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Medicaid records as a valid data source: the Tennessee experience

C F Federspiel, W A Ray, W Schaffner

    Medical Care
    |February 1, 1976
    PubMed
    Summary

    Tennessee Medicaid claim files are suitable for health care research, despite common concerns about data deficiencies. Automated processing enhances data accuracy and consistency for valuable research applications.

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    Area of Science:

    • Health Services Research
    • Health Informatics
    • Public Health Data Analysis

    Background:

    • Medicaid claim files are underutilized in health care research due to perceived fiscal and administrative limitations.
    • Previous studies have highlighted deficiencies in administrative data, discouraging its use for research purposes.
    • Limited resources necessitate exploring alternative data sources for health care research.

    Purpose of the Study:

    • To evaluate the suitability of Tennessee Medicaid claim files for health care research.
    • To demonstrate the accuracy and internal consistency of Medicaid data through analysis.
    • To explore potential applications of Medicaid claims data in health care administration and research.

    Main Methods:

    • Analysis of the July 1974 Tennessee Medicaid month of payment file.

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  • Examination of specimen legend drug results for ambulatory patients.
  • Evaluation of the Medicaid claims processing system.

    • Main Results:

    • Tennessee Medicaid data proved suitable for research, contrary to common assumptions.
    • A statewide automated data processing system mitigated many data errors.
    • Analysis confirmed the accuracy and internal consistency of the Medicaid claims data.
    • Data suggested potential for investigating physician prescribing patterns and other administrative applications.

    Conclusions:

    • Tennessee Medicaid claim files are a valuable and accurate resource for health care research.
    • Automated data processing significantly improves the quality of Medicaid administrative data.
    • Utilizing existing Medicaid claims data offers a cost-effective alternative to developing new data collection systems.