Explanatory Ability of the ACG System Regarding the Utilization and Expenditure of the National Health Insurance Population in Taiwan—A 5-year Analysis

BackgroundThe adjusted clinical group (ACG) is a diagnosis-based case-mix adjustment system, which has been widely evaluated in several countries other than Taiwan. The aim of this study was to assess the performance of the ACG system on the National Health Insurance (NHI) population in Taiwan.MethodsWe conducted longitudinal data analysis using the claims data of 1% of randomly sampled NHI enrollees from 2000 to 2004. The ACG software was used to assign each individual to 1 ACG category based on age, gender and aggre-gating diagnoses in each year from 2000 to 2004, respectively. The ACG distribution patterns and their relationships to expenditure were examined. Explanatory ability as measured by adjusted R2 of the ACG system for same-year and next-year ambulatory and inpatient expenditure were examined by multivariate regression models for each year.ResultsThe quality of NHI claim data was satisfactory in that 98.1% of the population could be assigned to ACG cate-gories. The population's ACG patterns were substantially consistent but unequally distributed across the 5 years. Eighty percent of NHI expenditure were spent on people assigned to 21 ACGs. The explanatory abilities of individual's ACG and its components with respect to the variance of same-year and next-year 99% truncated visits, ambulatory expenditure, inpatient expenditure, and total NHI expenditure were quite consistent across years and were superior to age and gender. The explanatory performance was better for ambulatory than inpatient expenditure and was comparable to the statistics demonstrated in other countries.ConclusionThe ACG system worked well for Taiwanese ambulatory visits and expenditure across years. Health care authorities can introduce the ACG system to quantify the population's morbidity burdens and medical needs. [J Chin Med Assoc 2008;71(4):191–199]