Declining accuracy in disease classification on health insurance claims: Should we reconsider classification by principal diagnosis?

Journal of Epidemiology

Volumn 20, Issue 2, 2010, Pages 166-175

  Okamoto, Etsuji ^a  

^a NATIONAL INSTITUTE OF PUBLIC HEALTH   (Japan)

Author keywords

Health insurance claims; ICD10; Intercategory variance; Intracategory variance; Log normal distribution

Indexed keywords

ARTICLE; CLASSIFICATION; ECONOMICS; GENERAL ASPECTS OF DISEASE; HEALTH CARE COST; HEALTH CARE SURVEY; HUMAN; INSURANCE; JAPAN; MEDICAL RECORD; PUBLIC HEALTH; STANDARD; STATISTICS;

DISEASE; HEALTH CARE COSTS; HEALTH CARE SURVEYS; HUMANS; INSURANCE CLAIM REPORTING; JAPAN; MEDICAL RECORDS; NATIONAL HEALTH PROGRAMS;

EID: 77950615078     PISSN: 09175040     EISSN: 13499092     Source Type: Journal    
DOI: 10.2188/jea.JE20090044     Document Type: Article

References (18)

1. Izumi Y, Tsuji I, Ohkubo T, Kuwahara A, Nishino Y, Hisamichi S. Impact of smoking habit on medical care use and its costs: a prospective observation of National Health Insurance beneficiaries in Japan. Int J Epidemiol. 2001 Jun;30(3):616-21
2. Tsuji I, Takahashi K, Nishino Y, Ohkubo T, Kuriyama S, Watanabe Y, et al. Impact of walking upon medical care expenditure in Japan: the Ohsaki Cohort Study. Int J Epidemiol. 2003 Oct;32(5):809-14
3. Okamoto E. Do individualized health promotional programs reduce health care expenditure? A systematic review of controlled trials in the "Health-Up" model projects of the National Health Insurance. Nippon Koshu Eisei Zasshi. 2008 Dec;55(12):822-9
4. Tanihara S, Kobayashi Y. Sequential evaluation of the national medical expenditures for asthma care in Japan. J Epidemiol. 2004 May;14(3):100-3
5. Toyokawa S, Kobayashi Y, Ohmori M. Refined method for estimating medical expenditures for liver diseases using the patient survey and claim data in Japan. Nippon Koshu Eisei Zasshi. 2005 Nov;52(11):957-61
6. Okamoto E. A critical comment on disease statistics and estimates of the national medical expenditure-A case of dialysis expenditure. Shakai Hoken Junpo. 2009;2376:10-5 (in Japanese)
7. Ryu SY, Park JK, Suh I, Jee SH, Park J, Kim CB, et al. The accuracy of myocardial infarction diagnosis in medical insurance claims. Korean Research Group for Cardiovascular Disease Prevention and Control. Yonsei Med J. 2000 Oct;41(5):570-6
8. Lin CC, Lai MS, Syu CY, Chang SC, Tseng FY. Accuracy of diabetes diagnosis in health insurance claims data in Taiwan. J Formos Med Assoc. 2005 Mar;104(3):157-63
9. Kiyota Y, Schneeweiss S, Glynn RJ, Cannuscio CC, Avorn J, Solomon DH. Accuracy of Medicare claims-based diagnosis of acute myocardial infarction: estimating positive predictive value on the basis of review of hospital records. Am Heart J. 2004 Jul;148(1):99-104
10. Aronsky D, Haug PJ, Lagor C, Dean NC. Accuracy of administrative data for identifying patients with pneumonia. Am J Med Qual. 2005 Nov-Dec;20(6):319-28
11. Bullano MF, Kamat S, Willey VJ, Barlas S, Watson DJ, Brenneman SK. Agreement between administrative claims and the medical record in identifying patients with a diagnosis of hypertension. Med Care. 2006 May;44(5):486-90
12. Setoguchi S, Solomon DH, Glynn RJ, Cook EF, Levin R, Schneeweiss S. Agreement of diagnosis and its date for hematologic malignancies and solid tumors between Medicare claims and cancer registry data. Cancer Causes Control. 2007 Jun;18(5):561-9
13. Tanihara S, Yamagata Z, Une H. Reliability of health insurance claim statistical data based on the principal diagnosis method. Nippon Eiseigaku Zasshi. 2008 Jan;63(1):29-35 (in Japanese)
14. Okamoto E. Cautions for health care cost analysis. Hokenfu Zasshi. 2006;62:624-7 (in Japanese)
15. Disease Classification for Social Insurance (119 classification). Institute of Social Insurance Affairs (Shakaihoken jitsumu kenkyujo), January 1995
16. The Kolmogorov Test. In: E.S. Keeping. Introduction to Statistical Inference. New York: Dover Publications;1995. p. 256-260
17. Okamoto E. How the change of classifiers affected the disease classification of health insurance claims? Jpn J Health Economics & Policy. 2005;17:43-58
18. Okamoto E, Hata E. Estimation of disease-specific costs in health insurance claims: a comparison of three methods. Nippon Koshu Eisei Zasshi. 2004;51:926-37