scholarly journals Diagnosis-based risk adjustment and Australian health system policy

2006 ◽  
Vol 30 (1) ◽  
pp. 83 ◽  
Author(s):  
Ronald Donato ◽  
Jeffrey Richardson
Keyword(s):  
Health System ◽  
Risk Adjustment ◽  
The United States ◽  
Parameter Estimates ◽  
System Reform ◽  
Data Sets ◽  
Hospital Inpatient ◽  
Data Set ◽  
Health System Reform ◽  
Individual Level

Diagnosis-based risk adjustment is increasingly seen as an important tool for establishing capitation payments and evaluating appropriateness and efficiency of services provided and has become an important area of research for many countries contemplating health system reform. This paper examines the application of a risk-adjustment method, extensively validated in the United States, known as diagnostic cost groups (DCG), to a large Australian hospital inpatient data set. The data set encompassed hospital inpatient diagnoses and inpatient expenditure for the entire metropolitan population residing in the state of New South Wales. The DCG model was able to explain 34% of individual-level variation in concurrent expenditure and 5.2% in subsequent year expenditure, which is comparable to US studies using inpatient-only data. The degree of stability and internal consistency of the parameter estimates for both the concurrent and prospective models indicate the DCG methodology has face validity in its application to NSW health data sets. Modelling and simulations were conducted which demonstrate the policy applications and significance of risk adjustment model(s) in the Australian context. This study demonstrates the feasibility of using large individual-level data sets for diagnosis-based risk adjustment research in Australia. The results suggest that a research agenda should be established to broaden the options for health system reform.

Origins and Destinations – Social Security Claimant Dynamics

1998 ◽  
Vol 27 (3) ◽  
pp. 351-369 ◽  
Author(s):  
MICHAEL NOBLE ◽  
SIN YI CHEUNG ◽  
GEORGE SMITH
Keyword(s):  
The United States ◽  
Data Sets ◽  
Income Support ◽  
Data Set ◽  
Family Structures ◽  
Highly Educated ◽  
Lone Parents ◽  
Lone Mothers ◽  
Time Period ◽  
Short Time

This article briefly reviews American and British literature on welfare dynamics and examines the concepts of welfare dependency and ‘dependency culture’ with particular reference to lone parents. Using UK benefit data sets, the welfare dynamics of lone mothers are examined to explore the extent to which they inform the debates. Evidence from Housing Benefits data show that even over a relatively short time period, there is significant turnover in the benefits-dependent lone parent population with movement in and out of income support as well as movement into other family structures. Younger lone parents and owner-occupiers tend to leave the data set while older lone parents and council tenants are most likely to stay. Some owner-occupier lone parents may be relatively well off and on income support for a relatively short time between separation and a financial settlement being reached. They may also represent a more highly educated and highly skilled group with easier access to the labour market than renters. Any policy moves paralleling those in the United States to time limit benefit will disproportionately affect older lone parents.

scholarly journals Exploring status and determinants of prenatal and postnatal visits in western China: in the background of the new health system reform

2017 ◽  
Vol 18 (1) ◽  
Author(s):  
Xiaojing Fan ◽  
Zhongliang Zhou ◽  
Shaonong Dang ◽  
Yongjian Xu ◽  
Jianmin Gao ◽  
...  
Keyword(s):  
Health System ◽  
Western China ◽  
System Reform ◽  
Health System Reform

Abstract 5921: Medicare Beneficiaries with Mild to Severe Heart Failure See 15–23 Different Providers Annually

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Robert L Page ◽  
Christopher Hogan ◽  
Kara Strongin ◽  
Roger Mills ◽  
JoAnn Lindenfeld
Keyword(s):  
Heart Failure ◽  
Severe Heart Failure ◽  
The United States ◽  
Outpatient Setting ◽  
Fiscal Year ◽  
Hospital Inpatient ◽  
Medicare Beneficiaries ◽  
Improvement Program ◽  
Data Set ◽  
Mild Disease

In fiscal year 2003, Medicare beneficiaries with heart failure (HF) accounted for 37% of all Medicare spending and nearly 50% of all hospital inpatient costs. On average, each beneficiary had 10.3 outpatient and 2 inpatient visits specifically for HF. Despite significant improvements in medical care for HF, mortality and hospital admissions remain high. No data exist regarding the number of providers ordering and providing care for this population. An analysis of fiscal year 2005 Medicare claims was conducted, using a 5% sample standard analytic and denominator file, limited data set version to extrapolate the 34,150,200 Medicare beneficiaries. Three cohorts were defined according to mild, moderate, severe HF employing the Centers for Medicare and Medicaid Services Hierarchical Condition Categories Model and Chronic Care Improvement Program definitions. HMO enrollees, persons without Part A and Part B coverage, and those outside the United States were excluded. We identified physicians by using the unique physician identification number of performing physicians. Based on inclusion criteria, 173,863 beneficiaries were identified. The average number of providers providing care in all sites were 15.9, 18.6, 23.1 for beneficiaries with mild, moderate, and severe HF, respectively; and 10.1, 11.5, and 12.1 in the outpatient setting, respectively. The average number of providers ordering care in all sites consisted of 8.3, 9.6, and 11.2 for beneficiaries with mild, moderate, and severe HF, respectively; and 6.5,7.3, and 7.8 in the outpatient setting, respectively. For beneficiaries with mild disease, only 10% of all office visits were specifically for HF, while those with moderate or severe disease, only 20% were specifically for HF. Medicare beneficiaries with HF, even those with mild disease, have a large number of providers ordering and providing care. These data highlight the importance for developing systems and processes of coordinated care for this population.

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