Development of Risk Assessment Models for Dental Care
Date Issued
2006
Date
2006
Author(s)
Chang, Ming-Fang
DOI
zh-TW
Abstract
Many countries have experienced the escalation of health care expenditure and have adopted prospective payment system. Under prospective payment system, risk-adjusted capitation has been considered and implemented to set budgets in recent years. In order to contain the growth of expenditure, Taiwan’s National Health Insurance program has adopted a global budget payment system, and budgets were not set through capitation. This study intends to develop risk assessment capitation models for dental care. The results may provide alternative approaches of allocating prospective budgets in Taiwan’s NHI program.
By using NHI’s research data bank of 2001 and 2002, 2,131,067 enrollees was randomly selected as the study sample. Three risk assessment models were developed through weight least square estimation and Classification and Regression Trees (CART) respectively. The independent variables of demographic model are age and sex. In addition to age and sex, while the prior utilization model includes individual’s 2001 outpatient expenditure of dental care as an independent variable, and the diagnostic model includes nine diseases as the independent variables. The dependent variable of the six models is enrollee’s 2002 annualized dental care expenditure.
The PR2 of risk assessment model through CART are slightly higher than those through regression. The PR2 of diagnostic model is better than demographic model and at least as good as the prior utilization model. The PR values of diagnostic model are similar to prior utilization model, and both of them are better than demographic model.
Demographic data are easy to gain but the PR2 is low. Although the PR2 of prior utilization model is higher than that of the demographic model, the improvement is somewhat limited. The reason may be related to the characteristics of dental care and the utilization behavior. The three oral diseases included in the diagnostic model account for most utilization of outpatient dental care; however, the correlation of individual expenditures between 2001 and 2002 is relatively low, only 0.125. The predictability of the diagnostic model is therefore restricted. It is encouraged to investigate the difference of the need for outpatient dental care in subsequent year for individual oral diseases. This subtle diagnostic information can provide a basis of developing refined diagnostic groups which may predict the need of outpatient dental care more accurately.
Subjects
牙醫
風險校正
分類與迴歸樹
Dental Care
Risk Adjustment
Classification and Regression Trees
Type
thesis
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