The Pharmacy-based Cost Group model: validating and adjusting the classification of medications for chronic conditions to the Dutch situation

Health Policy. 2004 Apr;68(1):113-21. doi: 10.1016/j.healthpol.2003.09.001.


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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Capitation Fee
  • Chronic Disease / classification
  • Chronic Disease / drug therapy*
  • Chronic Disease / economics
  • Databases as Topic
  • Drug Costs / statistics & numerical data*
  • Drug Prescriptions / classification
  • Drug Prescriptions / economics*
  • Drug Utilization / economics
  • Drug Utilization / statistics & numerical data
  • Drug Utilization / trends
  • Humans
  • Insurance, Pharmaceutical Services / economics*
  • Insurance, Pharmaceutical Services / statistics & numerical data
  • Models, Econometric*
  • National Health Programs / economics
  • National Health Programs / statistics & numerical data
  • Netherlands
  • Risk Adjustment / methods*