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Finding and Using Health Statistics

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Claims Data

Claims data, also known as administrative data, are another sort of electronic record, but on a much bigger scale. Claims databases collect information on millions of doctors’ appointments, bills, insurance information, and other patient-provider communications.

The good thing about claims data is that, like other medical records, they come directly from notes made by the health care provider, and the information is recorded at the time patient sees the doctor. Also, because of the large sample size of claims data, researchers can analyze groups of patients with rare illnesses and medical conditions. The downside to using claims data is there may be low validity due to certain illegal billing practices, like ordering unnecessary tests or billing for services that were not provided.

This table was generated using data from the CMS Chronic Conditions Public Use Files, a source of claims data.1.


Table 3: Average Payment per Enrollee for Medicare Part A & B by Number of Chronic Conditions
  # of CCs     # of Enrollees Part A     # of Enrollees Part B     Average Payment Part A     Average Payment Part B
NDE 0 10,138,926 7,497,739 $248 $1,156
  1 6,663,517 6,498,765 $1,314 $2,722
  2 4,583,587 4,514,823 $2,998 $4,258
  3 2,632,736 2,606,318 $5,968 $6,128
  4 1,399,364 1,389,361 $10,784 $8,472
  5 649,251 646,544 $17,537 $10,974
  6 251,404 250,820 $26,153 $13,597
  7 80,674 80,613 $36,243 $16,283
  8 19,532 19,543 $46,766 $18,729
  9 2,991 2,996 $56,014 $20,638
  10 225 225 $68,333 $22,367
DE 0 1,552,910 1,539,298 $716 $1,393
  1 1,405,876 1,439,872 $2,286 $3,289
  2 1,092,821 1,131,680 $4,414 $5,185
  3 806,921 838,053 $7,683 $7,285
  4 558,204 578,539 $12,572 $10,102
  5 339,370 350,926 $19,110 $12,954
  6 175,924 181,503 $27,390 $15,922
  7 75,353 77,374 $36,690 $18,869
  8 23,542 24,085 $46,137 $21,262
  9 4,720 4,841 $54,212 $23,586
  10 381 386 $62,888 $25,277

Source: 2009 Chronic Conditions PUF. NDE: Non-Dual Eligible; DE: Dual-Eligible; CC: Chronic Condition

1Erdem, Erkan. Chronic Conditions in Medicare. Research Brief #3. IMPAQ International LLC, November 2011.  http://www.impaqint.com/sites/default/files/research-briefs/Chronic_Conditions_PUF_Brief_Final.pdf

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