Skip to main content

Table 4 Expenditure-related characteristics of predicted top user groups identified by five risk adjustment models at three outcome thresholds

From: Comparison of alternative risk adjustment measures for predictive modeling: high risk patient case finding using Taiwan's National Health Insurance claims

  

Model 1:

Demographics

Model 2:

ACGs & Demographics

Model 3:

ADGs, Sel. EDCs & Demographics

Model 4:

2002 Expenditures & Demographics

Model 5:

ADGs, Sel. EDCs, 2002 Expenditures & Demographics

Outcome: 2003 top 0.5% user

predicted top 0.5% user group

2003 average total expenditures

58,136

108,433

303,755

389,851

391,583

 

2003 average drug expenditures

16,706

29,255

41,282

72,792

72,189

 

Top/bottom total expenditures ratio

4.1

7.7

23.1

30.7

30.7

 

Top/bottom drug expenditures ratio

4.2

7.4

10.6

19.5

19.3

 

2003/2002 total expenditures ratio

1.26

0.88

1.03

0.74

0.80

 

2003/2002 drug expenditures ratio

1.18

0.88

0.85

0.81

0.84

Outcome: 2003 top 1% user

predicted top 1% user group

2003 average total expenditures

54,520

114,802

220,395

268,398

262,609

 

2003 average drug expenditures

16,595

29,367

35,640

59,512

56,430

 

Top/bottom total expenditures ratio

3.8

8.5

17.7

22.3

21.7

 

Top/bottom drug expenditures ratio

4.2

7.7

9.5

16.9

15.9

 

2003/2002 total expenditures ratio

1.20

0.93

1.00

0.76

0.80

 

2003/2002 drug expenditures ratio

1.17

0.90

0.89

0.86

0.88

Outcome: 2003 top 5% user

predicted top 5% user group

2003 average total expenditures

51,590

78,295

96,411

110,795

111,235

 

2003 average drug expenditures

16,564

23,136

26,830

32,839

32,770

 

Top/bottom total expenditures ratio

4.1

6.9

9.4

11.5

11.6

 

Top/bottom drug expenditures ratio

4.8

7.5

9.3

12.6

12.6

 

2003/2002 total expenditures ratio

1.15

0.99

1.00

0.88

0.91

 

2003/2002 drug expenditures ratio

1.09

1.02

1.03

0.98

0.99