Risk-adjusted capitation based on the diagnostic cost group model: An empirical evaluation with health survey information

Health Services Research

Volumn 33, Issue 6, 1999, Pages 1727-1744

  Lamers, Leida M ^a  

^a NONE

Author keywords

Diagnostic information; Health insurance; Health survey; Risk adjusted capitation payments

Indexed keywords

ARTICLE; CAPITATION FEE; DEMOGRAPHY; HEALTH CARE COST; HEALTH INSURANCE; HEALTH SURVEY; NETHERLANDS; RISK ASSESSMENT;

ADOLESCENT; ADULT; AGED; AGED, 80 AND OVER; CAPITATION FEE; CHILD; DIAGNOSIS-RELATED GROUPS; FEMALE; HEALTH EXPENDITURES; HEALTH SURVEYS; HOSPITALIZATION; HUMANS; LEAST-SQUARES ANALYSIS; LONGITUDINAL STUDIES; MALE; MIDDLE AGED; MODELS, ECONOMETRIC; NATIONAL HEALTH PROGRAMS; NETHERLANDS; QUESTIONNAIRES; REPRODUCIBILITY OF RESULTS; RISK ADJUSTMENT;

EID: 0033063344     PISSN: 00179124     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (21)

1. Anderson, G. F., E. P. Steinberg, N. R. Powe, S. Antebi, J. Whittle, S. Horn, and R. Herbert. 1990. "Setting Payment Rates for Capitated Systems: A Comparison of Various Alternatives." Inquiry 27 (2): 225-33.
2. Ash, A., F. Porell, L. Gruenberg, E. Sawitz, and A. Beiser. 1989. "Adjusting Medicare Capitation Payments Using Prior Hospitalization Data." Health Care Financing Review 10 (4): 17-29.
3. _. 1986. An Analysis of Alternative AAPCC Models Using Data from the Continuous Medicare History Sample. Boston: Brandeis/Boston University.
4. Clark, D. O., M. von Korff, K. Saunders, W. M. Baluch, and G. E Simon. 1995. "A Chronic Disease Score with Empirically Derived Weights." Medical Care 33 (8): 783-95.
5. Ellis, R. P., and A. Ash. 1995. "Refining the Diagnostic Cost Group (DCG) Model." Inquiry 32 (winter 1995/96): 418-29.
6. Ellis, R. P., G. C. Pope, L. I. Iezzoni, J. Z. Ayanian, D. W. Bates, H. Burstin, and A. Ash. 1996. "Diagnosis-based Risk Adjustment for Medicare Capitation Payments." Health Care Financing Review 17 (3): 101-28.
7. Epstein, A. M., and E. J. Cumella. 1988. "Capitation Payment: Using Predictors of Medical Utilization to Adjust Rates." Health Care Financing Review 10 (1): 51-69.
8. Hornbrook, M. C., and M. J. Goodman. 1996. "Chronic Disease, Functional Health Status, and Demographics: A Multi-Dimensional Approach to Risk Adjustment." Health Services Research 31 (3): 283-307.
9. _. 1995. "Assessing Relative Health Plan Risk with the RAND-36 Health Survey." Inquiry 32 (1): 56-74.
10. Lamers, L. M. 1997. "Medical Consumption of Respondents and Non-Respondents to a Mailed Health Survey." European Journal of Public Health 7 (3): 267-71.
11. _. 1995. "Validating Survey Data via Comparison with Administrative Data." Proceedings of the International Conference on Survey Measurement and Process Quality, Contributed Papers, 1-4 April, Bristol, U.K., pp. 1-5. Alexandria, VA: American Statistical Association.
12. Lamers, L. M., B. A. Van Gameren, and H. C. A. M. Van Vliet. 1995. De ontwikkeling van Diagnose Kosten Groepen voor de Nederlandse situatie (The Development of a Diagnostic Cost Groups Classification for the Dutch Context). Rotterdam, The Netherlands: Department of Health Policy and Management, Erasmus University.
13. Lamers, L. M., and R. C. J. A. Van Vliet. 1996. "Multiyear Diagnostic Information from Prior Hospitalizations as a Risk-Adjuster for Capitation Payments." Medical Care 34 (6): 549-61.
14. Newhouse, J. P. 1986. "Rate Adjusters for Medicare Under Capitation." Health Care Financing Review 7 (Annual Supplement): 45-55.
15. Newhouse, J. P., W. G. Manning, E. B. Keeler, and E. M. Sloss. 1989. "Adjusting Capitation Rates Using Objective Health Measures and Prior Utilization." Health Care Financing Review 10 (3): 41-54.
16. Physician Payment Review Commission. 1994. A Comparison of Alternative Approaches to Risk Measurement. Selected External Research Series, Number 1. Washington, DC: Physician Payment Review Commission.
17. Thomas, J. W., and R. Lichtenstein. 1986. "Including Health Status in Medicare's Adjusted Average per Capita Cost Capitation Formula." Medical Care 24 (3): 259-75.
18. Van de Ven, W. P. M. M., and R. C.J. A. Van Vliet. 1992. "How Can We Prevent Cream Skimming in a Competitive Health Insurance Market? The Great Challenge for the 90's." In Health Economics Worldwide, edited by T. Frech and P. Zweifel, pp. 23-46. Amsterdam, The Netherlands: Kluwer Academic Publishers.
19. Van Vliet, R. C.J. A. 1992. "Predictability of Individual Health Care Expenditures." Journal of Risk and Insurance 59 (3): 443-61.
20. Van Vliet, R. C.J. A., and W. P. M. M. Van de Ven. 1992. "Towards a Capitation Formula for Competing Health Insurers." Social Science and Medicine 34 (9): 1035-48.
21. Weiner J. P., B. H. Starfield, D. M. Steinwachs, and L. M. Mumford. 1991. "Development and Application of a Population-Oriented Measure of Ambulatory Care Case-Mix." Medical Care 29 (5): 452-72.