A clinically detailed risk information system for cost

The authors discuss a system that describes the resources needed to treat different subgroups of the population under age 65, based on burden of disease. It is based on 173 conditions, each with up to 3 severity levels, and contains models that combine prospective diagnoses with retrospectively dete...

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Published inHealth care financing review Vol. 21; no. 3; pp. 65 - 91
Main Authors Carter, G M, Bell, R M, Dubois, R W, Goldberg, G A, Keeler, E B, McAlearney, J S, Post, E P, Rumpel, J D
Format Journal Article
LanguageEnglish
Published United States Superintendent of Documents 2000
CENTERS for MEDICARE & MEDICAID SERVICES
Subjects
Adolescent
Adult
Child
Child, Preschool
Cost of Illness
Demographics
Disease - classification
Disease - economics
Episode of Care
Female
Health care expenditures
Health Resources - economics
Health risk assessment
Humans
Infant
Infant, Newborn
Male
Medicaid
Michigan
Middle Aged
Models, Econometric
Public health
Risk Adjustment - economics
Severity of Illness Index
Statistical analysis
Studies
United States
United States
Michigan
United States > US
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Summary:The authors discuss a system that describes the resources needed to treat different subgroups of the population under age 65, based on burden of disease. It is based on 173 conditions, each with up to 3 severity levels, and contains models that combine prospective diagnoses with retrospectively determined elements. We used data from four different payers and standardized the cost of most services. Analyses showed that the models are replicable, are reasonably accurate, explain costs across payers, and reduce rewards for biased selection. A prospective model with additional payments for birth episodes and for serious problems in newborns would be an effective risk adjuster for Medicaid programs.
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SourceType-Scholarly Journals-1
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ISSN:0195-8631
1554-9887