比较识别医疗补助计划中未来高成本精神健康病例的方法。
Comparing methods for identifying future high-cost mental health cases in Medicaid.
机构信息
Department of Mental Health Law and Policy, Florida Mental Health Institute, University of South Florida, Tampa, FL 33612, USA.
出版信息
Value Health. 2012 Jan;15(1):198-203. doi: 10.1016/j.jval.2011.08.007. Epub 2011 Oct 14.
OBJECTIVE
This article examines methods for identifying future high-cost cases of Medicaid-covered mental health care services.
METHODS
Florida Medicaid claims data are used to compare methods based on prior cost, and concurrent and prospective diagnosis-based models. Individuals with prior year expenditures in the top decile or with predicted expenditures in the top decile from the diagnosis-based models were expected to be high-cost individuals.
RESULTS
Individuals in the top decile of prior year costs averaged $13,684 (U.S. dollars) in costs in the following year with 50% remaining in the top decile of spending. Individuals classified as high cost by diagnosis-based models averaged $10,935 to $10,974, with 34% meeting the criteria for a high-cost case in the following year.
CONCLUSION
In contrast to research on high-costs cases for physical health care, prior cost was superior to diagnosis-based models at identifying future high cases for mental health care.
目的
本文探讨了识别医疗补助覆盖的精神保健服务未来高成本病例的方法。
方法
利用佛罗里达州医疗补助索赔数据，对基于既往成本的方法，以及基于同期和前瞻性诊断的模型进行比较。预计上一年度支出在前十分位数或基于诊断的模型预测支出在前十分位数的个人将是高成本个体。
结果
上一年度费用最高十分位数的个人，次年的费用平均为 13684 美元（美元），有 50%的人仍在前十分位数的支出范围内。基于诊断模型分类为高成本的个人平均为 10935 至 10974 美元，有 34%的人在下一年符合高成本病例的标准。
结论
与针对身体健康高成本病例的研究相比，既往成本在识别精神保健未来高成本病例方面优于基于诊断的模型。
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