Administrative and Claims Records as Sources of Health Care Cost Data
Administrative and Claims Records as Sources of Health Care Cost Data
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DOI：
10.1097/mlr.0b013e31819c95aa
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发表时间：
2009-07-01
期刊：
影响因子：
3
通讯作者：
Riley, Gerald F.
中科院分区：
文献类型：
--
作者：
Riley, Gerald F.
背景：许多疾病的经济研究需要个人层面的成本数据，以确定诊断病例，并捕捉特定服务的类型和时间。成本数据的一个来源是与健康保险计划和医疗保健提供者相关的索赔和其他管理记录。目的：描述和比较各种行政和索赔数据库的优势和局限性。数据和方法：数据来源包括医疗保险、医疗补助和私人保险公司的索赔和登记记录；退伍军人健康管理局记录；国家医院出院数据集；医疗成本与利用项目医院数据库；管理式医疗计划数据系统；供应商成本报告。索赔提供有关付款的信息，而成本报告则产生为提供服务而产生的资源成本。通过与疾病登记和调查的联系，可以大大增加行政数据。结果：行政数据通常可用于大量登记人群，具有个人服务使用的详细信息，并可按服务类型、发作和患者进行汇总。服务的使用和成本通常可以进行纵向跟踪。由于收集这些数据不是为了研究目的，因此很难访问和使用管理数据。限制包括普遍性、复杂性、覆盖范围和利益限制，以及缺乏覆盖连续性。关联数据集允许识别疾病事件病例，并按诊断阶段、护理阶段、合并症状况、收入和保险状况分析卫生保健费用。结论：行政数据是疾病经济负担研究的重要信息来源。成本估算可能因具体措施（付款、收费、成本收费比）和不同数据源而有很大差异。
Background: Many economic Studies of disease require cost data at the person level to identify diagnosed cases and to capture the type and timing of specific services. One source of cost data is claims and other administrative records associated with health insurance programs and health care providers.Objective: To describe and compare strengths and limitations of various administrative and claims databases.Data and Methods: Data sources included claims and enrollment records from Medicare, Medicaid, and private insurers; Veterans' Health Administration records; state hospital discharge datasets; Healthcare Cost and Utilization Project hospital databases; managed care plan data systems; and provider cost reports. Claims provide information on payments, whereas cost reports yield resource costs incurred to produce services. Administrative data may be significantly augmented by linkage to disease registries and surveys.Results: Administrative data are often available for large, enrolled populations, have detailed information on individual service use, and can be aggregated by service type, episode, and patient. Service use and costs can often be tracked longitudinally. Because they are not collected for research purposes, administrative data can be difficult to access and use. Limitations include generalizability, complexity, coverage and benefit restrictions, and lack of coverage continuity. Linked datasets permit identification of incident cases of disease, and analyses of health care costs by stage at diagnosis, phase of care, comorbidity status, income, and insurance status.Conclusions: Administrative data are an essential source of information for studies of the financial burden of disease. Cost estimates can vary substantially by specific measures (payments, charges, cost to charge ratios) and across data sources.