UMMS Affiliation

Department of Quantitative Health Sciences

Publication Date


Document Type



Adolescent; Adult; Aged; Child; Child, Preschool; Cost Allocation; Demography; Diagnosis-Related Groups; Eligibility Determination; Female; Health Expenditures; Humans; Infant; Male; Managed Care Programs; Medicaid; Medicare; Middle Aged; *Models, Econometric


Biostatistics | Epidemiology | Health Services Research


The Diagnostic Cost Group Hierarchical Condition Category (DCG/HCC) payment models summarize the health care problems and predict the future health care costs of populations. These models use the diagnoses generated during patient encounters with the medical delivery system to infer which medical problems are present. Patient demographics and diagnostic profiles are, in turn, used to predict costs. We describe the logic, structure, coefficients and performance of DCG/HCC models, as developed and validated on three important data bases (privately insured, Medicaid, and Medicare) with more than 1 million people each.


Health Care Financ Rev. 2000 Spring;21(3):7-28. Link to article on publisher's site

Journal/Book/Conference Title

Health care financing review

PubMed ID


Related Resources

Link to Article in PubMed



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