Variability in Healthcare Expenditure According to the Stratification of Adjusted Morbidity Groups in the Canary Islands (Spain)

Abstract

Morbidity is the main item in the distribution of expenditure on healthcare services. The Adjusted Morbidity Group (AMG) measures comorbidity and complexity and classifies the patient into mutually exclusive clinical categories. The aim of this study is to analyse the variability of healthcare expenditure on users with similar scores classified by the AMG. Observational analytical and retrospective study. Population: 1,691,075 subjects, from Canary Islands (Spain), aged over 15 years with data from health cards, clinical history, Basic Minimum Specialised Healthcare Data Set, AMG, hospital agreements information system and Electronic Prescriptions. A descriptive, bivariant (ANOVA coefficient η2) and multivariant analysis was conducted. There is a correlation between the costs and the weight of AMG (rho = 0.678) and the prescribed active ingredients (rho = 0.689), which is smaller with age and does not exist with the other variables. As for the influence of the AMG morbidity group on the total costs of the patient, the coefficient η2 (0.09) obtains a median effect in terms of the variability of expenditure, hence there is intra- and inter-group variability in the cost. In a first model created with all the variables and the cost, an explanatory power of 36.43% (R2 = 0.3643) was obtained; a second model that uses solely active ingredients, AMG weight, being female and a pensioner obtained an explanatory power of 36.4%. There is room for improvement in terms of predicting the expenditure.

Differences in healthcare service utilization in patients with polypharmacy according to their risk level by adjusted morbidity groups: a population-based cross-sectional study

“…High- and medium-risk patients were more prevalent among polypharmacy patients than among those without polypharmacy, as well as when contrasting to the overall population of Madrid or other regions of Spain stratified by the AMG [ 20 , 29 ], although similar to another Spanish study with adults over 65 years living alone [ 30 ]. Younger patients and males showed higher levels of risk and complexity, probably because their severe conditions shortened their life expectancy and men have a shorter lifespan [ 21 ].…”

“…The factors significantly associated with a higher number of contacts with PC by polypharmacy patients were a high level of risk and an elevated weight of the complexity index, since these patients presented with more comorbidities usually requiring further needs for care, which generates higher healthcare expenditures [ 12 , 20 , 21 , 30 ]. The prescription of medicines for these patients should be done with caution, since, as consequence of their complex condition, they may visit multiple medical specialists, who need to carefully communicate with the patient as well as with other physicians and prescribers to be aware of all the medications they are taking and to avoid inappropriate prescribing [ 5 , 32 , 39 , 42 ].…”

Care Needs of Highly Complex Chronic Patients in the Canary Islands: An Observational Study

“…The classification of patients using the AMG is useful in planning care, but it is necessary to continue improving the quality of available information in the EHR so that it can be used in the stratification system. This is demonstrated by the large variability in healthcare costs for users in similar complexity percentiles [ 26 ]. In this respect, the weight of care needs identified through NDs has not been sufficiently researched or assessed for these types of patients.…”