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Challenges in merging Medicaid and Medicare databases to obtain healthcare costs for dual-eligible beneficiaries: using diabetes as an example.

Publication ,  Journal Article
Prela, CM; Baumgardner, GA; Reiber, GE; McFarland, LV; Maynard, C; Anderson, N; Maciejewski, M
Published in: Pharmacoeconomics
2009

Dual-eligible Medicaid-Medicare beneficiaries represent a group of people who are in the lowest income bracket in the US, have numerous co-morbidities and place a heavy financial burden on the US healthcare system. As cost-effectiveness analyses are used to inform national policy decisions and to determine the value of implemented chronic disease control programmes, it is imperative that complete and valid determination of healthcare utilization and costs can be obtained from existing state and federal databases. Differences and inconsistencies between the Medicaid and Medicare databases have presented significant challenges when extracting accurate data for dual-eligible beneficiaries. To describe the challenges inherent in merging Medicaid and Medicare claims databases and to present a protocol that would allow successful linkage between these two disparate databases. Healthcare claims and costs were extracted from both Medicaid and Medicare databases for King County, Seattle, WA, USA. Three Medicaid files were linked to eight Medicare files for unique dual-eligible beneficiaries with type 2 diabetes mellitus. Although major differences were identified in how variables and claims were defined in each database, our method enabled us to link these two different databases to compile a complete and accurate assessment of healthcare use and costs for dual-eligible beneficiaries with a costly chronic condition. For example, of the 1759 dual-eligible beneficiaries with diabetes, the average cost of healthcare was USD 15,981 per capita, with an average of 76 claims per person per year. The resulting merged database provides a virtually complete documentation of both utilization and costs of medical care for a population who receives coverage from two different programmes. By identifying differences and implementing our linkage protocol, the merged database serves as a foundation for a broad array of analyses on healthcare use and costs for effectiveness research.

Duke Scholars

Published In

Pharmacoeconomics

DOI

ISSN

1170-7690

Publication Date

2009

Volume

27

Issue

2

Start / End Page

167 / 177

Location

New Zealand

Related Subject Headings

  • Washington
  • United States
  • Systems Integration
  • Medicare
  • Medical Record Linkage
  • Medicaid
  • Insurance, Health, Reimbursement
  • Insurance Claim Review
  • Humans
  • Health Policy & Services
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Prela, C. M., Baumgardner, G. A., Reiber, G. E., McFarland, L. V., Maynard, C., Anderson, N., & Maciejewski, M. (2009). Challenges in merging Medicaid and Medicare databases to obtain healthcare costs for dual-eligible beneficiaries: using diabetes as an example. Pharmacoeconomics, 27(2), 167–177. https://doi.org/10.2165/00019053-200927020-00007
Prela, Cecilia M., Greg A. Baumgardner, Gayle E. Reiber, Lynne V. McFarland, Charles Maynard, Nancy Anderson, and Matthew Maciejewski. “Challenges in merging Medicaid and Medicare databases to obtain healthcare costs for dual-eligible beneficiaries: using diabetes as an example.Pharmacoeconomics 27, no. 2 (2009): 167–77. https://doi.org/10.2165/00019053-200927020-00007.
Prela CM, Baumgardner GA, Reiber GE, McFarland LV, Maynard C, Anderson N, et al. Challenges in merging Medicaid and Medicare databases to obtain healthcare costs for dual-eligible beneficiaries: using diabetes as an example. Pharmacoeconomics. 2009;27(2):167–77.
Prela, Cecilia M., et al. “Challenges in merging Medicaid and Medicare databases to obtain healthcare costs for dual-eligible beneficiaries: using diabetes as an example.Pharmacoeconomics, vol. 27, no. 2, 2009, pp. 167–77. Pubmed, doi:10.2165/00019053-200927020-00007.
Prela CM, Baumgardner GA, Reiber GE, McFarland LV, Maynard C, Anderson N, Maciejewski M. Challenges in merging Medicaid and Medicare databases to obtain healthcare costs for dual-eligible beneficiaries: using diabetes as an example. Pharmacoeconomics. 2009;27(2):167–177.
Journal cover image

Published In

Pharmacoeconomics

DOI

ISSN

1170-7690

Publication Date

2009

Volume

27

Issue

2

Start / End Page

167 / 177

Location

New Zealand

Related Subject Headings

  • Washington
  • United States
  • Systems Integration
  • Medicare
  • Medical Record Linkage
  • Medicaid
  • Insurance, Health, Reimbursement
  • Insurance Claim Review
  • Humans
  • Health Policy & Services