Development of Risk Assessment Models for Chinese Medicine
Date Issued
2006
Date
2006
Author(s)
Chang, Ya-Lan
DOI
zh-TW
Abstract
In order to contain the escalation of health care expenditure and allocate resource fairly, many developed countries have introduced a prospective budget payment system. To maintain the equity and efficiency of health care, the risk-adjusted capitation approach is considered to be one of the effective mechanisms, in which health-based risk adjusters are used to predict personal medical expenses. Although abundant studies on risk adjustment have been conducted in Taiwan, none of them aims at the care of Chinese medicine. This study intends to develop risk assessment models for Chinese medicine and evaluate the predictability. The results can provide a reference of allocating Chinese medical budgets in Taiwan’s National Health Insurance.
With 2001 and 2002 NHI data, 2,131,067 enrollees were selected as the study sample. Using demographic adjusters, prior utilization adjusters, diagnostic-based adjusters and a preference for Chinese medicine, this study develops four risk assessment models through weighted least square estimation and evaluates the predictability. Diagnostic-based adjusters are first classified by the Classification and Regression Trees（CART）.
The results show that the risk assessment model based on solely demographic information has a poor predictability of 1.24%. Adding the diagnostic information into the demographic model can increase the predictability to 6.49%. Moreover, including the preference to Chinese medicine further increases the model’s predictability to 17.51%. Nevertheless, the prior utilization model has the highest predictability of 33.15%. The PR values of the diagnosis-preference model are close to 1, except for Northern, Eastern, Central districts and few diseases.
The risk assessment model based on diagnostic information and the preference to the Chinese medicine can considerably improve the predictability. Because the Chinese medicine is a traditional medical practice in Taiwan, it may serve as a complementary or alternative medicine to the western medicine. The preference to different medical practices indeed plays an important role on individual’s medicine utilization. However, this study only analyzes the utilization of the Chinese medicine and provides information only relevant for setting additive budgets for different health care sectors, i.e., the current budget setting system. Further research on the relation with Chinese medicine and western medicine is encouraged and may provide the more complete panorama of utilization of medical care as well as budget setting.
Subjects
中醫
風險校正
分類與迴歸樹
Chinese medicine
Risk adjustment
Classification and Regession Trees
Type
thesis
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