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Med Care 39:86-99.
Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
BACKGROUND: While the adjusted clinical group (ACG) system has been extensively validated in the United States, its use in other developed nations has been limited. This article examines the performance of the system in 2 Canadian provinces and assesses the extent to which ACGs can account for same-year and next-year health care expenditures.
METHODS: The study population included all residents of Manitoba and British Columbia who were continuously enrolled in the provincial health plans from April 1, 1995, to March 31, 1997. ACGs were assigned through diagnoses from fee-for-service physician claims and hospital separation records. “Physician” costs were calculated from the fee-for-service tariffs, and for Manitobans, “total” costs were also computed by combining physician and hospital costs. Linear regression was used to examine the ability of the ACG system to explain variation in individual costs (truncated at the 99th percentile).
RESULTS: The British Columbia and Manitoba data were generally acceptable, with fewer than 2% rejected diagnoses. Higher costs were associated with both the accumulation of morbidities and their relative severity. For physician costs, the ACG system explained approximately 50% and approximately 25% of the variation in same-year and next-year truncated costs, respectively. For total costs, the system explained approximately 40% and approximately 14% of these respective costs.
CONCLUSIONS: The application of ACGs in Canada is feasible using existing data. The ability of the ACG system to explain variation in costs is similar to that found in US health systems. While application of ACGs in Canada shows promise, further research is required to examine how closely they reflect population morbidity burdens and health care needs.
[keywordsd]Morbidity Burden,Diagnostic Certainty,Performance Assessment,Canada,Adolescent,Adult,Aged,80 and over,British Columbia/epidemiology,Child,Preschool,Fees,Medical,Hospital Charges,Infant,Newborn,Linear Models,Gender,Manitoba/epidemiology,Middle Aged,Multivariate Analysis,Pregnancy,Reproducibility of Results[/keywords]
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