Select Currency
Translate this page

IMPACT OF NON-TRADITIONAL VARIABLES IN HEALTH CARE RISK ADJUSTMENT

Format: MS WORD  |  Chapter: 1-5  |  Pages: 57  |  2387 Users found this project useful  |  Price NGN3,000

  DOWNLOAD THE FULL PROJECT

IMPACT OF NON-TRADITIONAL VARIABLES IN HEALTH CARE RISK ADJUSTMENT

 

CHAPTER ONE

INTRODUCTION   

1.1  Background of the Study 

The business of risk adjustment has come a long way since the publication of the Academy’s “Monograph Number One” with the title, “Health Risk Assessment and Health Risk Adjustment—Crucial Elements in Effective Health Care Reform” in May 2013. Less than ten years later, we had hospital inpatient diagnosis-based approaches, such as the model used by the Market Stabilization Pool for small group and individual coverage in NYS in conjunction with mandated community rating. The PIP-DCG approach for Medicare + Choice, also inpatient only, soon followed.  Risk adjustment models have included variables such as demographic (i.e. age and gender) and clinical markers based either on ICD-9 diagnosis codes and/or pharmacy codes such as the National Drug Codes (NDCs). Literature points to other variables such as geography, Body Mass Index (BMI), education, and income that also explain the variation in healthcare cost – but have hitherto not been included in risk adjustment programs mainly because such variables are not typically found in claim data. If these nontraditional variables explain meaningful variation in cost beyond traditional risk adjustment models – then this may provide incentives for issuers to select certain members. If such incentives lead to selection that affects the financial performance of issuers – then the policy goals of the risk adjustment program will be undermined. 

 

Recognizing the importance of fortifying risk adjustment programs against selection based on nontraditional variables, the Society of Actuaries’ Health Section sponsored an in-depth study into the relationship of nontraditional variables with health costs. This report presents the results of this study. We used the Medical Expenditure Panel Survey (MEPS) data in this research. Specific details concerning the data and preparation can be found in Section 3.2. This data is unique in that it includes a large number of individual characteristics (from BMI to whether a person has difficulty enjoying hobbies) together with healthcare claim data. There are limitations to the use of MEPS data, and these limitations are discussed further in Section 4. 

 

The results of this research demonstrate that it is important to adjust the traditional risk adjustment model in order to recognize nontraditional variables. The report develops a new measure (Loss Ratio Advantage or LRA) to help quantify the potential of a nontraditional variable to affect a risk adjustment program. With the help of this measure, the report compares the importance of over thirty variables that were systematically narrowed down from a list of over fifteen hundred variables describing various characteristics of the general population (i.e. the purchasers of healthcare insurance coverage). The nontraditional variables were broadly categorized into (1) demographic, (2) economic, (3) lifestyle, (4) psychological self-assessment (i.e. how a person feels about their mental health), and (5) physical self-assessment.

1.2  Statement of the Problem 

Risk adjustment of any kind is inherently imperfect, the complexity and sophistication of risk adjustment models has increased significantly in the past couple decades. With the passage of the Affordable Care Act (ACA), risk adjustment will be required for non-grandfathered commercial small group and individual coverage both inside and outside Exchanges. Using a structured and scientific approach, the researcher has examined a long list of non-traditional drivers of health cost, chosen the most relevant ones, and tested their effect on bottom-line medical cost when included in the traditional risk adjustment formula.  

1.3  Objectives of the Study 

1. To determine the relationship between non-traditional variables and health care risk adjustment in Nigeria.
2. To ascertain the impact of non-traditional variables on health care risk adjustment in Nigeria. 

 

1.4   Research questions 

1. Is there a relationship between non-traditional variables and health care risk adjustment in Nigeria?
2. Does non-traditional variables significantly impacts on health care risk adjustment in Nigeria?

1.5   Research hypotheses 

Ho: There is no relationship between non-traditional variables and health care risk adjustment in Nigeria.
Hi: There is a relationship between non-traditional variables and health care risk adjustment in Nigeria
Ho: Non-traditional variables have no significant impact on health care risk adjustment in Nigeria.
Hi: Non-traditional variables significantly impacts on health care risk adjustment in Nigeria.

 

1.6   Significance of the study 

The Affordable Care Act (ACA) includes the mechanism of risk adjustment in commercial small group and individual markets in order to further the policy goals of premium stabilization, mitigating incentives for issuers of healthcare coverage policies (issuers) to avoid unhealthy members, and to remove any advantages or disadvantages for plans inside healthcare exchanges compared to plans outside of such exchanges. The importance of risk adjustment to these policy goals cannot be overemphasized, and details such as the variables that are included in the risk assessment formula affect the extent to which the program is successful in meeting these goals.

1.7   Scope of the study 

The study focuses on the impact of non-traditional variables in health care risk adjustment in Nigeria, University of Uyo Teaching Hospital (UTH) in Uyo Local Government Area of Akwa Ibom state was used as the case study.

1.8   Limitations of the study 

This study has some limitations most especially in the area of data collection. Financial constraints as well as time available for the completion of the study are among other factors that would limit the scope of the study.

