The Pharmacy-based Cost Group model: validating and adjusting the classification of medications for chronic conditions to the Dutch situation.
In 2002, the Dutch government implemented a Pharmacy-based Cost Group (PCG) model in the social health insurance sector. This model uses specific types of medication prescribed to individuals in a base year as markers for chronic conditions, which are then employed to adjust capitation payments to their sickness fund in the subsequent year. In this study, a classification of prescribed medication is derived for 22 chronic conditions, based on an assessment of the relation between prescribed medication and diagnoses indicated by physicians on their prescriptions. Of the 22 chronic conditions in this classification, 13 were included in the PCG model that is currently used in the Netherlands.
Lamers
Leida M
LM
Department of Health Policy and Management, Erasmus MC (University Medical Center Rotterdam), P.O. Box 1738, 3000 DR Rotterdam, The Netherlands. lamers@bmg.eur.nl
van Vliet
René C J A
RC
D002204:Capitation Fee; D002908:Chronic Disease / Q000145:classification / Q000188:drug therapy* / Q000191:economics; D019992:Databases as Topic; D016527:Drug Costs / Q000706:statistics & numerical data*; D011307:Drug Prescriptions / Q000145:classification / Q000191:economics*; D004363:Drug Utilization / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000191:economics* / Q000706:statistics & numerical data; D017059:Models, Econometric; D009313:National Health Programs / Q000191:economics / Q000706:statistics & numerical data; D009426:Netherlands; D020379:Risk Adjustment / Q000379:methods*