reports

Using the ACG case-mix adjustment system to evaluate veteran’s morbidity burdens and medical utilizations in Taiwan

J Healthc Manag 8:67-84. Published in Chinese.

Department of Medical Affairs and Planning, Taipei Veterans General Hospital, Taipei City, Taiwan, ROC

OBJECTIVES: Veterans have been reported to use more medical resources than the general populations, but their morbidity burdens have not been evaluated. The objective of this study is to assess veterans morbidity burdens and to adjust their medical utilizations accordingly.

METHODS: Johns Hopkins Adjusted Clinical Groups (ACGs) system was used to group morbidity burdens based on individual s age, sex, and all ambulatory and inpatient ICD-9 codes in 2004. Veterans were limited to the retired soldiers who were eligible to the copayment waivers as defined by the National Health Insurance. Individual s medical utilization parameters included the number of visits, ambulatory pharmacy expenditure, total ambulatory expenditure, length of inpatient stay, total inpatient expenditures, and total medical expenditures in 2004. Medical utilizations were compared between veterans and non-veterans by multivariate regression methods with and without adjustment for individual s age, sex, waiver status, and morbidity burdens modeled as dummy variables of unique Aggregated Diagnosis Groups (ADGs).

RESULTS: Ninety-nine percent of populations could be appropriately assigned to ACGs. Ninety percent of veterans were assigned to 13 high-morbid ACGs. Veterans had higher morbidity burdens than the general populations (9.0 vs. 5.5, p0.001), especially in chronic diseases, psychosocial disorders and malignancy. Before case-mix adjustment, veterans had significantly higher ambulatory and inpatient utilizations than the non-veterans. After adjustment, veteans had higher ambulatory expenditures but shorter lengths of stay, fewer inpatient and total expenditures than the non-veterans. Older age, waiver for copayment, and ADG-based morbidity burdens were associated with high medical utilizations. Among them, individual s morbidity burdens explained the largest share of variance in ambulatory and inpatient utilizations.

CONCLUSIONS: Individual s morbidity burdens could be appropriately grouped by the ACG system in Taiwan. Veterans had higher morbidity burdens than the general populations.