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Improving risk equalization using information on physiotherapy diagnoses
BACKGROUND: Worldwide, risk-equalization (RE) models in competitive health insurance markets have evolved from simple demographic models to sophisticated models containing diagnosis and pharmacy-based indicators of health. However, these models still have important imperfections; adding information...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5813071/ https://www.ncbi.nlm.nih.gov/pubmed/28185028 http://dx.doi.org/10.1007/s10198-017-0874-x |
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author | Eijkenaar, Frank van Vliet, René C. J. A. |
author_facet | Eijkenaar, Frank van Vliet, René C. J. A. |
author_sort | Eijkenaar, Frank |
collection | PubMed |
description | BACKGROUND: Worldwide, risk-equalization (RE) models in competitive health insurance markets have evolved from simple demographic models to sophisticated models containing diagnosis and pharmacy-based indicators of health. However, these models still have important imperfections; adding information on (diagnoses of) physiotherapy treatment may further improve RE-models. Therefore, a new risk-adjuster based on physiotherapy costs in the prior year was introduced in the Dutch RE-model of 2016. METHODS: Physiotherapy claims-data (2012) and administrative data on costs and risk-characteristics (2013) for 94% of the Dutch population (N = 15.8 million) are used to evaluate the current risk-adjuster based on physiotherapy costs and to assess the effects of replacing it by different modalities of a risk-adjuster based on physiotherapy diagnoses. Of the 89 diagnoses in the claims-data, 62 are dropped because they relate to temporary health problems. The 27 retained diagnoses are added to the Dutch model in 4 modalities: 27 separate risk-classes, 9 diagnosis-clusters based on main pathology category, 4 diagnosis-clusters based on residual costs, and the 4 clusters of modality 3 interacted with age. RESULTS: Although the cost-based risk-adjuster improves the model’s predictive power and removes the average undercompensation (€919) for enrollees with physiotherapy costs in the prior year, it is outperformed by all 4 diagnosis-based modalities. Of these modalities, modality 3 is preferred based on its simplicity and comparable predictive power. CONCLUSIONS: Adding information on physiotherapy can further improve the performance of sophisticated RE-models. Regarding the Dutch model, a risk-adjuster containing 4 risk-classes for clustered diagnoses based on residual costs is the preferred modality. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s10198-017-0874-x) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5813071 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-58130712018-02-26 Improving risk equalization using information on physiotherapy diagnoses Eijkenaar, Frank van Vliet, René C. J. A. Eur J Health Econ Original Paper BACKGROUND: Worldwide, risk-equalization (RE) models in competitive health insurance markets have evolved from simple demographic models to sophisticated models containing diagnosis and pharmacy-based indicators of health. However, these models still have important imperfections; adding information on (diagnoses of) physiotherapy treatment may further improve RE-models. Therefore, a new risk-adjuster based on physiotherapy costs in the prior year was introduced in the Dutch RE-model of 2016. METHODS: Physiotherapy claims-data (2012) and administrative data on costs and risk-characteristics (2013) for 94% of the Dutch population (N = 15.8 million) are used to evaluate the current risk-adjuster based on physiotherapy costs and to assess the effects of replacing it by different modalities of a risk-adjuster based on physiotherapy diagnoses. Of the 89 diagnoses in the claims-data, 62 are dropped because they relate to temporary health problems. The 27 retained diagnoses are added to the Dutch model in 4 modalities: 27 separate risk-classes, 9 diagnosis-clusters based on main pathology category, 4 diagnosis-clusters based on residual costs, and the 4 clusters of modality 3 interacted with age. RESULTS: Although the cost-based risk-adjuster improves the model’s predictive power and removes the average undercompensation (€919) for enrollees with physiotherapy costs in the prior year, it is outperformed by all 4 diagnosis-based modalities. Of these modalities, modality 3 is preferred based on its simplicity and comparable predictive power. CONCLUSIONS: Adding information on physiotherapy can further improve the performance of sophisticated RE-models. Regarding the Dutch model, a risk-adjuster containing 4 risk-classes for clustered diagnoses based on residual costs is the preferred modality. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s10198-017-0874-x) contains supplementary material, which is available to authorized users. Springer Berlin Heidelberg 2017-02-09 2018 /pmc/articles/PMC5813071/ /pubmed/28185028 http://dx.doi.org/10.1007/s10198-017-0874-x Text en © The Author(s) 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Original Paper Eijkenaar, Frank van Vliet, René C. J. A. Improving risk equalization using information on physiotherapy diagnoses |
title | Improving risk equalization using information on physiotherapy diagnoses |
title_full | Improving risk equalization using information on physiotherapy diagnoses |
title_fullStr | Improving risk equalization using information on physiotherapy diagnoses |
title_full_unstemmed | Improving risk equalization using information on physiotherapy diagnoses |
title_short | Improving risk equalization using information on physiotherapy diagnoses |
title_sort | improving risk equalization using information on physiotherapy diagnoses |
topic | Original Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5813071/ https://www.ncbi.nlm.nih.gov/pubmed/28185028 http://dx.doi.org/10.1007/s10198-017-0874-x |
work_keys_str_mv | AT eijkenaarfrank improvingriskequalizationusinginformationonphysiotherapydiagnoses AT vanvlietrenecja improvingriskequalizationusinginformationonphysiotherapydiagnoses |