Measuring low-value health services using Health Insurance claims data

Health insurance and the demand for medical care: Instrumental variable estimates using health insurer claims data.

This paper takes a different approach to estimating demand for medical care that uses the negotiated prices between insurers and providers as an instrument. The instrument is viewed as a textbook "cost shifting" instrument that impacts plan offerings, but is unobserved by consumers. The paper finds a price elasticity of demand of around -0.20, matching the elasticity found in the RAND Health In...

HEALTH INSURANCE CLAIMS AND RISK EQUALISATION IN AUSTRALIA Health Insurance Claims and Risk Equalisation in Australia

Identification of ovarian cancer symptoms in health insurance claims data.

BACKGROUND Women with ovarian cancer have reported abdominal/pelvic pain, bloating, difficulty eating or feeling full quickly, and urinary frequency/urgency prior to diagnosis. We explored these findings in a general population using a dataset of insured women aged 40-64 and investigated the potential effectiveness of a routine review of claims data as a prescreen to identify women at high risk...

Risk factors for ill health insurance claims.

OBJECTIVES This study examined the information available at application for income protection insurance, to determine if any factors were predictive of a claim. The strength and significance of such factors were assessed and a predictive model was developed. BACKGROUND The factors underlying life assurance risks are well known, but this is not the case for income protection insurance. For acc...

Applying value-based insurance design to high-cost health services.

Value-based insurance design programs have focused on reducing consumer cost sharing in health insurance for preventive tests and medications for chronic diseases. But for value-based design principles to have a stronger clinical and economic impact, they should be extended to expensive services and to those for which the evidence is limited or controversial. This paper proposes applying value-...