Deductible imputation in administrative medical claims datasets.

Autor: Cliff BQ; Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA., Eddelbuettel JCP; PhD Program in Health Policy, Harvard University, Cambridge, Massachusetts, USA., Meiselbach MK; Health Policy and Management, Johns Hopkins University, Baltimore, Maryland, USA., Eisenberg MD; Health Policy and Management, Johns Hopkins University, Baltimore, Maryland, USA.; Johns Hopkins University, Baltimore, Maryland, USA.
Jazyk: angličtina
Zdroj: Health services research [Health Serv Res] 2024 Apr; Vol. 59 (2), pp. e14278. Date of Electronic Publication: 2024 Jan 17.
DOI: 10.1111/1475-6773.14278
Abstrakt: Objective: To validate imputation methods used to infer plan-level deductibles and determine which enrollees are in high-deductible health plans (HDHPs) in administrative claims datasets.
Data Sources and Study Setting: 2017 medical and pharmaceutical claims from OptumLabs Data Warehouse for US individuals <65 continuously enrolled in an employer-sponsored plan. Data include enrollee and plan characteristics, deductible spending, plan spending, and actual plan-level deductibles.
Study Design: We impute plan deductibles using four methods: (1) parametric prediction using individual-level spending; (2) parametric prediction with imputation and plan characteristics; (3) highest plan-specific mode of individual annual deductible spending; and (4) deductible spending at the 80th percentile among individuals meeting their deductible. We compare deductibles' levels and categories for imputed versus actual deductibles.
Data Collection/extraction Methods: Not applicable.
Principal Findings: All methods had a positive predictive value (PPV) for determining high- versus low-deductible plans of ≥87%; negative predictive values (NPV) were lower. The method imputing plan-specific deductible spending modes was most accurate and least computationally intensive (PPV: 95%; NPV: 91%). This method also best correlated with actual deductible levels; 69% of imputed deductibles were within $250 of the true deductible.
Conclusions: In the absence of plan structure data, imputing plan-specific modes of individual annual deductible spending best correlates with true deductibles and best predicts enrollees in HDHPs.
(© 2024 The Authors. Health Services Research published by Wiley Periodicals LLC on behalf of Health Research and Educational Trust.)
Databáze: MEDLINE
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