Administrative Claims Databases
Claims systems are an important source for service utilization data, offering large sample sizes across a geographically dispersed population, identifiable at the state, county, and postal zip code level. Health insurance claims databases may also capture eye care services provided outside the scope of ophthalmology and optometry, such as services provided by general practitioners, pediatricians, and other specialists, or services provided in emergency department or inpatients settings. However, a fundamental limitation of claims data is that these are principally payment records and are based on diagnostic coding that may be driven by reimbursement concerns, thus may or may not always accurately reflect the true medical condition. For more information, please visit the Review of Claims and Registries Report pdf icon[PDF – 870 KB]external icon.
Administrative claims databases include insurance claims and payment information. VEHSS plans to include the following five claims databases:
| Medicare | Medicaid | MarketScan | VSP | Military Health System | |
|---|---|---|---|---|---|
| Nationally Representative | Partial | No | No | No | No |
| Geographic Representation | |||||
| State Representation | Yes | Yes | Partial | Yes | Partial |
| County Representation | Yes | Yes | Partial | Partial | Partial |
| Patient Groups | |||||
| Age 0-65 | Partial | Yes | Yes | Yes | Yes |
| Age 65+ | Yes | Partial | Partial | Yes | Partial |
| Undiagnosed Patients | No | No | No | No | No |
| Uninsured Patients | No | No | No | Partial | No |
| Care Type and Setting | |||||
| Vision Services | No | Partial | No | Yes | Yes |
| Eye Care | Yes | Yes | Yes | Partial | Yes |
| Other Medical | Yes | Yes | Yes | No | Yes |
| Conditions | |||||
| All Medical Diagnoses | Yes | Yes | Yes | No | Yes |
| Risk Factors | Yes | Yes | Yes | Partial | Yes |
| Uncorrected Acuity | No | No | No | No | Partial |
| Corrected Acuity | No | No | No | Partial | Partial |