Pharmaceutical Cost Management in an Ambulatory Setting Using a Risk Adjustment Tool

Background Pharmaceutical expenditure is undergoing very high growth, and accounts for 30% of overall healthcare expenditure in Spain. In this paper we present a prediction model for primary health care pharmaceutical expenditure based on Clinical Risk Groups (CRG), a system that classifies individu...

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Detalhes bibliográficos
Autores: Vivas-Consuelo, David|||0000-0003-2945-7525, Guadalajara Olmeda, María Natividad|||0000-0002-5992-3446, Usó Talamantes, Ruth, Trillo Mata, José Luis, Sancho Mestre, Carla, Buigues Pastor, Laia
Formato: artículo
Fecha de publicación:2014
País:España
Recursos:Universitat Politècnica de València (UPV)
Repositorio:RiuNet. Repositorio Institucional de la Universitat Politécnica de Valéncia
Idioma:inglés
OAI Identifier:oai:riunet.upv.es:10251/62569
Acesso em linha:https://riunet.upv.es/handle/10251/62569
Access Level:acceso abierto
Palavra-chave:Risk adjustment
Predictive models
Pharmaceutical expenditure
Chronic condition
Clinical Risk Groups
Capitation Payments
ECONOMIA, SOCIOLOGIA Y POLITICA AGRARIA
ECONOMIA APLICADA
ECONOMIA FINANCIERA Y CONTABILIDAD
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spelling Pharmaceutical Cost Management in an Ambulatory Setting Using a Risk Adjustment ToolVivas-Consuelo, David|||0000-0003-2945-7525Guadalajara Olmeda, María Natividad|||0000-0002-5992-3446Usó Talamantes, RuthTrillo Mata, José LuisSancho Mestre, CarlaBuigues Pastor, LaiaRisk adjustmentPredictive modelsPharmaceutical expenditureChronic conditionClinical Risk GroupsCapitation PaymentsECONOMIA, SOCIOLOGIA Y POLITICA AGRARIAECONOMIA APLICADAECONOMIA FINANCIERA Y CONTABILIDADBackground Pharmaceutical expenditure is undergoing very high growth, and accounts for 30% of overall healthcare expenditure in Spain. In this paper we present a prediction model for primary health care pharmaceutical expenditure based on Clinical Risk Groups (CRG), a system that classifies individuals into mutually exclusive categories and assigns each person to a severity level if s/he has a chronic health condition. This model may be used to draw up budgets and control health spending. Methods Descriptive study, cross-sectional. The study used a database of 4,700,000 population, with the following information: age, gender, assigned CRG group, chronic conditions and pharmaceutical expenditure. The predictive model for pharmaceutical expenditure was developed using CRG with 9 core groups and estimated by means of ordinary least squares (OLS). The weights obtained in the regression model were used to establish a case mix system to assign a prospective budget to health districts. Results The risk adjustment tool proved to have an acceptable level of prediction (R2 0.55) to explain pharmaceutical expenditure. Significant differences were observed between the predictive budget using the model developed and real spending in some health districts. For evaluation of pharmaceutical spending of pediatricians, other models have to be established. Conclusion The model is a valid tool to implement rational measures of cost containment in pharmaceutical expenditure, though it requires specific weights to adjust and forecast budgets.This study was financed by a grant from the Fondo de Investigaciones de la Seguridad Social Instituto de Salud Carlos III, the Spanish Ministry of Health (FIS PI12/0037). The authors would like to thank members (Juan Bru and Inma Saurf) of the Pharmacoeconomics Office of the Valencian Health Department. The opinions expressed in this paper are those of the authors and do not necessary reflect those of the afore-named. Any errors are the authors' responsibility. We would also like to thank John Wright for the English editing.BioMed CentralFacultad de Administración y Dirección de EmpresasDepartamento de Economía y Ciencias SocialesCentro de Investigación de Ingeniería EconómicaMinisterio de Economía y CompetitividadRepositorio Institucional de la Universitat Politècnica de València Riunet20142014-10-21journal articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfapplication/pdfhttps://riunet.upv.es/handle/10251/62569reponame:RiuNet. Repositorio Institucional de la Universitat Politécnica de Valénciainstname:Universitat Politècnica de València (UPV)InglésengMinisterio de Economía y Competitividad http://dx.doi.org/10.13039/501100003329 PI12%2F00037 Análisis y modelización del gasto farmacéutico utilizando Clinical Risk Groupopen accesshttp://purl.org/coar/access_right/c_abf2Reconocimiento (by)http://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:riunet.upv.es:10251/625692026-06-13T07:49:27Z
dc.title.none.fl_str_mv Pharmaceutical Cost Management in an Ambulatory Setting Using a Risk Adjustment Tool
title Pharmaceutical Cost Management in an Ambulatory Setting Using a Risk Adjustment Tool
spellingShingle Pharmaceutical Cost Management in an Ambulatory Setting Using a Risk Adjustment Tool
