Risk-adjusted resource allocation: using Taiwan's National Health Insurance as an example.
OBJECTIVE
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.
Johns Hopkins University, Baltimore, MD, USA hchang2@jhsph.edu.
Hsien-Yen
HY
Chang
Johns Hopkins University, Baltimore, MD, USA.
David P
DP
Bodycombe
National Yang-Ming University, Taipei City, Taiwan.
Weng-Foung
WF
Huang
Johns Hopkins University, Baltimore, MD, USA.
Jonathan P
JP
Weiner
D015276:Health Care Rationing / Q000706:statistics & numerical data; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D009313:National Health Programs / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D020379:Risk Adjustment; D013624:Taiwan
Adjusted Clinical Group; National Health Insurance; Taiwan; resource allocation; risk adjustment