financ Rev. 1986;1986(Spec No):45-55.
5
Provider behavior under prospective reimbursement. Cost sharing and supply.
J Health Econ. 1986 Jun;5(2):129-51. doi: 10.1016/0167-6296(86)90002-0.
6
A model of the impact of reimbursement schemes on health plan choice.
J Health Econ. 1998 Jun;17(3):297-320. doi: 10.1016/s0167-6296(97)00029-5.
7
Diagnosis-based risk adjustment for Medicare capitation payments.
Health Care Financ Rev. 1996 Spring;17(3):101-28.
8
Diagnostic risk adjustment for Medicaid: the disability payment system.
Health Care Financ Rev. 1996 Spring;17(3):7-33.
9
Risk-adjusted Medicare capitation rates using ambulatory and inpatient diagnoses.
Health Care Financ Rev. 1996 Spring;17(3):77-99.
10
Applying population-based case mix adjustment in managed care: the Johns Hopkins Ambulatory Care Group system.
Manag Care Q. 1994 Summer;2(3):21-34.

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