Refinements to the Diagnostic Cost Group (DCG) model

Article Abstract:

Previous work on the Diagnostic Cost Group (DCG) model was extended with a more thorough method for classifying hospitalizations by degrees of discretion using 1984-85 data. The linear regression model was developed by Ash et al. as an alternative to the Adjusted Average Per Capita Cost in computing for payments to Medicare health maintenance organizations. It uses both demographic and diagnostic information to predict total plan payments.

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Constructing episodes of care from encounter and claims data: some methodological issues

Article Abstract:

A computerized approach was used to group into five generic types of episodes of health care the 31 illnesses that incur the majority of expenses for a health maintenance organization. Episodes of care methodology from encounter and claims data provide effective means of analyzing health care delivery. Studies were done since the 1970s to analyze the potential contribution of the episode of care approach to health services research.

Health Care, Health Care and Social Assistance, Research, Medical care, Medical care, Cost of, Health care costs

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The impact of accounting and actuarial practice differences on medical loss ratios: an exploratory study of five HMOs

Article Abstract:

The impact of accounting practices used by various health maintenance organizations (HMOs) on their administrative costs and profitability is analyzed. Additional information on differences in HMO accounting practices is also included.

United States, Finance, Managed care plans (Medical care)

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