1.9   Definition of Terms 

Health Care: The organized provision of medical care to individuals or a community. Non-traditional: Not conforming to or in accord with tradition.
Risk Adjustment: A concept that refines an investment's return by measuring how much risk is involved in producing that return.

  DOWNLOAD THE FULL PROJECT

Not What You Are Looking For?



For Quick Help Chat with Us Now!

+234 814 010 7220

+233 54 135 1187


Here's what our amazing customers are saying

Emmanuel Essential
Kogi state University
I actually took the risk,you know first time stuff But i was suprised i received as requested. I love you guys 🌟 🌟 🌟 🌟
Very Good
Azeez Abiodun
Moshood Abiola polytechnic
I actually googled and saw about iproject master, copied the number and contacted them through WhatsApp to ask for the availability of the material and to my luck they have it. So there was a delay with the project due to the covid19 pandemic. I was really scared before making the payment cause I’ve been scammed twice, they attended so well to me and that made me trust the process and made the payment and provided them with proof, I got my material in less than 10minutes
Very Good
Gbadamosi Solomon Oluwabunmi
Lasu
Swift delivery within 9 minutes of payment. Thank you project master
Excellent
JONNAH EHIS
Ajayi Crowther University, Oyo
I was scared at first when I saw your website but I decided to risk my last 3k and surprisingly I got my complete project in my email box instantly. This is so nice!!!
Excellent
MATTHEW NGBEDE
Ahmadu Bello University
I wish I knew you guys when I wrote my first degree project, it took so much time and effort then. Now, with just a click of a button, I got my complete project in less than 15 minutes. You guys are too amazing!
Excellent
Temitayo Ayodele
Obafemi Awolowo University
My friend told me about iprojectmaster website, I doubted her until I saw her download her full project instantly, I tried mine too and got it instantly, right now, am telling everyone in my school about iprojectmaster.com, no one has to suffer any more writing their project. Thank you for making life easy for me and my fellow students... Keep up the good work
Very Good
Stancy M
Abia State University, Uturu
I did not see my project topic on your website so I decided to call your customer care number, the attention I got was epic! I got help from the beginning to the end of my project in just 3 days, they even taught me how to defend my project and I got a 'B' at the end. Thank you so much iprojectmaster, infact, I owe my graduating well today to you guys...
Excellent
Ibrahim Muhammad Muhammad
Usmanu danfodiyo university, sokoto
It's a site that give researcher student's to gain access work,easier,affordable and understandable. I appreciate the iproject master teams for making my project work fast and available .I will surely,recommend this site to my friends.thanks a lot..!
Excellent
Dau Mohammed Kabiru
Kaduna State College of Education Gidan Waya
This is my first time..Your service is superb. But because I was pressed for time, I became jittery when I did not receive feedbackd. I will do more business with you and I will recommend you to my friends. Thank you.
Very Good
Joseph M. Yohanna
Thanks a lot, am really grateful and will surely tell my friends about your website.
Excellent

HOW TO GET YOUR COMPLETE PROJECT INSTANTLY

  • Select 3 Project Topics of your choice from your Department.
  • Submit the 3 topics to your Supervisor for Approval.
  • Call Our Instant Help Desk on +234 814 010 7220 and Get Your Complete Project Material Instantly.
  • All project materials on this website are well researched by professionals with high level of professionalism.

FREQUENTLY ASKED QUESTIONS

How do i choose a Project Topic?

Look for your department and select any topic of your choice

I have a fresh topic that is not on your website. How do I go about it?

How fast can i get a complete project from your website?

Within 15 minutes if the exact project topic is on our website

Is it a complete research project or just materials?

It is a Complete Research Project i.e Chapters 1-5, Abstract, Table of Contents, Full References, Questionnaires / Secondary Data

One of your topics suites my project, but the case study is different. What do i do?

Call Our Instant Help Desk Now: +234 814 010 7220 and you will be responded to immediately

How do i get my complete project?

Your Complete Project Material will be sent to your Email Address in Ms Word document format

Can I get my Complete Project through WhatsApp?

Yes! We can send your Complete Research Project to your WhatsApp Number

What if my Project Supervisor made some changes to a topic i picked from your website?

Call Our Instant Help Desk Now: +234 814 010 7220 and you will be responded to immediately

Do you assist students with Assignment and Project Proposal?

Yes! Call Our Instant Help Desk Now: +234 814 010 7220 and you will be responded to immediately

What if i do not have any project topic idea at all?

Smiles! We've Got You Covered. Chat with us on WhatsApp Now to Get Instant Help: +234 814 010 7220

How can i trust this site?

We are well aware of fraudulent activities that have been happening on the internet. It is regrettable, but hopefully declining. However, we wish to reinstate to our esteemed clients that we are genuine and duly registered with the Corporate Affairs Commission as "PRIMEDGE TECHNOLOGY". This site runs on Secure Sockets Layer (SSL), therefore all transactions on this site are HIGHLY secure and safe!