van Kleef Richard C, van Vliet René C J A
Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam. The Netherlands.
Inquiry. 2010;47(4):343-58. doi: 10.5034/inquiryjrnl_47.04.343.
This paper examines a new risk adjuster for capitation payments to Dutch health plans, based on the prior use of durable medical equipment (DME). The essence is to classify users of DME in a previous year into clinically homogeneous classes and to apply the resulting classification as a risk adjuster for capitation payments in the subsequent year. We evaluate 143 DME types in terms of incentives, validity, predictive value, and measurability, resulting in 14 functional disability classes (FDCs). We conclude that FDCs can significantly improve the Dutch risk adjustment model, although possible incentives for oversupply have to be monitored.
本文研究了一种用于向荷兰健康计划进行按人头付费的新风险调整器，该调整器基于耐用医疗设备（DME）的既往使用情况。其核心是将上一年DME的使用者分类为临床同质类别，并将所得分类应用于次年按人头付费的风险调整器。我们从激励性、有效性、预测价值和可测量性方面评估了143种DME类型，得出了14个功能残疾类别（FDC）。我们得出结论，FDC可以显著改善荷兰的风险调整模型，不过必须监测可能存在的供应过剩激励因素。
