Abstract
Introduction:Effective risk adjustment is an aspect that is more and more given weight on the background of competitive health insurance systems and vital healthcare systems.The objective of this review was to obtain an overview of existing models of risk adjustment as well as on crucial weights in risk adjustment. Moreover, the predictive performance of selected methods in international healthcare systems should be analysed.Theory and methods:A comprehensive, systematic literature review on methods of risk adjustment was conducted in terms of an encompassing, interdisciplinary examination of the related disciplines.Results:In general, several distinctions can be made: in terms of risk horizons, in terms of risk factors or in terms of the combination of indicators included. Within these, another differentiation by three levels seems reasonable: methods based on mortality risks, methods based on morbidity risks as well as those based on information on (self-reported) health status.Conclusions and discussion:After the final examination of different methods of risk adjustment it was shown that the methodology used to adjust risks varies. The models differ greatly in terms of their included morbidity indicators. The findings of this review can be used in the evaluation of integrated healthcare delivery systems and can be integrated into quality- and patient-oriented reimbursement of care providers in the design of healthcare contracts.
Highlights
Effective risk adjustment is an aspect that is more and more given weight on the background of competitive health insurance systems and vital healthcare systems
In general, a thematic distinction could be made, since the articles included in this review addressed different fields in medicine and care, such as pediatrics, intensive care, geriatric care or long-term care
In addition to the information on the use of medications the number and type of inpatient diagnoses is a necessity. This s pecific development stage of the RxGroup model includes a combination with the Hierarchical Condition Categories Inpatient
Summary
Risk Adjustment Effective risk adjustment is an aspect that is more and more given weight on the background of competitive health insurance systems and vital healthcare systems [1]. The aim of using such morbidity-oriented classification methods is to achieve a reliable and robust quantification of the expected (present or future) resource utilisation In terms of their selectivity, these methods are far superior to the “previous” methods which are based only on the demographic characteristics of age and gender and possibly the status of reduced earning capacity [2]. In the second step these references underwent an analysis of title and/or abstracts Doing this the research group used predefined inclusion and exclusion criteria. These included language (= German, English), publication date (> 1980), and content (calculation of insurance premiums and fees, review article of certain methods of risk adjustment, method comparisons). After analysing abstracts and full texts and together with an ongoing desk research 331 references could be extracted
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