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National Repository of Grey Literature 3 records found  Search took 0.00 seconds. 
Improvement of risk adjustment for health insurance companies in the Czech Republic - compensation of costs of patients with renal failure
 Škodová, Magdalena ; Votápková, Jana (advisor) ; Bryndová, Lucie (referee)
Risk adjustment models are used to predict health care costs of insurees and represent an important part of mechanisms for redistribution of funds among insurance companies. In the Czech Republic, pharmacy-based cost groups (PCGs) were introduced into the risk adjustment model in 2018, reflecting the costs of chronic diseases in addition to age and gender. The thesis reviews the model for the most expensive chronic disease - renal failure. Using the sample of General Health Insurance fund (GHI) insurees reported with typical health care consumption for kidney disease in years 2015-2018, we tested the current model and subsequently modified the classification criteria for PCG "renal failure". The classification based on the number of dialysis procedures proved to be much better indicator of costs than the currently used consumption of typical drugs. The incorporation of dialysis-based approach into the PCG model improved the explained variation from 26 % to 49 %, and the predictive power increased substantially. The study suggests improvements of the Czech risk adjustment model and proposes a fairer fund redistribution among insurance companies, while no additional data collection is needed.
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Improvement of Risk Adjustment Model to Strengthen the Competition among Health Insurance Companies in Slovakia
 Chochláčová, Barbora ; Hodyc, Daniel (advisor) ; Bryndová, Lucie (referee)
As it is in many other sectors also in case of health insurance companies it is crucial to ensure sufficient competition what at the same reduces undesired adverse selection of enrollees. Therefore, the key is to have risk adjustment model that accurately captures future health care costs of individuals. PCG model currently used in Slovakia works apart from the simple demographic characteristics of the population as predictors also with chronic conditions. The main aim of the thesis is to compare this model in the form applied today with its modifications classifying more potentially chronic patients into the group, focusing on Hypercholesterolemia. We find a potential for improvement of the model in its adjusted versions bringing better results as from the profit/loss point of view so from R2 increase. While the implementation of the suggested models into the system is not practically limited by the availability of the necessary information nor the time or financial demand.
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The Pharmacy-based Cost Group Model: Application in the Czech Health Care System
 Hajíčková, Tereza ; Votápková, Jana (advisor) ; Paulus, Michal (referee)
The risk adjustment model currently used does not adequately compensate insurers for predictable differences in individuals' health care expenditures in the Czech Republic. It then leads to financial inequality in the redistribution of funds to the insurance companies and causes their financial problems. This study introduces a PCG model as another method for risk adjustment and determines to what extent the predictive performance of the model can be improved when applied to Czech data. We analyze 10% of population sample in the Czech Republic in years 2011 and 2012. Our results confirm the appropriateness of the PCG model for the Czech environment. When the PCG variables are added to the demographic model, R2 value of the prediction model increases from 2.03% to 13.87%.
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