Synonyms
Definition
Risk adjustment is a method to predict healthcare resource or service use or health outcome differences among individuals for a fixed period of time (usually 1 year).
Overview
Risk adjustment is a method that uses individual-level relevant and available information to predict individuals’ healthcare needs and costs and to use this information in allocating funds to competing health plans or healthcare providers. Usually it is used to predict healthcare utilizations or costs for the next year.
While risk adjustment has been used to predict the differences in severity of patients when comparing patient outcomes across providers (Majeed et al. 2001; Iezzoni 1997a, b), its primary purpose in the USA has been to adjust capitation or other forms of payments to health insurance plans or health providers such as family practice, physician groups, or hospitals (Majeed et al. 2001; Rice and Smith 2001; Van de Ven and Ellis 2000). It is extensively...
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References
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Sari, N. (2019). Risk Adjustment: Applications in Healthcare Markets. In: Gu, D., Dupre, M. (eds) Encyclopedia of Gerontology and Population Aging. Springer, Cham. https://doi.org/10.1007/978-3-319-69892-2_997-1
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DOI: https://doi.org/10.1007/978-3-319-69892-2_997-1
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