Diagnoses-based cost groups in the Dutch risk-equalization model: The effects of including outpatient diagnoses
In: Health policy (Amsterdam. Print), Jg. 115 (2014), Heft 1, S. 52-59
academicJournal
- print, 17 ref
Zugriff:
Background: The Dutch basic health-insurance scheme for curative care includes a risk equalization model (RE-model) to compensate competing health insurers for the predictable high costs of people in poor health. Since 2004, this RE-model includes the so-called Diagnoses-based Cost Groups (DCGs) as a risk adjuster. Until 2013, these DCGs have been mainly based on diagnoses from inpatient hospital treatment. Objectives: This paper examines (1) to what extent the Dutch RE-model can be improved by extending the inpatient DCGs with diagnoses from outpatient hospital treatment and (2) how to treat outpatient diagnoses relative to their corresponding inpatient diagnoses. Method: Based on individual-level administrative costs we estimate the Dutch RE-model with three different DCG modalities. Using individual-level survey information from a prior year we examine the outcomes of these modalities for different groups of people in poor health. Conclusions: We find that extending DCGs with outpatient diagnoses has hardly any effect on the R-squared of the RE-model, but reduces the undercompensation for people with a chronic condition by about 8%. With respect to incentives, it may be preferable to make no distinction between corresponding inpatient and outpatient diagnoses in the DCG-classification, although this will be at the expense of the predictive accuracy of the RE-model.
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Diagnoses-based cost groups in the Dutch risk-equalization model: The effects of including outpatient diagnoses
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Autor/in / Beteiligte Person: | VAN KLEEF, R. C ; VAN VLIET, R. C. J. A ; VAN ROOIJEN, E. M |
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Zeitschrift: | Health policy (Amsterdam. Print), Jg. 115 (2014), Heft 1, S. 52-59 |
Veröffentlichung: | Amsterdam: Elsevier, 2014 |
Medientyp: | academicJournal |
Umfang: | print, 17 ref |
ISSN: | 0168-8510 (print) |
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