Prior Use of Durable Medical Equipment as a Risk Adjuster for Health-Based Capitation

This paper examines a new risk adjuster for capitation payments to Dutch health plans, based on the prior use of durable medical equipment (DME). The essence is to classify users of DME in a previous year into clinically homogeneous classes and to apply the resulting classification as a risk adjuste...

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Bibliographic Details
Published in:Inquiry (Chicago) 2010, Vol.47 (4), p.343-358
Main Authors: van Kleef, Richard C., van Vliet, René C. J. A.
Format: Article
Language:English
Subjects:
Adult
Capitation
Capitation Fee - statistics & numerical data
Disabilities
Drug design
Durable Medical Equipment - economics
Equalization
Female
Financial risk
Health care industry
Health care payments
Health care policy
Health Expenditures - statistics & numerical data
Health insurance
Humans
Insurance premiums
Insurance providers
Male
Medical equipment
Middle Aged
National Health Programs - economics
Netherlands
Risk Adjustment - methods
Socioeconomic status
Studies
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Summary:This paper examines a new risk adjuster for capitation payments to Dutch health plans, based on the prior use of durable medical equipment (DME). The essence is to classify users of DME in a previous year into clinically homogeneous classes and to apply the resulting classification as a risk adjuster for capitation payments in the subsequent year. We evaluate 143 DME types in terms of incentives, validity, predictive value, and measurability, resulting in 14 functional disability classes (FDCs). We conclude that FDCs can significantly improve the Dutch risk adjustment model, although possible incentives for oversupply have to be monitored.
ISSN:0046-9580
1945-7243
DOI:10.5034/inquiryjrnl_47.04.343