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At least 1,153 records · Page 64Linked to original sources
PubMed1989

Analysis of mortality patterns and workers' compensation awards among asbestos insulation workers in Ontario.

Mortality and workers' compensation patterns were studied among 1,064 Ontario asbestos insulation workers. A proportional mortality analysis of 153 asbestos worker deaths found increased mortality from malignant diseases (65 deaths observed; 35.1 expected), cancers of the lungs and pleura (32 deaths observed; 11.5 expected), peritoneal mesothelioma (4 deaths), and respiratory diseases (14 deaths observed; 7.9 expected). Despite the publicity given to asbestos-associated diseases, dependents of many men potentially eligible for workers compensation awards have not received pensions because claims were not filed. These findings suggest that much occupationally related disease is not being recognized in Ontario.

Asbestos↗
PubMed1994

Workers' compensation for nonmalignant asbestos-related lung disease.

Workers' compensation claims filed for occupational illness are generally more complicated to resolve than are injury claims, and they may therefore face higher likelihood of rejection. This study analyzed outcomes and predictive factors for claims filed from one clinic in Washington State between 1982 and 1986 by 157 male patients for nonmalignant asbestos-related lung disease. Among 50 federal Longshore claims, 46 (92%) were unresolved or could not be located by claims administrators. In contrast, 118 (89%) of State Fund claims had been resolved, with 48% accepted without consistent relationship to disease severity. Claims filed under both jurisdictions showed a twofold greater risk of rejection by the State Fund (relative risk, RR = 2.0; 95% confidence interval, 95% CI = 1.3-3.2). State Fund claims filed for nonwhite patients were rejected more often than those of white patients, although the association was explained at least partially by jurisdictional overlap (adjusted RR = 1.5; 95% CI = 1.05-2.1). This study indicates a need to scrutinize the handling of occupational disease claims by the federal Longshore system and to consider the adverse influences of jurisdictional conflicts and possible race-associated factors on compensation of occupational illness.

Aged↗
PubMed2001

Equity considerations in health care: the relevance of claims.

The general issues of equity and efficiency are central to the analysis of resource allocation problems in health care. We examine them using axiomatic bargaining theory. We study different solutions that have been proposed and relate them to previous literature on health care allocation. In particular, we focus on the solutions based on axiomatic bargaining with claims, and show that they are appealing as distributive criteria in health policy. Finally, we present the results of a survey that tries to elicit moral intuitions of people about resource allocation problems and their different solutions.

Collective Bargaining↗
PubMed1991

Managing loss adjustment expenses: strategies for health care risk managers.

Like most businesses, adjusting companies are not charitable organizations. They are entitled to a reasonable profit, which the risk manager should not begrudge. As a buyer of adjusting services, a risk manager with an inordinate obsession with slashing adjusting bills can destroy the goal of high-quality service. It is best for risk managers to pick and choose the areas for cutting adjusting expenses. To an extent, health care risk managers should view payment of high-quality adjusting services as an investment, with the payback being money saved by fighting fraudulent, exaggerated, and questionable claims.

Financial Management, Hospital↗
PubMed2004

Self-reported use of mental health services versus administrative records: care to recall?

Estimates of the level of unmet need for mental health treatment often rely on self-reported use of mental health services. However, depressed persons may over-report their use in relation to administrative records if they are highly distressed. This study seeks to replicate and explicate the finding that persons at a high level of distress report more mental health service use than recorded in their healthcare records. The study sample, N = 36,892, 12 years and older, was drawn from the 1996/97 Ontario portion of the Canadian National Population Health Survey. Respondents were individually linked to their administrative mental healthcare records 12 months backward in time. Of these, 96.5% agreed to the link and 23,063 (62.5%) were linked. Almost two-thirds of those who were depressed in the past year were currently at a high level of distress. Differential reporting of use for highly distressed persons in excess of 100% remained in the use of different types of physician providers after adjustments for other potential determinants of use. Telescoping was also not an explanation. The patterns of differential reporting between groups expected to diverge and converge in their recall ability were consistent with a recall bias. As this study was not able to rule out a recall bias, it further accentuates concerns about the impact of bias in the measurement of mental health-service use and inferences made concerning the determinants of use.

Adolescent↗
PubMedDate not supplied

Data validity issues in using claims data.

