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Diagnoses-based cost groups in the Dutch risk-equalization model: The effects of including outpatient diagnoses

Author

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  • van Kleef, R.C.
  • van Vliet, R.C.J.A.
  • van Rooijen, E.M.

Abstract

The Dutch basic health-insurance scheme for curative care includes a risk equalization model (RE-model) to compensate competing health insurers for the predictable high costs of people in poor health. Since 2004, this RE-model includes the so-called Diagnoses-based Cost Groups (DCGs) as a risk adjuster. Until 2013, these DCGs have been mainly based on diagnoses from inpatient hospital treatment.

Suggested Citation

  • van Kleef, R.C. & van Vliet, R.C.J.A. & van Rooijen, E.M., 2014. "Diagnoses-based cost groups in the Dutch risk-equalization model: The effects of including outpatient diagnoses," Health Policy, Elsevier, vol. 115(1), pages 52-59.
    • Handle: RePEc:eee:hepoli:v:115:y:2014:i:1:p:52-59
    DOI: 10.1016/j.healthpol.2013.07.005
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    References listed on IDEAS

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    1. Buchner, Florian & Goepffarth, Dirk & Wasem, Juergen, 2013. "The new risk adjustment formula in Germany: Implementation and first experiences," Health Policy, Elsevier, vol. 109(3), pages 253-262.
    2. Kanika Kapur & Chien-Wen Tseng & Afshin Rastegar & Grace Carter & Emmett Keeler, 2003. "Medicare calibration of the clinically detailed risk information system for cost," Open Access publications 10197/274, School of Economics, University College Dublin.
    3. Lamers, Leida M., 1998. "Risk-adjusted capitation payments: Developing a diagnostic cost groups classification for the Dutch situation," Health Policy, Elsevier, vol. 45(1), pages 15-32, July.
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    Cited by:

    1. Bauhoff, Sebastian & Fischer, Lisa & Göpffarth, Dirk & Wuppermann, Amelie C., 2017. "Plan responses to diagnosis-based payment: Evidence from Germany’s morbidity-based risk adjustment," Journal of Health Economics, Elsevier, vol. 56(C), pages 397-413.
    2. Michel Oskam & Richard C. van Kleef & René C. J. A. van Vliet, 2023. "Improving diagnosis-based cost groups in the Dutch risk equalization model: the effects of a new clustering method and allowing for multimorbidity," International Journal of Health Economics and Management, Springer, vol. 23(2), pages 303-324, June.
    3. Marica Iommi & Savannah Bergquist & Gianluca Fiorentini & Francesco Paolucci, 2022. "Comparing risk adjustment estimation methods under data availability constraints," Health Economics, John Wiley & Sons, Ltd., vol. 31(7), pages 1368-1380, July.
    4. Richard C. Kleef & Thomas G. McGuire & René C. J. A. Vliet & Wynand P. P. M. de Ven, 2017. "Improving risk equalization with constrained regression," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 18(9), pages 1137-1156, December.
    5. Richard van Kleef & Thomas McGuire & Rene van Vliet & Wynand van de Ven, 2015. "Improving Risk Equalization with Constrained Regression," NBER Working Papers 21570, National Bureau of Economic Research, Inc.
    6. Frank Eijkenaar & René C. J. A. Vliet, 2018. "Improving risk equalization using information on physiotherapy diagnoses," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(2), pages 203-211, March.
    7. Bryndová, Lucie & Hroboň, Pavel & Tulejová, Henrieta, 2019. "The 2018 risk-adjustment reform in the Czech Republic: Introducing Pharmacy-based Cost Groups and strengthening reinsurance," Health Policy, Elsevier, vol. 123(8), pages 700-705.

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