Commentary: improving risk-adjustment models for capitation payment and global budgeting

• Published in: Health services research Vol. 33; no. 6; pp. 1745 - 1751
• Main Author: Hornbrook, M C
• Format: Journal Article
• Language: English
• Published: United States Health Research and Educational Trust 01.02.1999; Blackwell Publishing Ltd
• Subjects: Activities of daily living; Adjustment; Ambulatory care; Ambulatory medical care; Bias; Budgeting; Budgets; Budgets - organization & administration; Capitated payment systems (Medical care); Capitation; Capitation Fee; Demographics; Diagnosis-Related Groups - classification; Diagnosis-Related Groups - economics; Disease; Economic aspects; Expenditures; Forecasts and trends; Health care costs; Health care expenditures; Health care policy; Health insurance; Health Surveys; Hospitals; Humans; Information systems; International; Medical care, Cost of; Medicare; Medicare - organization & administration; Models, Econometric; National health insurance; Per capita; Predictions; Response rates; Risk Adjustment; Risk assessment; United States; United States
• ISSN: 0017-9124; 1475-6773

The study conducted on risk adjustment in capitation payment systems in the healthcare industry provides a practical model for predicting medical per capita expenditures. This model may be refined further by incorporating data on ambulatory diagnoses instead of focusing on inpatient expenditures alone. Ambulatory expenditures have greater predictive accuracy as compared to the inpatient expenditures as relatively few health consumers get hospitalized annually. Use of data on sickness funds poses possible biased findings as these funds are not uniformly managed.