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Table 4 Expenditure-related characteristics of predicted top user groups identified by five risk adjustment models at three outcome thresholds

From: Comparison of alternative risk adjustment measures for predictive modeling: high risk patient case finding using Taiwan's National Health Insurance claims

   Model 1:
Demographics
Model 2:
ACGs & Demographics
Model 3:
ADGs, Sel. EDCs & Demographics
Model 4:
2002 Expenditures & Demographics
Model 5:
ADGs, Sel. EDCs, 2002 Expenditures & Demographics
Outcome: 2003 top 0.5% user
predicted top 0.5% user group 2003 average total expenditures 58,136 108,433 303,755 389,851 391,583
  2003 average drug expenditures 16,706 29,255 41,282 72,792 72,189
  Top/bottom total expenditures ratio 4.1 7.7 23.1 30.7 30.7
  Top/bottom drug expenditures ratio 4.2 7.4 10.6 19.5 19.3
  2003/2002 total expenditures ratio 1.26 0.88 1.03 0.74 0.80
  2003/2002 drug expenditures ratio 1.18 0.88 0.85 0.81 0.84
Outcome: 2003 top 1% user
predicted top 1% user group 2003 average total expenditures 54,520 114,802 220,395 268,398 262,609
  2003 average drug expenditures 16,595 29,367 35,640 59,512 56,430
  Top/bottom total expenditures ratio 3.8 8.5 17.7 22.3 21.7
  Top/bottom drug expenditures ratio 4.2 7.7 9.5 16.9 15.9
  2003/2002 total expenditures ratio 1.20 0.93 1.00 0.76 0.80
  2003/2002 drug expenditures ratio 1.17 0.90 0.89 0.86 0.88
Outcome: 2003 top 5% user
predicted top 5% user group 2003 average total expenditures 51,590 78,295 96,411 110,795 111,235
  2003 average drug expenditures 16,564 23,136 26,830 32,839 32,770
  Top/bottom total expenditures ratio 4.1 6.9 9.4 11.5 11.6
  Top/bottom drug expenditures ratio 4.8 7.5 9.3 12.6 12.6
  2003/2002 total expenditures ratio 1.15 0.99 1.00 0.88 0.91
  2003/2002 drug expenditures ratio 1.09 1.02 1.03 0.98 0.99