德国基于发病率的风险赔偿计划的药房成本组
Christian J A Schindler1, Benjamin Berndt2, Dennis Häckl2,3
1WIG2 Scientific Institute for Health Economics and Health System Research, Leipzig, Germany. christian.schindler@wig2.de.
概括
德国 德国 德国 德国
科学领域:
- 卫生经济学 卫生经济学
- 医疗保健政策 医疗保健政策
- 医疗信息学医学信息学
背景情况:
- 德国的法定医疗保险 (SHI) 使用基于诊断的风险调整计划.
- 人们对诊断编码的质量和操作性存在担忧.
- 本研究探讨药物数据作为替代品或补充.
研究的目的:
- 评估德国SHI的基于药房的风险调整模型.
- 评估其作为扩展或替代当前基于诊断的系统的潜力.
- 分析其对模型性能和风险选择的影响.
主要方法:
- 根据德国的条件,调整了一个现有的基于药房的模型.
- 用了大约450万受保人的索赔数据作为代表性样本.
- 使用R2,卡明斯预测量 (CPM) 和平均绝对预测误差 (MAPE) 评估的模型.
主要成果:
- 一个样本与德国SHI数据密切匹配.
- 将诊断数据替换为药房成本组 (PCG) 产生了可比的模型质量,但对弱势群体的低/过度补偿情况恶化.
- 将PCG整合到现有模型中改善了大多数绩效指标.
结论:
- 基于药房的模型显示了德国风险补偿的巨大潜力.
- 通过PCG扩展现有系统,可以提高统计绩效和病率测量.
- 这种方法提供了一个可行的策略,以减轻诊断编码操纵的激励.
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