Challenges of using medical insurance claims data for utilization analysis

Patrick T. Tyree, Bonnie Lind, William E. Lafferty

Research output: Contribution to journalArticle

54 Scopus citations

Abstract

Research use of insurance claims data presents unique challenges and requires a series of value judgments that are intended to improve the data quality. In this study, medical insurance claims from 2 large companies were combined to assess utilization of complementary and alternative medicine. Challenges included assessing and improving the quality of data, combining data from 2 different companies with dissimilar coding systems, and determining the most appropriate ways to describe utilization. This article addresses 4 methodologic challenges in creating the analytic files: (1) conversion of claims into unique visits, (2) identification of incomplete claims data, (3) categorization of providers and locations of service, and (4) selecting the most useful measures of utilization and expenditures.

Original languageEnglish (US)
Pages (from-to)269-275
Number of pages7
JournalAmerican Journal of Medical Quality
Volume21
Issue number4
DOIs
Publication statusPublished - Jul 1 2006
Externally publishedYes

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Keywords

  • Administrative data
  • Data quality
  • Expenditures
  • Insurance claims
  • Location of service
  • Methods
  • Provider type
  • Utilization

ASJC Scopus subject areas

  • Health Policy

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