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Behrend, C. ; Buchner, F.* ; Happich, M. ; Holle, R. ; Reitmeir, P. ; Wasem, J.*

Risk-adjusted capitation payments: How well do principal inpatient diagnosis-based models work in the German situation? Results from a large data set.

Eur. J. Health Econ. 8, 31-39 (2007)
DOI PMC
Open Access Green as soon as Postprint is submitted to ZB.
Five models of risk adjusters were tested as a (proxy) measure for health status with data from a large German sickness fund. The first two models use standard demographic and socio-demographic variables. One model incorporates a simple binary indicator for hospitalization and the last two are based on the hierarchical coexisting conditions (HCCs: DxCG® Risk Adjustment Software Release 6.1) using in-patient diagnoses. Special investigations were done on the subgroups of insurees who left, joined or stayed with the fund over the observation period. Age and gender grouping accounted for 3.2% of the variation in total expenditure for concurrent as well as prospective models. The current German risk adjusters age, sex, and invalidity status account for 5.1 and 4.5% of the variance in the concurrent and prospective models, respectively. Age, gender, invalidity status and in-patient HCC covariates explain about 37% of the variations of the total expenditures in a concurrent model and roughly 12% of the variations of total expenditures in a prospective model. Only modest improvement can be achieved with the long-term-care (LTC) indicator. For high-risk (cost) groups, substantial under-prediction remains; conversely, for the low-risk group, represented by enrolees who did not show any health care expense in the base year, all of the models over-predict expenditure. Special investigations were done on the subgroups of insurees who left, joined or stayed with the fund over the observation period.
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Publication type Article: Journal article
Document type Scientific Article
Corresponding Author
Keywords Risk adjustment; HCCs; Long-term care; Germany
ISSN (print) / ISBN 1618-7598
e-ISSN 1618-7601
Journal The European journal of health economics
Quellenangaben Volume: 8, Issue: 1, Pages: 31-39 Article Number: , Supplement: ,
Publisher Springer
Publishing Place Berlin ; Heidelberg
Non-patent literature Publications
Reviewing status Peer reviewed
Institute(s) Institute of Health Economics and Health Care Management (IGM)