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Title
Analysis of underwriting factors for AAPCC (adjusted average per capita cost).
First Author
Manton, Kenneth G
Date of Pub
1992 Fall
Pages
117-132
Volume
14
Issue
1
Other Authors
Stallard, Eric
Abstract
The adjusted average per capita cost (AAPCC) formula is used to determine payment to health maintenance organizations (HMOs) by Medicare. The four original underwriting factors (i.e., age, sex, institutional status, and welfare status) for the AAPCC were calibrated from the Current Medicare Surveys for 1974-76. Those factors have been updated by various actuarial adjustments. Revised calculations of the AAPCC underwriting factors are presented using survey data from the 1984 National Long-Term Care Survey and expenditure data from the Medicare Part A and Part B bill files. Also examined is the effect on the underwriting factors of chronic functional disability, defined as having one or more chronic limitations in activities of daily living. Comparison of alternative underwriting factors is conducted by simulating the dollar impact on payment to HMOs for select enrollee populations.
Abstract Continued
N/A
MeSH
Actuarial Analysis : Aged : Computer Simulation : Costs and Cost Analysis/statistics & numerical data : Disabled Persons/statistics & numerical data : Female : Health Maintenance Organizations/economics : Health Status Indicators : Human : Institutionalization/economics : Male : Medicare Part A/economics/statistics & numerical data : Medicare Part B/economics/statistics & numerical data : Prospective Payment System/statistics & numerical data : Socioeconomic Factors : Support, U.S. Gov't, Non-P.H.S. : Support, U.S. Gov't, P.H.S. : United States
NTIS Number
PB95-123279