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https://doi.org/10.21256/zhaw-23890| Publication type: | Article in scientific journal |
| Type of review: | Peer review (publication) |
| Title: | Decomposition of outpatient health care spending by disease : a novel approach using insurance claims data |
| Authors: | Stucki, Michael Nemitz, Janina Trottmann, Maria Wieser, Simon |
| et. al: | No |
| DOI: | 10.1186/s12913-021-07262-x 10.21256/zhaw-23890 |
| Published in: | BMC Health Services Research |
| Volume(Issue): | 21 |
| Issue: | 1264 |
| Issue Date: | 22-Nov-2021 |
| Publisher / Ed. Institution: | BioMed Central |
| ISSN: | 1472-6963 |
| Language: | English |
| Subjects: | Cost-of-illness; Healthcare cost; Outpatient care; Spending decomposition |
| Subject (DDC): | 360: Social problems and social insurance 362.1041: Health economics |
| Abstract: | Background: Decomposing health care spending by disease, type of care, age, and sex can lead to a better understanding of the drivers of health care spending. But the lack of diagnostic coding in outpatient care often precludes a decomposition by disease. Yet, health insurance claims data hold a variety of diagnostic clues that may be used to identify diseases. Methods: In this study, we decompose total outpatient care spending in Switzerland by age, sex, service type, and 42 exhaustive and mutually exclusive diseases according to the Global Burden of Disease classification. Using data of a large health insurance provider, we identify diseases based on diagnostic clues. These clues include type of medication, inpatient treatment, physician specialization, and disease specific outpatient treatments and examinations. We determine disease-specific spending by direct (clues-based) and indirect (regression-based) spending assignment. Results: Our results suggest a high precision of disease identification for many diseases. Overall, 81% of outpatient spending can be assigned to diseases, mostly based on indirect assignment using regression. Outpatient spending is highest for musculoskeletal disorders (19.2%), followed by mental and substance use disorders (12.0%), sense organ diseases (8.7%) and cardiovascular diseases (8.6%). Neoplasms account for 7.3% of outpatient spending. Conclusions: Our study shows the potential of health insurance claims data in identifying diseases when no diagnostic coding is available. These disease-specific spending estimates may inform Swiss health policies in cost containment and priority setting. |
| URI: | https://digitalcollection.zhaw.ch/handle/11475/23890 |
| Fulltext version: | Published version |
| License (according to publishing contract): | CC BY 4.0: Attribution 4.0 International |
| Departement: | School of Management and Law |
| Organisational Unit: | Winterthur Institute of Health Economics (WIG) |
| Appears in collections: | Publikationen School of Management and Law |
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| File | Description | Size | Format | |
|---|---|---|---|---|
| 2021_Stucki-etal_Decomposition-outpatient-health-care-spending.pdf | 1.98 MB | Adobe PDF |  View/Open |
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Stucki, M., Nemitz, J., Trottmann, M., & Wieser, S. (2021). Decomposition of outpatient health care spending by disease : a novel approach using insurance claims data. BMC Health Services Research, 21(1264). https://doi.org/10.1186/s12913-021-07262-x
Stucki, M. et al. (2021) ‘Decomposition of outpatient health care spending by disease : a novel approach using insurance claims data’, BMC Health Services Research, 21(1264). Available at: https://doi.org/10.1186/s12913-021-07262-x.
M. Stucki, J. Nemitz, M. Trottmann, and S. Wieser, “Decomposition of outpatient health care spending by disease : a novel approach using insurance claims data,” BMC Health Services Research, vol. 21, no. 1264, Nov. 2021, doi: 10.1186/s12913-021-07262-x.
STUCKI, Michael, Janina NEMITZ, Maria TROTTMANN und Simon WIESER, 2021. Decomposition of outpatient health care spending by disease : a novel approach using insurance claims data. BMC Health Services Research. 22 November 2021. Bd. 21, Nr. 1264. DOI 10.1186/s12913-021-07262-x
Stucki, Michael, Janina Nemitz, Maria Trottmann, and Simon Wieser. 2021. “Decomposition of Outpatient Health Care Spending by Disease : A Novel Approach Using Insurance Claims Data.” BMC Health Services Research 21 (1264). https://doi.org/10.1186/s12913-021-07262-x.
Stucki, Michael, et al. “Decomposition of Outpatient Health Care Spending by Disease : A Novel Approach Using Insurance Claims Data.” BMC Health Services Research, vol. 21, no. 1264, Nov. 2021, https://doi.org/10.1186/s12913-021-07262-x.
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