منابع مشابه
Risk adjustment: beyond patient classification systems.
UNLABELLED Diagnosis related groups (DRGs) are widely used in several countries. Their various versions aim to value the cost of hospital production. In Europe, the patient classification systems and standard weights used are usually the American originals. OBJECTIVES The objective of this study was to analyse the extent to which DRGs and DRG-weights explain patient cost variability. Differen...
متن کاملGoing beyond patient classification systems to create an evidence-based staffing methodology.
The Department of Veterans Affairs developed a nationally standardized nurse staffing methodology, using an evidence-based process. We present an overview, linking an integrative review of recent literature on patient classification systems, interdisciplinary expert panel consultation, operational feasibility assessment, and frontline manager involvement. This resulted in 7 candidate indicators...
متن کاملRisk Selection and Risk Adjustment
Synopsis: Risk selection, which occurs when an individual’s demand for a product is correlated with her risk, creates inefficiencies and inequalities in markets for those products and services. Studies have shown that risk selection often occurs in health care markets, especially in markets for health insurance. Risk adjustment is a method that has been developed to correct those inefficiencies...
متن کاملCapping risk adjustment?
When premiums are community-rated, risk adjustment (RA) serves to mitigate competitive insurers' incentive to select favorable risks. However, unless fully prospective, it also undermines their incentives for efficiency. By capping its volume, one may try to counteract this tendency, exposing insurers to some financial risk. This in term runs counter the quest to refine the RA formula, which wo...
متن کاملCost-minimizing risk adjustment.
Conventional risk adjustment, which sets capitation payments equal to the average cost of individuals with similar observable characteristics, is not optimal if health plans can use private information to select low-cost enrollees. "Cost-minimizing risk adjustment" minimizes the sum of capitated HMO premiums plus FFS costs by balancing the gains from HMO cost efficiency against the overpayments...
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ژورنال
عنوان ژورنال: Gaceta Sanitaria
سال: 2001
ISSN: 0213-9111
DOI: 10.1016/s0213-9111(01)71596-8