建立台灣診斷基礎風險計價模式及模式妥適性評估之國際比較
Date Issued
2005-07-31
Date
2005-07-31
Author(s)
DOI
932416H002043
Abstract
This study intends to develop a diagnostic information risk adjustment
model, and to examine the performance
of ACG and DCG/HCC systems in
Taiwan National Health Insurance
program. Assess the extent to which ACG
and DCG/HCC can account for
same-year and next-year outpatient and
total health care expenditures.
A total of 164,275 beneficiaries,
eligible for the National Health Insurance
(NHI) from January 1, 2000 to December
31, 2002 were randomly selected from
the enrollment file of National Health
Insurance Research Database. ACG,
DCG/HCC and TASGs+TPIPDCG were
assigned through diagnoses from
physician and hospital claim files. We use
2000 and 2001 diagnostic profiles to
predict costs in 2001 and 2002,
respectively. Linear regression was used
to examine the predictability of the ACGs,
DCG/HCC, TASGs+TPIPDCG systems
to explain variation in individual costs. In
order to avoid overfitting, a split-sample
method was employed to partition the
study sample into an estimation sample
and a validation sample randomly.
For Outpatient cost, while the ACGs
system explained 12.87%~11.2%, the
DCG/HCC system explained
10.24%~9.49%, and the
TASGs+TPIPDCG system explained
20.92%~20.37% of variation in costs. For
total cost, while the ACG system
explained 15.43%~10.56%, the
DCG/HCC system explained
11.5%~8.29%, and the
TASGs+TPIPDCG system explained
24.76%~22.7% of variation in costs. The
TASGs+TPIPDCG system performs
better than ACGs and DCG/HCC system.
The ACG system performs better than
DCG/HCC system in Taiwan National
Health Insurance program. The
predictabilities of both ACG and
DCG/HCC systems are fairly stable in
the same-year and next-year costs. The
results demonstrate that the application of
ACG and DCG/HCC in Taiwan is
feasible using existing data. Relative to
the applications in other countries, the
ability of the ACG and DCG/HCC
systems to explain variation in costs is
comparatively low. It is suggested that
the introduction of the ACG and
DCG/HCC systems into Taiwan requires
some modifications in order to harmonize
with local practice and disease patterns.
Subjects
health insurance
risk adjustment
diagnostic information
Publisher
臺北市：國立臺灣大學公共衛生學院醫療機構管理研究所
Type
report
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