In 2002, the Dutch government implemented a Pharmacy-based Cost Group (PCG) model in the social health insurance sector. This model uses specific types of medication prescribed to individuals in a base year as markers for chronic conditions, which are then employed to adjust capitation payments to their sickness fund in the subsequent year. In this study, a classification of prescribed medication is derived for 22 chronic conditions, based on an assessment of the relation between prescribed medication and diagnoses indicated by physicians on their prescriptions. Of the 22 chronic conditions in this classification, 13 were included in the PCG model that is currently used in the Netherlands.

Capitation payments, Prescribed drugs, Risk adjustment,
Health Policy
Erasmus School of Health Policy & Management (ESHPM)

Lamers, L.M, & van Vliet, R.C.J.A. (2004). The Pharmacy-based Cost Group model: Validating and adjusting the classification of medications for chronic conditions to the Dutch situation. Health Policy, 68(1), 113–121. doi:10.1016/j.healthpol.2003.09.001