This paper overviews the use of claims data in pharmacoepidemiology, examines problems related to claims data use, and focuses on the uncertain validity of diagnosis data. Two contrasting studies are provided of drug-induced neutropenia and Stevens-Johnson Syndrome; both studies were launched at the same time with similar designs. Neutropenia is a laboratory-driven diagnosis, easy to make and confirm. The neutropenia study yielded many useful results, ranging from incidence rates to results with specific drug classes and individual drugs. However, the medical records revealed major unexpected issues from chronic and cyclic neutropenia. In contrast, Stevens-Johnson Syndrome is harder to diagnose, and is represented poorly in the ICD-9-CM coding system. The result was a study productive of much less clinical information. These studies show the important implications of variable data validity to study interpretation. Uniquely problematic situations exist: the illness does not reliably come to medical attention; inpatient drug exposures; an outcome is poorly defined by the diagnostic coding system; descriptive studies; drug effects are delayed and patients lose eligibility; and there are important unknown confounders such as cigarette smoking, occupation, menarche, menopause, etc., about which information cannot be obtained without accessing the patient.

Adverse Drug Reaction Reporting Systems↗
PubMedDate not supplied

Pattern recognition in health insurance claims databases.

Information in claims databases resides in data patterns rather than in data elements. Finding this information requires new terminology, a willingness to pose questions of form rather than specific hypotheses, and a quality control system that elevates the correctness of data relations above the validity of single facts. The language of claims data is a newspeak of CPT (Current Procedural Terminology), HCPCS (Health Care Financing Agency Common Procedure Coding System), ICD (International Classification of Disease), and NDC (National Drug Codes) for pharmaceutical codes. The techniques of pattern discovery are really ways of asking the data for classes of relations, and they vary in their reliance on external information. Sometimes, the question is entirely constrained by preceding factors. Other times we may recast the natural history of disease into a claims context and ask the data to give us the shape of disease evolution. We can use highly automated systems to evaluate the relations between prespecified factors, or empirical techniques to search out common relations that we have not specified in advance. Using massive data sets requires that quality control corresponds to the nature of the high-level information that we derive from large databases.

Databases as Topic↗
PubMedDate not supplied

Using databases for studying and comparing health care costs and resource use.

Data sources such as medical insurance claims are increasingly used in health outcomes research. We present opportunities and limitations associated with the use of such data for conducting studies of health care costs and resource use. We also provide examples on using databases for conducting research when the primary objective is to study costs or resource use. This information is intended to be helpful to experienced health services researchers and to those new to the field of either outcomes research or cost effectiveness research. We examine the reasons for using databases to study costs and resource use, desirable attributes of databases used for this purpose, potential pitfalls, other issues associated with conducting cost and resource use studies with databases, and appropriate methods for this research. Through examples and references, we examine issues to be considered in each of these areas, and make recommendations. Strengths and limitations of databases are indicated. Research using claims data to determine health care cost and resource use should be carried out responsibly. Limitations must be acknowledged for research using databases, and appropriate methods must be used. Still, databases represent a rich opportunity to conduct research in health care costs and resource use, and much can be learned using databases.

Databases as Topic↗
PubMedDate not supplied

A claims data approach to defining an episode of care.

OBJECTIVE: To utilize health services research techniques in developing an episode of care using an administrative data set. This method is demonstrated for an episodic clinical condition, migraine. DATA SOURCES: Medicaid administrative data set of 3,372 patients with a diagnosis of migraine (ICD-9-CM 346.0, 346.1) in the state of Pennsylvania between May 1990 and March 1992. STUDY DESIGN: The duration of a migraine episode was measured by assessing the magnitude of resource utilization and the proportion of patients with charges in the period after the index migraine as compared to the period before the index migraine. A confidence interval (CI) was developed around each measure using bootstrap techniques. DATA COLLECTION METHODS: All charge data were extracted daily for a 113-day observation period surrounding each index migraine in order to observe the duration of impact of a migraine diagnosis on resource utilization. PRINCIPAL FINDINGS: The lower limits of both the 95% and 99% CIs for the difference in charges are greater than 0 for three weeks. The lower limits of both CIs for the difference in the proportion of patients with charges are above 0 for six weeks. CONCLUSIONS: Our analysis demonstrates that a health services research framework can be used to define an episode of care for a chronic disease category such as migraine. This method can be used to evaluate episodes of care for clinical studies of limited or episodic conditions and to complement clinical expertise in developing time horizons for clinical trials.

