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Table 3 Prospective adjusted R2 and mean absolute prediction error of alternate risk factors and different categories of expenditure.

From: An in-depth assessment of a diagnosis-based risk adjustment model based on national health insurance claims: the application of the Johns Hopkins Adjusted Clinical Group case-mix system in Taiwan

 

Total expenditure

Type of expenditure

Source of expenditure

  

Medical

Pharmacy

Inpatient

Outpatient

R 2 : (1) raw expenditure

     

Demographics-only

0.0442

0.0308

0.0323

0.0146

0.0435

ACGs

0.0853

0.0643

0.0531

0.0312

0.0833

ADGs and demographics

0.1014

0.0714

0.0752

0.0353

0.1022

ADGs, 19 EDCs and demographics

0.2194

0.2154

0.1310

0.0797

0.3285

264 EDCs and demographics

0.2250

0.2196

0.1481

0.0842

0.3281

R 2 : (2) expenditure truncated at 2 standard deviation above mean of log (raw expenditure+1)

Truncated criterion

618,385

344,754

98,239

294,026

462,867

% of truncated cases

0.27%

0.37%

0.32%

0.29%

0.19%

Demographics-only

0.0635

0.0516

0.1489

0.0281

0.0710

ACGs

0.1187

0.1015

0.2202

0.0562

0.1305

ADGs and demographics

0.1427

0.1179

0.2943

0.0661

0.1594

ADGs, 19 EDCs and demographics

0.2746

0.2130

0.3483

0.0902

0.3670

264 EDCs and demographics

0.2830

0.2193

0.3972

0.0989

0.3740

R 2 : (3) expenditure truncated at top 0.5%

     

Truncated criterion

356,940

276,041

74,088

194,860

124,309

% of truncated cases

0.49%

0.48%

0.47%

0.50%

0.48%

Demographics-only

0.0889

0.0579

0.1662

0.0326

0.1664

ACGs

0.1580

0.1126

0.2427

0.0611

0.2819

ADGs and demographics

0.1920

0.1310

0.3227

0.0728

0.3454

ADGs, 19 EDCs and demographics

0.2814

0.2105

0.3814

0.0935

0.4207

264 EDCs and demographics

0.2960

0.2177

0.4283

0.1031

0.4495

Mean absolute prediction error: raw expenditure

     

Demographics-only

111.76%

120.43%

115.22%

180.28%

97.42%

ACGs

102.21%

112.01%

105.59%

172.66%

87.81%

ADGs and demographics

103.64%

115.56%

104.12%

175.53%

87.85%

ADGs, 19 EDCs and demographics

95.83%

106.84%

97.97%

170.66%

80.84%

264 EDCs and demographics

96.52%

108.51%

97.30%

172.85%

81.81%

  1. Number of study sample (validation only): 49,369.
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BMC Medicine

ISSN: 1741-7015

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