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The medication-based Rx-Defined Morbidity Groups was useful in predicting pharmacy cost as well as total cost in Taiwan.
The number of patients in the two sickest morbidity groups was small and therefore combined in all analyses.
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Five morbidity groups were built by grouping diagnostic categories, and six by grouping subcategories.
*Percentage of patients in each age, sex, and morbidity groups were calculated for each practice.
Morbidity groups were deduced from main and secondary diagnoses coded in hospital medical records.
Based on checklist responses, four "morbidity" groups were created for comparisons relevant to the primary study objectives.
For patients with procedures the morbidity groups are made by unique combinations of a diagnosis and one or more procedures.
While some drugs-based morbidity groups were very specific (i.e. tuberculosis, vertigo, psoriasis, neutropenia), others were broad (viral diseases, malignant neoplasms).
This study has demonstrated that the Rx-Defined Morbidity Groups are applicable for predicting the total cost and the medication cost in a universal health insurance system.
Morbidity groups were attributed independently to all insured inpatients from coded diagnoses (Table 3, ICD-10 column) and dispensed drugs (Table 3, ATC codes).
At the end of the analysis, 15 morbidity groups were retained for morbidity indicators (Table 2, letter M), to which 16 were added for insurers' risk adjustment (letter R) and six further groups for ambulatory cost adjustment (letter C).
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