Generalized modeling approaches to risk adjustment of skewed outcomes data
Open accessAbstract
There are two broad classes of models used to address the econometric problems caused by skewness in data commonly encountered in health care applications: (1) transformation to deal with skewness (e.g., ordinary least square (OLS) on ln(y)); and (2) alternative weighting approaches based on exponential conditional models (ECM) and generalized linear model (GLM) approaches. In this paper, we encompass these two classes of models using the three parameter generalized Gamma (GGM) distribution, which includes several of the standard alternatives as special cases-OLS with a normal error, OLS for the log-normal, the standard Gamma and exponential with a log link, and the Weibull. Using simulation methods, we find the tests of identifying distributions to be robust. The GGM also provides a potentially more robust alternative estimator to the standard alternatives. An example using inpatient expenditures is also analyzed.
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Exponential weighting has previously been used in both medical and non-medical error/risk analysis.
“exponential weighting has previously been used in both medical42–44 and non-medical45 46 error/risk analysis.”
From Clinical AI Scribes in primary care: accuracy, error severity and implications for clinical practice (2025) · cites this paper as [44]
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Zalla, J. M., Stoddard, G. J., & Yoder, B. A. (2014) · Journal of Pediatric Surgery · doi:10.1016/j.jpedsurg.2014.11.002 · Cited by 69 · see citing works
Kawatkar, A. A., Jacobsen, S. J., Levy, G. D., Medhekar, S. S., Venkatasubramaniam, K. V., & Herrinton, L. J. (2012) · Arthritis Care & Research · doi:10.1002/acr.21755 · Cited by 69 · see citing works
The listed authors are on behalf of the Health Economic Evaluation Working Group, C. S. P. I. U. C. (., Sun, X., Shi, J., Guo, L.-W., Huang, H., Yao, N. A., Gong, J., Sun, Y., Liu, G., Mao, A., et al. (2018) · BMC Cancer · doi:10.1186/s12885-018-4357-y · Cited by 68 · see citing works
Zhang, Y., Lave, J. R., Donohue, J. M., Fischer, M. A., Chernew, M. E., & Newhouse, J. P. (2010) · Medical Care · doi:10.1097/mlr.0b013e3181d68978 · Cited by 68 · see citing works
Hill, S. C., & Miller, G. (2009) · Health Economics · doi:10.1002/hec.1498 · Cited by 75 · see citing works
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A COUNTRY FOR OLD MEN? LONG‐TERM HOME CARE UTILIZATION IN EUROPE
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Graves, J. M., Mackelprang, J., Moore, M., Abshire, D., Rivara, F., Jimenez, N., Fuentes, M., & Vavilala, M. (2018) · Health Services Research · doi:10.1111/1475-6773.13096 · Cited by 60 · see citing works
GMM for panel count data models
Windmeijer, F. A. G. (2006) · Cemmap working papers · doi:10.1920/wp.cem.2006.2106 · Cited by 67 · see citing works
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Analyzing repeated measures semi-continuous data, with application to an alcohol dependence study
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Modeling Health Care Costs and Counts
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Self-citationCost analysis of enhanced recovery after surgery in microvascular breast reconstruction
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The costs of social anxiety disorder: the role of symptom severity and comorbidities
Stuhldreher, N., Leibing, E., Leichsenring, F., Beutel, M. E., Herpertz, S., Hoyer, J., Konnopka, A., Salzer, S., Strauss, B., Wiltink, J., et al. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.04.039 · Cited by 63 · see citing works
- Authors
- Manning, W. G., Basu, A., & Mullahy, J.
- Affiliations
- University of Chicago (US)
- National Bureau of Economic Research (US)
- Corresponding author
- Manning, Willard G.
- Venue
- Journal of Health Economics
- Publisher
- Elsevier BV
- Published
- 2005-05
- Volume
- 24
- Issue
- 3
- Pages
- 465-488
- ISSN
- 0167-6296 (ISSN-L)
- OpenAlex
- W3122533613
- Cited by
- 760
- References
- 17
- Citations by year
- 2026: 21 · 2025: 27 · 2024: 29 · 2023: 32 · 2022: 38 · 2021: 40 · 2020: 43 · 2019: 52 · 2018: 51 · 2017: 52 · 2016: 41 · 2015: 57 · 2014: 46 · 2013: 56 · 2012: 42
- FWCI
- 17.64
- Type
- journal article
- Language
- en
- Open access
- green
- www.nber.org
- Locations
- Journal of Health Economics (publishedVersion)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Funders
- National Institutes of Health (5r01aa012664-03)
- National Institute on Alcohol Abuse and Alcoholism (1 R01 AA 12664-01 A2)
- Topics
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Distribution Estimation and Applications
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods and Bayesian Inference
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Keywords
- risk adjustment, logarithmic transformation, generalized linear models, hospital costs
- MeSH terms
- United States, Models, Statistical, Risk Adjustment
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