Thomas J W, Lichtenstein R
Med Care. 1986 Mar;24(3):259-75. doi: 10.1097/00005650-198603000-00008.
Actuarial factors currently comprising Medicare's HMO capitation formula, the Adjusted Average Per Capita Cost (AAPCC), are considered by many researchers to be inadequate as predictors of future period health care costs. While it is often suggested that the formula should incorporate beneficiary health status, no measure of health status suitable for this purpose has yet been identified. The authors present initial results from a study of 1,934 randomly selected Medicare beneficiaries in Michigan. Beneficiaries were surveyed to obtain data on several alternative measures of health status. Medicare claims were used to estimate beneficiary health care costs for periods before and after the survey. In regressions on future period Medicare payments, equations including the AAPCC factors plus a health status measure achieved R2 values ranging from 0.013 to 0.072, depending on the health status measure, compared with an R2 value of 0.003 for the equation with AAPCC factors alone.
精算因素目前构成了医疗保险的健康维护组织（HMO）人头费计算公式，即调整后的人均成本（AAPCC），许多研究人员认为这些因素作为未来时期医疗保健成本的预测指标并不充分。虽然人们经常建议该公式应纳入受益人的健康状况，但尚未确定适合此目的的健康状况衡量标准。作者展示了对密歇根州1934名随机选择的医疗保险受益人的研究初步结果。对受益人进行了调查，以获取有关几种健康状况替代衡量标准的数据。医疗保险理赔数据用于估计调查前后各时期受益人的医疗保健成本。在对未来时期医疗保险支付的回归分析中，包含AAPCC因素加上健康状况衡量标准的方程的R2值在0.013至0.072之间，具体取决于健康状况衡量标准，而仅包含AAPCC因素的方程的R2值为0.003。
