Quantifying morbidities by Adjusted Clinical Group system for a Taiwan population: a nationwide analysis.
BACKGROUND
The Adjusted Clinical Group (ACG) system has been used in measuring an individual's and a population's morbidities. Although all required inputs for running the ACG system are readily available, patients' morbidities and their associations to health care utilizations have been rarely studied in Taiwan. Therefore, the objective of this study was using the ACG system to quantify morbidities for Taiwanese population and to examine their relationship to ambulatory utilizations and costs.


METHODS
This secondary analysis examined claims data for ambulatory services provided to 2.71 million representative Taiwanese in 2002 and 2003. People were grouped by the ACG system according to age, gender, and all ambulatory diagnosis codes in a given year. The software collapses the full set of ACGs into six morbidity categories (Non-users, Healthy, Low-morbidity, Moderate-, High- and Very-high) termed Resource Utilization Bands (RUBs). Each ACG was assigned a relative weight (RW), which was calculated as the ratio of mean ambulatory cost for each ACG to that for the overall. The distribution of morbidities was compared between years 2002 and 2003. The consistency of the distributions of visits, costs, and RWs of each ACG were examined for a two-year period. The relationship between people's morbidities and their ambulatory utilizations and costs was assessed.


RESULTS
Ninety-eight percent of the subjects were correctly assigned to ACGs. Except for non-users (7.9 approximately 8.3%), most subjects were assigned to ACGs of acute and minor diseases and ACGs of moderate-to-high-morbid chronic diseases. The distributions of ACG-based morbidities were highly consistent (r = 0.949, p < 0.001) between 2002 and 2003. The ACG-specific visits (r = 0.955, p < 0.001), costs (r = 0.966, p < 0.001) and RWs (r = 0.991, p < 0.001) were correlated across two years. People grouped to the high-morbid ACGs had more visits and costs than those grouped to the low-morbid ACGs. Forty-six percent of the total ambulatory costs were spent by eighteen percent of the population, who were grouped to the High- and Very-high-morbidity RUBs.


CONCLUSIONS
This study demonstrated the feasibility, validity, and reliability of using the ACG system to measure morbidities in a Taiwan population and to explain their associations with ambulatory utilizations and costs for the whole country.
Lee
Wui-Chiang
WC
Department of Medical Affairs and Planning, Taipei Veterans General Hospital, Taipei City, Taiwan. wclee@vghtpe.gov.tw
D000208:Acute Disease / Q000453:epidemiology; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data*; D002908:Chronic Disease / Q000453:epidemiology; D005240:Feasibility Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review; D009017:Morbidity; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology