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Title
Adjusting Medicare capitation payments using prior hospitalization data.
First Author
Ash, Arlene S
Date of Pub
1989 Summer
Pages
17-29
Volume
10
Issue
4
Other Authors
Beiser, Alexa; Gruenberg, Leonard; Porell, Frank W; Sawitz, Eric
Abstract
The diagnostic cost group approach to a reimbursement model for health maintenance organizations is presented. Diagnostic information about previous hospitalizations is used to create empirically determined risk groups, using only diagnoses involving little or no discretion in the decision to hospitalize. Diagnostic cost group and other models (including Medicare's current formula and other prior-use models) are tested for their ability to predict future costs, using R2 values and new measures of predictive performance. The diagnostic cost group models perform relatively well with respect to a range of criteria, including administrative feasibility, resistance to provider manipulation, and statistical accuracy.
Abstract Continued
N/A
MeSH
Capitation Fee : Fees and Charges : Models, Theoretical : Costs and Cost Analysis/trends : Data Collection : Diagnosis-Related Groups/economics : Fee Schedules : Health Maintenance Organizations/economics : Hospitalization/economics : Medicare/organization & administration : Probability : Reimbursement Mechanisms : Support, U.S. Gov't, Non-P.H.S. : United States
NTIS Number
PB89-232342