ACG index and quality criteria

-Automatic translation

In the funding model of primary healthcare, the funding of each healthcare centre reflects the user's burden of disease.

• Healthcare centres in the capital area (Icelandic) have been paid according to the funding system since the beginning of 2017

• Healthcare centres outside the capital area (Icelandic) have been paid according to the funding system since the beginning of 2021

At the request of the Ministry of Health, the Directorate of Health is responsible for calculating some of the components that form the basis of the funding model. These components are weight (burden of disease), ACG index, the target group of health-promoting receptions and specific quality criteria.

Below is a brief description of the basis of the calculations, what data is used and how the weight and the ACG index of each primary healthcare centre are used in the funding model. Each quality criterion is discussed separately.

Weight and ACG index

According to the funding model, part of the fixed funding for the operation of primary healthcare centres is divided by the user's burden of disease.

The burden of disease, ACG classification

The Adjusted Clinical Group (ACG) classification system classifies individuals according to their burden of disease. The burden of disease is assessed by age, gender and the diseases that an individual has been diagnosed with over a period of time. The individuals are weighed differently depending on the combination of diagnoses.

The classification system and the software for classification were developed by Johns Hopkins University in Baltimore, USA, based on research on the relationship between morbidity and the use of healthcare. The system is widely used as a basis for distributing funds for health care.

Data for classification

Data from the Register of Primary Health Care Contacts is used to classify individuals according to the ACG classification system and to assess the burden of disease. The register receives data from all primary health care centres in Iceland in accordance with recommendations on minimum recording in primary health care and medical offices (Icelandic). Data from primary health care are sent to the Directorate of Health in real time.

The ACG classifier uses information on diagnoses (ICD-10) from electronic medical records recorded 15 months before the calculations were performed.

It does not matter if a diagnosis is recorded once or more in 15 months (active diagnosis), if the diagnosis is recorded at the primary health centre to which the individual belongs when the calculation is made, or at another primary health care centre. When more than 15 months have passed since the last registration of a diagnosis, the classifier no longer includes it in the calculation.

Registration at the primary health care centres is based on information from Icelandic Health Insurance at the end of each reference period. If persons move between primary health care centres, the diagnoses of the last 15 months will be transferred with them to the new centre.

The weight, outcome of ACG classification

An ACG index is calculated for each primary health care centre and is based on the average burden of disease of the individuals registered at the centre. This factor is called weight.

As the index is based on the diagnoses recorded for individuals belonging to primary health care centres, it may increase or decrease in accordance with the diagnoses recorded for each period. Therefore, the weight indicates a change in the burden of disease of the individuals belonging to each health care centre.

Use of weight in the funding model

Before the calculated weight of each primary health care centre is used in the funding model, it is equalised so that it is divided by the average weight of individuals and an ACG index is created for each centre. The index is calculated separately for primary health care centres in the capital area and primary health centres outside the capital area.

The weight is re-evaluated monthly to determine the funding allocated to each primary health care centre.

Quality criteria and special projects

Part of the variable funding allocated to primary health care centres depends on the status of each centre according to specific quality criteria and special projects. The Ministry of Welfare initially selected these quality criteria in collaboration with the Primary Health Care of the Capital Area.

The criteria were chosen according to the quality criteria used in Sweden, where this system has been used for several years and adjusted to Icelandic reality. In addition, a working group organised by the Ministry of Health has worked on new quality criteria that will come into effect in 2023 and 2024. The quality criteria can change as time passes and depending on the priorities at any given time.

Data

The calculation of the quality criteria is based on data from the Register of Primary Health Care Contacts. In addition, information on vaccinations is based on data from the Vaccination Register. A list of registered individuals at each primary health care centre is sent monthly from the Icelandic Health Insurance and is based on the registration status at the end of each month.

It does not matter at which primary health care centre the registration of diagnoses takes place. The diagnoses follow the individuals to the centre where they are registered in each reference period. However, It should be noted that the medication list review must take place at the individual's primary health care centre.