Health-based risk adjustment: Improving the pharmacy-based cost group model to reduce gaming possibilities

European Journal of Health Economics

Volumn 4, Issue 2, 2003, Pages 107-114

  Lamers, Leida M ^a   Vliet, R C J A ^b  

^a ERASMUS MEDICAL CENTER   (Netherlands)

^b NONE

Author keywords

Capitation payments; Prescribed drugs; Risk adjustment

Indexed keywords

ARTICLE; COMORBIDITY; DEMOGRAPHY; HEALTH CARE COST; HEALTH CARE PLANNING; HUMAN; MAJOR CLINICAL STUDY; PHARMACY; PRIORITY JOURNAL; RISK ASSESSMENT;

EID: 0038267571     PISSN: 16187598     EISSN: None     Source Type: Journal    
DOI: 10.1007/s10198-002-0159-9     Document Type: Article

References (20)

1. Newhouse JP, Manning WG, Keeler EB, Sloss EM (1989) Adjusting capitation rates using objective health measures and prior utilization. Health Care Financ Rev 10:41-54
2. Ash A, Porell F, Gruenberg L, Sawitz E, Beiser A (1989) Adjusting Medicare capitation payments using prior hospitalization data. Health Care Financ Rev 10:17-29
3. Anderson GP, Steinberg EP, Powe NR, Antebi S, Whittle J, Horn S, Herbert R (1990) Setting payment rates for capitated systems: a comparison of various alternatives. Inquiry 27:225-233
4. Epstein AM, Cumella EJ (1988) Capitation payment: using predictors of medical utilization to adjust rates. Health Care Financ Rev 10:51-69
5. Giacomini M, Luft HS, Robinson JC (1995) Risk adjusting community rated health plan premiums: a survey of risk assessment literature and policy applications. Annu Rev Public Health 16:401-430
6. Ellis RP, Ash A (1995) Refinements to the diagnostic cost group (DCG) model. Inquiry 32:418-429
7. Ellis RP, Pope GC, Iezonni LI, et al (1996) Diagnosis-based risk adjustment for Medicare capitation payments. Health Care Financ Rev 17:101-128
8. Lamers LM (1998) Risk-adjusted capitation payments: developing a diagnostic cost group classification for the Dutch situation. Health Policy 45:15-32
9. Pope GC, Ellis RP, Ash A, et al (2000) Principal inpatient diagnostic cost group model for Medicare risk adjustment. Health Care Financ Rev 21:93-118
10. Hornbrook MC, Goodman MJ (1991) Health plan case mix: definition, measurement, and use. in: Hornbrook MC (ed) Advances in health economics and health services research, vol 12. JAI: London, pp 111-148
11. Weiner JP, Starfield BH, Steinwachs DM, Mumford LM (1991) Development and application of a population-oriented measure of ambulatory care case-mix. Med Care 29:452-472
12. Weiner JP, Dobson A, Maxwell SL, Coleman K, Starfield BH, Anderson GF (1996) Risk-adjusted Medicare capitation rates using ambulatory and inpatient diagnoses. Health Care Financ Rev 17:77-99
13. Clark DO, Korff M von, Saunders K, Baluch WM, Simon GE (1995) A chronic disease score with empirically derived weights. Med Care 33:783-795
14. Lamers LM (1999) Pharmacy costs groups: a risk-adjuster for capitation payments based on the use of prescribed drugs. Med Care 37:824-830
15. GAO (US General Accounting Office) (1994) Health care reform: Considerations for risk adjustment under community rating. GAO/HEHS, Washington, 94-173
16. Lamers LM, Vliet RCJA van, Ven WPMM van de (1999) Farmacie Kosten Groepen: een verdeelkenmerk voor normuitkeringen gebaseerd op medicijngebruik in het verleden (Pharmacy-based cost groups: a risk adjuster for capitation payments based on the utilization of prescribed drugs). Department of Health Policy and Management, Erasmus University: Rotterdam
17. Lamers LM, Vliet RCJA van, Ven WPMM van de (2002) Risk adjusted premium subsidies and risk sharing: key elements of the competitive sickness fund market in the Netherlands. Health Policy (in press)
18. WHO Collaborating Centre for Drug Statistics Methodology (1999) Anatomical Therapeutic Chemical (ATC) classification index. WHO Collaborating Centre for Drug Statistics Methodology: Oslo
19. Lamers LM (2001) Health-based risk adjustment: Is inpatient and outpatient diagnostic information sufficient? Inquiry 38:423-431
20. Gilmer T, Kronick R, Fishman P, Ganiats TG (2001) The Medicaid RX model, pharmacy-based risk adjustment for public programs. Med Care 39:1188-1202