Administrative and Claims Records as Sources of Health Care Cost Data

Riley, Gerald F.

doi:10.1097/mlr.0b013e31819c95aa

Cited by 220 publications

(179 citation statements)

References 11 publications

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“…But although the NHIC claims data cover almost the entire Korean population, the main purpose for these claims data is for reimbursement (Riley, 2009;Cheng et al, 2011;Oh et al, 2011). Also it is known that identifying an epidemiologic parameter such as the incident rate of diseases by using claims data is difficult (Riley, 2009).…”

Section: Introductionmentioning

confidence: 99%

“…Also it is known that identifying an epidemiologic parameter such as the incident rate of diseases by using claims data is difficult (Riley, 2009). Therefore various algorithms have been developed and applied for the use of health services research to cover these shortcomings 2011;Park et al, 2006;Yoon et al, 2007;Kim et al, 2008;Oh et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

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A Comparison of the Cancer Incidence Rates between the National Cancer Registry and Insurance Claims Data in Korea

Seo¹,

Oh²,

Yoon³

2012

Asian Pacific Journal of Cancer Prevention

113

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Although much health services research has been conducted using national health insurance claims data in Korea, the validity of this method has not been ascertained. The objective of this study was to validate the use of claims data for health services research by comparing incidence rate of cancers found using insurance claims data against rates of the national cancer registry of Korea. An algorithm to estimate incidence rates using claims data was developed and applied. The claims data from 2005-2008 were acquired and the patients admitted to hospitals due to cancer in 2008 without admission to hospital from 2005-2007 by the same diagnosis code were regarded as incident cases. The acquired results were compared with the values from the National Cancer Registry of Korea. The incidence rate of all cancers found using claims data was 363.1 per 100,000 people, which is very similar to the 361.9 per 100,000 rate of the national cancer registry. Also the age-, gender-and disease-specific rates between the two data sources were similar. Therefore, national health insurance claims data may be a worthwhile resource for health services research if appropriate algorithms are applied, especially considering the cost effectiveness of this method.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Comparison of the Cancer Incidence Rates between the National Cancer Registry and Insurance Claims Data in Korea

Seo¹,

Oh²,

Yoon³

2012

Asian Pacific Journal of Cancer Prevention

113

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“…This system relies on coded diagnoses, procedures, and is adjusted for specific demographics 2,4 . The trauma registry used the Injury Severity Scoring (ISS) system.…”

Section: Methodsmentioning

confidence: 99%

“…As the landscape of healthcare continues to adapt to an environment focused on quality improvement and clinical outcomes, there is an increasing need for readily accessible data related to patient outcomes, healthcare costs, and resource utilization 1,2,3 . Administrative financial data are widely available, use information that is already collected for billing purposes, and are generated from discharge reports submitted to payers.…”

Section: Introductionmentioning

confidence: 99%

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The trauma registry compared to All Patient Refined Diagnosis Groups (APR-DRG)

Hackworth

Askegard-Giesmann

Rouse

et al. 2017

Injury

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Long-term Acute Care Hospital Utilization After Critical Illness

Kahn

Benson

Appleby

et al. 2010

JAMA

273

210

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Context Long-term acute care hospitals have emerged as a novel approach for the care of patients recovering from severe acute illness, but the extent and growth of their activity at the national level is unknown. Objective To examine temporal trends in long-term acute care hospital utilization after an episode of critical illness among fee-for-service Medicare beneficiaries ≥ 65 years of age. Design, Setting and Patients Retrospective cohort study using the Medicare Provider Analysis and Review files from 1997 to 2006. We included all Medicare hospitalizations involving admission to an intensive care unit of an acute-care, non-federal hospital within the continental United States. Main outcome measures Overall long-term acute care utilization, associated costs, and survival following transfer. Results The number of long-term acute care hospitals in the United States increased at a mean rate of 8.8% per year, from 192 in 1997 to 408 in 2006. During that time, the annual number of long-term acute care admissions after critical illness increased from 13,732 to 40,353, with annual costs increasing from $484 million to $1.325 billion. The age-standardized population incidence of long-term acute care utilization after critical illness increased from 38.1/100,000 in 1997 to 99.7/100,000 in 2006, with greater use among male individuals and black individuals in all time periods. Over time, transferred patients had higher numbers of comorbidities (5.0 in 1997–2000 versus 5.8 in 2004–2006, p<0.001), and were more likely to receive mechanical ventilation at the long-term acute care hospital (16.4% in 1997–2000 versus 29.8% in 2004–2006, p<0.001). One-year mortality after long-term acute care hospital admission was high throughout the study period: 50.7% in 1997–2000 and 52.2% in 2004–2006. Conclusions Long-term acute care hospital utilization after critical illness is common and increasing. Survival among Medicare beneficiaries transferred to long-term acute care after critical illness is poor.

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Administrative and Claims Records as Sources of Health Care Cost Data

Abstract: 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.

Cited by 220 publications

References 11 publications

A Comparison of the Cancer Incidence Rates between the National Cancer Registry and Insurance Claims Data in Korea

A Comparison of the Cancer Incidence Rates between the National Cancer Registry and Insurance Claims Data in Korea

The trauma registry compared to All Patient Refined Diagnosis Groups (APR-DRG)

Long-term Acute Care Hospital Utilization After Critical Illness

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