Skip to Main Content
Title
A clinically detailed risk information system for cost
First Author
Carter, Grace M
Date of Pub
2000 Spring
Pages
65-91
Volume
21
Issue
3
Other Authors
Bell, Robert M; Dubois, Robert W; Goldberg, George A; Keeler, Emmett B; McAlearney, John S; Post, Edward P; Rumpel, J David
Abstract
The authors discuss a system that describes the resources needed to treat different subgroups of the population under age 65, based on burden of disease. It is based on 173 conditions, each with up to 3 severity levels, and contains models that combine prospective diagnoses with retrospectively determined elements. We used data from four different payers and standardized the cost of most services. Analyses showed that the models are replicable, are reasonably accurate, explain costs across payers, and reduce rewards for biased selection. A prospective model with additional payments for birth episodes and for serious problems in newborns would be an effective risk adjuster for Medicaid programs.
Abstract Continued
N/A
MeSH
Costs and Cost Analysis/methods : Health Expenditures : Insurance Selection Bias : Disease/classification : Fee-for-Service Plans : Health Maintenance Organizations : Medicaid : Regression Analysis : Risk Factors : Support, U.S. Gov't, non-P.H.S. : United States
NTIS Number
N/A