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Medicare Claims Data as Public Use Files: A New Tool for Public Health Surveillance

Erdem, Erkan PhD; Korda, Holly PhD, MA; Haffer, Samuel “Chris PhD”; Sennett, Cary MD, PhD

Journal of Public Health Management & Practice: July/August 2014 - Volume 20 - Issue 4 - p 445–452
doi: 10.1097/PHH.0b013e3182a3e958
Original Articles

Claims data are an important source of data for public health surveillance but have not been widely used in the United States because of concern with personally identifiable health information and other issues. We describe the development and availability of a new set of public use files created using de-identified health care claims for fee-for-service Medicare beneficiaries, including individuals 65 years and older and individuals with disabilities younger than 65 years, and their application as tools for public health surveillance. We provide an overview of these files and their attributes; a review of beneficiary de-identification procedures and implications for analysis; a summary of advantages and limitations for use of the public use files for surveillance, alone and in combination with other data sources; and discussion and examples of their application for public health surveillance using examples that address chronic conditions monitoring, hospital readmissions, and prevalence and expenditures in diabetes care.

This article describes the development and availability of a new set of public use files created using de-identified health care claims for fee-for-service Medicare beneficiaries, including individuals 65 years and older and individuals with disabilities younger than 65 years, and their application as tools for public health surveillance.

IMPAQ International, Washington, District of Columbia (Dr Erdem); Health Systems Research Associates, Portland, Maine (Dr Korda); Office of Information Products & Data Analytics, US Centers for Medicare & Medicaid Services, Baltimore, Maryland (Dr Haffer); and IMPAQ International, Columbia, Maryland (Dr Sennett).

Correspondence: Holly Korda, PhD, MA, Health Systems Research Associates, 15 Birch Lane, Portland, ME 04064 (HKorda@aol.com).

The research in this article was supported by the Centers for Medicare & Medicaid Services under contract number 500-2006-00007I/#T0004 with IMPAQ International.

The views expressed in this article are those of the authors and do not necessarily reflect the views of the US Department of Health and Human Services, the Centers for Medicare & Medicaid Services, or IMPAQ International. The authors declare no conflicts of interest.

© 2014 Lippincott Williams & Wilkins, Inc.