papers

Risk-adjusted resource allocation: using Taiwan’s National Health Insurance as an example

Asia Pac J Public Health 27:NP958-971.

Department of Health Policy & Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.

OBJECTIVES: To determine if access to medical services differed by regions and to demonstrate the extent of the differences of adopting a claims-based risk-adjustment system versus a demographic model for regional resource allocation.
METHODS: The claims of a 1% random sample of Taiwan’s National Health Insurance enrollees (N = 173,175) in 2002 was used. The number of visits and morbidity-adjusted resource consumption were calculated individually then collapsed regionally. Regional expected resource allocation was compared with actual consumption.
RESULTS: After controlling for diagnosis-based health measures, the average numbers of visits were stable across regions. Two models were consistent in showing over- or underutilization; the overall difference between two models in resource allocation was 5.8% at the district level. We observed strong urban overutilization and rural underutilization.
CONCLUSIONS: Access to medical services is similar across regions. The adoption of a diagnosis-based model over a demographic-adjusted budgeting method would affect resource allocation considerably.

PMID: 23343643