+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Health-based risk adjustment: improving the pharmacy-based cost group model by adding diagnostic cost groups



Health-based risk adjustment: improving the pharmacy-based cost group model by adding diagnostic cost groups



Inquiry 44(4): 469-480



Since 1991, risk-adjusted premium subsidies have existed in the Dutch social health insurance sector, which covered about two-thirds of the population until 2006. In 2002, pharmacy-based cost groups (PCGs) were included in the demographic risk adjustment model, which improved the goodness-of-fit, as measured by the R2, to 11.5%. The model's R2 reached 22.8% in 2004, when inpatient diagnostic information was added in the form of diagnostic cost groups (DCGs). PCGs and DCGs appear to be complementary in their ability to predict future costs. PCGs particularly improve the R2 for outpatient expenses, whereas DCGs improve the R2 for inpatient expenses. In 2006, this system of risk-adjusted premium subsidies was extended to cover the entire population.

Please choose payment method:






(PDF emailed within 1 workday: $29.90)

Accession: 053493355

Download citation: RISBibTeXText

PMID: 18338519


Related references

Health-Based Risk Adjustment: Improving the Pharmacy-Based Cost Group Model by Adding Diagnostic Cost Groups. Inquiry - Journal of Health Care Organization, Provision and Financing 44(4): 469-480, 2007

Health-based risk adjustment Improving the pharmacy-based cost group model to reduce gaming possibilities. European Journal of Health Economics 4(2): 107-114, 2003

Risk-adjusted capitation based on the Diagnostic Cost Group Model: an empirical evaluation with health survey information. Health Services Research 33(6): 1727-1744, 1999

Principal inpatient diagnostic cost group model for Medicare risk adjustment. Health Care Financing Review 21(3): 93-118, 2000

The Pharmacy-based Cost Group model: validating and adjusting the classification of medications for chronic conditions to the Dutch situation. Health Policy 68(1): 113-121, 2004

Diagnosis-based Cost Groups in the Dutch Risk-equalization Model. Medical Care 56(1): 91-96, 2018

The effect of cost construction based on either DRG or ICD-9 codes or risk group stratification on the resulting cost-effectiveness ratios. Pharmacoeconomics 22(18): 1209-1216, 2004

High cost pool or high cost groups-How to handle high(est) cost cases in a risk adjustment mechanism?. Health Policy 120(2): 141-147, 2016

An in-depth assessment of a diagnosis-based risk adjustment model based on national health insurance claims: the application of the Johns Hopkins Adjusted Clinical Group case-mix system in Taiwan. Bmc Medicine 8: 7, 2010

The differences between claim-based health risk adjustment models and cost prediction models. Disease Management 7(2): 153-158, 2004

Cost and cost-effectiveness of community based and health facility based directly observed treatment of tuberculosis in Dar es Salaam, Tanzania. Cost Effectiveness and Resource Allocation 3: 6, 2005

The effects of acquisition cost and budget-based compensation on the attitudes of pharmacy directors toward the adoption of a cost-effective new drug. Pharmacoeconomics 13(2): 223-230, 1998

What the dead cost - concerns with Morbi-RSA (morbidity-based risk adjustment). Mmw Fortschritte der Medizin 154(15): 12-12, 2012

The Medicaid Rx model: pharmacy-based risk adjustment for public programs. Medical Care 39(11): 1188-1202, 2001

Diagnoses-based cost groups in the Dutch risk-equalization model: the effects of including outpatient diagnoses. Health Policy 115(1): 52-59, 2014