Imputing deductibles in claims information – Healthcare Economist

Many researchers are all for how price sharing impacts well being care utilization, price and affected person outcomes. That is very true as high-deductible well being plans (HDHP) have grow to be extra frequent within the US. In 2023, 29% of coated staff within the US had a HDHP.

One useful sort of knowledge for analyzing HDHPs is claims information. Nonetheless, there are challenges with utilizing these information:

The primary sort [of claims data] consists of detailed details about plan construction however usually has poor externality validity as it’s usually sourced from a single well being insurer or small subset of enrollees. The second sort has improved exterior validity by pooling throughout insurers however doesn’t often embody plan-structure variables mandatory to differentiate between HDHPs and plans with decrease deductibles, or interpret what binary “HDHP” variables characterize.

A paper by Cliff et al. (2024) goals to look at how nicely one can predict plan deductibles utilizing claims information utilizing Optum Labs information. The Optum information do have info on plan deductibles which are used because the “gold commonplace”. 4 totally different imputation approaches are used:

  • Parametric prediction with spending (regress on spending methodology). Enrollee’s annual deductible spending is regressed on their complete annual spending (plan plus out-of-pocket), frequent demographic covariates (gender and age), and stuck results for every plan Use regression to foretell deductibles conditional for set spending degree with plan fastened results. Utilizing the coefficients from the best-fit regression mannequin, deductibles are predicted for every plan at a hard and fast quantity of complete spending, (which the authors set at $10,000 to exceed most deductibles).
  • Parametric prediction with imputation and plan traits (Regress on imputed deductibles methodology). This strategy makes use of two phases. First, deductibles are inputed for a subset of plans the place they’re simply recognized. For the second stage, a set of covariates is created describing noticed deductible spending and plan traits and collapse information from the person to the plan degree. Utilizing the subset of plans with an imputed deductible, the imputed deductible quantities are regressed on the set of covariates; generated coefficients are then used to foretell deductibles for plans unable to be imputed within the first stage.
  • Modal deductible spending (mode methodology). This straightforward methodology inputes the very best (non-zero) modal deductible spending quantity amongst enrollees in a plan and applies this deductible to all enrollees in that plan.
  • eightieth percentile of deductible spending (eightieth percentile methodology). Following Rabideau (2021), particular person spending is tracked month-over-month, and people the place spending will increase in a given month however deductible spending doesn’t change are assumed to have reached their deductible. Then, the person degree information is collapsed to the plan degree and the deductible for all enrollees within the plan is about to the eightieth percentile of annual deductible spending within the plan.

To guage the accuracy of the imputation approaches, the authors calculate the sensitivity, specificity, and constructive/detrimental predictive worth (PPV/NPV) of every methodology for classifying enrollees into HDHP vs. non-HDHP plans.

Surprisingly, the easy “mode methodology” carried out greatest by way of classifying people into HDHP vs. not. It additionally carried out nicely by way of predicting deductible spending.

The mode methodology performs greatest; 72% of plans are accurately labeled into every class and 69% of plans have an imputed deductible inside $250 of the particular deductible. For this methodology, limiting imputation to teams with greater than 50 enrollees improved sensitivity to 85% of plans accurately labeled by class and decreased the common distinction between the imputed and precise deductible from $700 to $496

You possibly can learn the total paper right here.

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