Validation Of The Risk Adjustment Method - Adjusted Clinical Groups (ACG) As Applied To The Chinese Healthcare System

Abstract

With the expansion of both health insurance coverage and the scale of health insurance fund, the basic Chinese health insurance has covered 97% of the Chinese population. As a result, the payment from third parties accounts for a large amount of healthcare expense. These result in increasing power from the third party payers to influence the healthcare market and the delivery of care in the long run. Thus, using advanced information technology to improve administrative ability and developing analytical methods for health insurance data to aid managerial decisions and policy implementation are needed. Risk adjustment of health insurance represents an opportunity to improve efficiency and equity of the health system. This study is the first time to validate and evaluate one of the best known risk adjustment methods - the Johns Hopkins Adjusted Clinical Groups (ACG) Case-Mix System to China's health system based on large amounts of Chinese health insurance claims.