The methodology for risk-adjusted capitation model construction and payment calculation
10.3760/cma.j.cn111325-20230313-00199
- VernacularTitle:按人头付费的风险调整模型构建方法及费用标准测算
- Author:
Xinyue JIANG
1
;
Boya ZHAO
;
Jing WU
Author Information
1. 天津大学药物科学与技术学院，天津 300072
- Keywords:
Capitation;
Risk adjustment;
Payment standard;
Medical insurance payment;
Health insurance
- From:
Chinese Journal of Hospital Administration
2023;39(10):769-773
- CountryChina
- Language:Chinese
-
Abstract:
Risk-adjusted capitation is a payment method that measures capitation rates based on patient′s characteristics such as age, gender, and clinical diseases. The cost standard calculation model is the basis for its application. This paper focused on risk-adjusted capitation, introduced the methodology of risk-adjusted model construction(including identifying the model type, variables, statistical models, and evaluation indicators) and applied an example of the model to measure risk-adjusted capitation payment standard. It is recommended that the academic community should promote the methodology research of risk adjustment model construction. Provinces and cities met the conditions should actively explore the risk adjustment capitation payment in practice, explore and deepen medical insurance payment reform, especially in outpatient services. When applying risk-adjusted capitation, supporting measures such as establishing and continuously improving basic database construction, model updating mechanisms, and adjusting special capitation payment standards should be established.
