Diagnosis-based risk adjustment for Medicare capitation payments.
Health Care Financ Rev
; 17(3): 101-28, 1996.
Article
em En
| MEDLINE
| ID: mdl-10172666
ABSTRACT
Using 1991-92 data for a 5-percent Medicare sample, we develop, estimate, and evaluate risk-adjustment models that utilize diagnostic information from both inpatient and ambulatory claims to adjust payments for aged and disabled Medicare enrollees. Hierarchical coexisting conditions (HCC) models achieve greater explanatory power than diagnostic cost group (DCG) models by taking account of multiple coexisting medical conditions. Prospective models predict average costs of individuals with chronic conditions nearly as well as concurrent models. All models predict medical costs far more accurately than the current health maintenance organization (HMO) payment formula.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Métodos de Controle de Pagamentos
/
Capitação
/
Sistemas Pré-Pagos de Saúde
/
Medicare
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Health_economic_evaluation
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Female
/
Humans
/
Male
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Health Care Financ Rev
Ano de publicação:
1996
Tipo de documento:
Article
País de afiliação:
Estados Unidos