Vivas-Consuelo, David|||0000-0003-2945-7525
Risk adjustment
Predictive models
Pharmaceutical expenditure
Chronic condition
Clinical Risk Groups
Capitation Payments
ECONOMIA, SOCIOLOGIA Y POLITICA AGRARIA
ECONOMIA APLICADA
ECONOMIA FINANCIERA Y CONTABILIDAD
title_short Pharmaceutical Cost Management in an Ambulatory Setting Using a Risk Adjustment Tool
title_full Pharmaceutical Cost Management in an Ambulatory Setting Using a Risk Adjustment Tool
title_fullStr Pharmaceutical Cost Management in an Ambulatory Setting Using a Risk Adjustment Tool
title_full_unstemmed Pharmaceutical Cost Management in an Ambulatory Setting Using a Risk Adjustment Tool
title_sort Pharmaceutical Cost Management in an Ambulatory Setting Using a Risk Adjustment Tool
dc.creator.none.fl_str_mv Vivas-Consuelo, David|||0000-0003-2945-7525
Guadalajara Olmeda, María Natividad|||0000-0002-5992-3446
Usó Talamantes, Ruth
Trillo Mata, José Luis
Sancho Mestre, Carla
Buigues Pastor, Laia
author Vivas-Consuelo, David|||0000-0003-2945-7525
author_facet Vivas-Consuelo, David|||0000-0003-2945-7525
Guadalajara Olmeda, María Natividad|||0000-0002-5992-3446
Usó Talamantes, Ruth
Trillo Mata, José Luis
Sancho Mestre, Carla
Buigues Pastor, Laia
author_role author
author2 Guadalajara Olmeda, María Natividad|||0000-0002-5992-3446
Usó Talamantes, Ruth
Trillo Mata, José Luis
Sancho Mestre, Carla
Buigues Pastor, Laia
author2_role author
author
author
author
author
dc.contributor.none.fl_str_mv Facultad de Administración y Dirección de Empresas
Departamento de Economía y Ciencias Sociales
Centro de Investigación de Ingeniería Económica
Ministerio de Economía y Competitividad
Repositorio Institucional de la Universitat Politècnica de València Riunet
dc.subject.none.fl_str_mv Risk adjustment
Predictive models
Pharmaceutical expenditure
Chronic condition
Clinical Risk Groups
Capitation Payments
ECONOMIA, SOCIOLOGIA Y POLITICA AGRARIA
ECONOMIA APLICADA
ECONOMIA FINANCIERA Y CONTABILIDAD
topic Risk adjustment
Predictive models
Pharmaceutical expenditure
Chronic condition
Clinical Risk Groups
Capitation Payments
ECONOMIA, SOCIOLOGIA Y POLITICA AGRARIA
ECONOMIA APLICADA
ECONOMIA FINANCIERA Y CONTABILIDAD
description Background Pharmaceutical expenditure is undergoing very high growth, and accounts for 30% of overall healthcare expenditure in Spain. In this paper we present a prediction model for primary health care pharmaceutical expenditure based on Clinical Risk Groups (CRG), a system that classifies individuals into mutually exclusive categories and assigns each person to a severity level if s/he has a chronic health condition. This model may be used to draw up budgets and control health spending. Methods Descriptive study, cross-sectional. The study used a database of 4,700,000 population, with the following information: age, gender, assigned CRG group, chronic conditions and pharmaceutical expenditure. The predictive model for pharmaceutical expenditure was developed using CRG with 9 core groups and estimated by means of ordinary least squares (OLS). The weights obtained in the regression model were used to establish a case mix system to assign a prospective budget to health districts. Results The risk adjustment tool proved to have an acceptable level of prediction (R2 0.55) to explain pharmaceutical expenditure. Significant differences were observed between the predictive budget using the model developed and real spending in some health districts. For evaluation of pharmaceutical spending of pediatricians, other models have to be established. Conclusion The model is a valid tool to implement rational measures of cost containment in pharmaceutical expenditure, though it requires specific weights to adjust and forecast budgets.
publishDate 2014
dc.date.none.fl_str_mv 2014
2014-10-21
dc.type.none.fl_str_mv journal article
http://purl.org/coar/resource_type/c_6501
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://riunet.upv.es/handle/10251/62569
url https://riunet.upv.es/handle/10251/62569
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.relation.none.fl_str_mv Ministerio de Economía y Competitividad http://dx.doi.org/10.13039/501100003329 PI12%2F00037 Análisis y modelización del gasto farmacéutico utilizando Clinical Risk Group
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
Reconocimiento (by)
http://creativecommons.org/licenses/by/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
Reconocimiento (by)
http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv BioMed Central
publisher.none.fl_str_mv BioMed Central
dc.source.none.fl_str_mv reponame:RiuNet. Repositorio Institucional de la Universitat Politécnica de Valéncia
instname:Universitat Politècnica de València (UPV)
instname_str Universitat Politècnica de València (UPV)
reponame_str RiuNet. Repositorio Institucional de la Universitat Politécnica de Valéncia
collection RiuNet. Repositorio Institucional de la Universitat Politécnica de Valéncia
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,300719

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