Adult↗
PubMed1994

Analysis of a claims database for the identification of patients with carcinoma of the breast.

To develop and optimize algorithms for the identification of newly diagnosed and treated cases of women with carcinoma of the breast, an analysis was performed of cases identified from the claims database of a large health maintenance organization (U.S. Healthcare). An initial algorithm was developed from the patterns of claims which suggested common clinical presentations of carcinoma of the breast, and the positive predictive value was 88% (411/469). To attempt to improve upon the positive predictive value, multiple modifications of the initial algorithm were performed. The best identified modification of the initial algorithm yielded a positive predictive value of 93% (400/432) with a loss of only 3% (11/411) of the true positive cases. These results demonstrate that logic-based algorithms can be used as a valid and efficient method of identifying large numbers of cases from claims data with specific clinical characteristics. The best algorithm identified provides a powerful and accurate tool to perform health care analysis and research on large populations of women with newly diagnosed and treated carcinoma of the breast.

Adult↗
PubMed1991

Health care utilization and costs for injury in a corporate setting.

This article presents the incidence and costs for non-work-related injuries among 15,408 employees and their families based on health insurance claims data analysis. The treatment of injuries accounted for 11.3% of the plan's total health care costs ($31 million) for the 1986 policy year. For adults, women had a higher incidence rate than men; but for children, males had a higher incidence rate than females. A disproportionately high share of claims and charges for adults were attributed to low back disorders. Hospital admissions, length of stay and hospital days per 1,000 persons were similar for males and females, but much higher for adults than for children. This article provides an example of the utility of health insurance claims data as a source of morbidity information for disease surveillance and epidemiologic research. The analysis of claims data can be seen as a prerequisite to the development of preventive programs aimed at reducing injury rates and health care costs for injuries in a corporate setting.

Age Factors↗
PubMed1994

Use of Medicaid for mental health care by clients of community support programs.

The use of Medicaid for mental health services by the severely mentally ill is examined using paid Medicaid claims for clients of Community Support Programs in Wisconsin. The extent to which clients participate in Medicaid, the types and amounts of mental health services, and the costs of services are discussed. A narrow majority of CSP clients use Medicaid, which provides a substantial amount of case management service for program participants. Psychotropic medications are also used by a large percentage of clients. Other relatively common services covered by Medicaid are medication checks and psychotherapy. Average annual Medicaid payments for mental health services (including medications) are $2438.

Chronic Disease↗
PubMed2001

ADHD treatment in a behavioral health care carve-out: medications, providers, and service utilization.

Children's mental health services are increasingly being managed by managed behavioral health organizations (MBHOs) through carve-outs. Little information is available, however, about services and interventions being received by children whose mental health benefits are carved out. Using claims data, this study explores the treatment of children with a common child psychiatric disorder, attention deficit hyperactivity disorder (ADHD). Children being treated for ADHD see a variety of provider combinations. Children diagnosed with comorbid mood or anxiety disorders are more likely to see a psychiatrist than a primary care physician or therapist, and they are more likely to be in treatment with both a psychiatrist and a therapist than with just one mental health professional. After controlling for severity indicators, costs were significantly lower for patients being treated by just a psychiatrist than for patients seeing both a psychiatrist and therapist. This finding raises the possibility that attempts to save money by "splitting treatment" may not be cost-effective.

Attention Deficit Disorder with Hyperactivity↗
PubMed1994

Women and outpatient mental health services: use by black, Hispanic, and white women in a national insured population.

Factors affecting ethnic differences in women's use of outpatient mental health services were analyzed to determine whether lower use by black and Hispanic women occurred when socioeconomic and other factors are controlled. Employing the Andersen and Newman model of health use, insurance claims of 1.2 million federal employees insured by Blue Cross/Blue Shield in 1983 were analyzed to identify significant predictors of use. Results revealed that black and Hispanic women had lower probabilities and amounts of use when compared to white women even after controlling for a number of variables. Further research is needed to examine cultural and gender-related factors that may underlie ethnic differences; attitudinal factors and service system barriers are also implicated. Such findings have policy implications in the current climate of health care reform for which efforts are needed to increase access to care for ethnic minority women and other underserved populations.

Adult↗