Risk-adjusted resource allocation: Using Taiwan's national health insurance as an example

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)NP958-NP971
JournalAsia-Pacific Journal of Public Health
Volume27
Issue number2
DOIs
Publication statusPublished - Mar 4 2015

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Keywords

  • Adjusted Clinical Group
  • National Health Insurance
  • resource allocation
  • risk adjustment
  • Taiwan

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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