Quantifying under-reporting of pathology tests in Medical Benefits Schedule claims data

Area of Science:

• Health Services Research
• Medical Informatics
• Public Health

Background:

• Australian Medical Benefits Schedule (MBS) claims data is a crucial resource for health research.
• Pathology test recording in MBS data can be incomplete due to specific data collection practices.
• Understanding data limitations is essential for accurate health outcome analysis.

Purpose of the Study:

• To investigate the completeness of pathology test recording in Australian MBS claims data.
• To assess the impact of 'episode coning' on the recording of prostate-specific antigen (PSA) tests.
• To quantify the potential under-recording of pathology tests in claims data.

Main Methods:

• Analysis of MBS data from the 45 and Up Study for male participants.
• Examination of pathology test items and costs within each episode of care.
• Identification of episodes potentially affected by 'episode coning' for PSA tests (Item 66655).

Main Results:

• Over 1 million episodes of care for nearly 120,000 men were analyzed.
• Approximately 11% of episodes included a recorded PSA test request.
• An additional 7.5% of episodes may have had unrecorded PSA tests due to episode coning.

Conclusions:

• 'Episode coning' leads to under-reporting of pathology tests in MBS data.
• This under-reporting creates uncertainty regarding the actual performance of specific tests, like PSA.
• Estimating the extent of unrecorded tests is vital for reliable interpretation of MBS claims data.