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Concordance between Patient Self-Reports and Claims Data on Clinical Diagnoses, Medication Use, and Health System Utilization in Taiwan

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  • Chi-Shin Wu
  • Mei-Shu Lai
  • Susan Shur-Fen Gau
  • Sheng-Chang Wang
  • Hui-Ju Tsai

Abstract

Purpose: The aim of this study was to evaluate the concordance between claims records in the National Health Insurance Research Database and patient self-reports on clinical diagnoses, medication use, and health system utilization. Methods: In this study, we used the data of 15,574 participants collected from the 2005 Taiwan National Health Interview Survey. We assessed positive agreement, negative agreement, and Cohen's kappa statistics to examine the concordance between claims records and patient self-reports. Results: Kappa values were 0.43, 0.64, and 0.61 for clinical diagnoses, medication use, and health system utilization, respectively. Using a strict algorithm to identify the clinical diagnoses recorded in claims records could improve the negative agreement; however, the effect on positive agreement and kappa was diverse across various conditions. Conclusion: We found that the overall concordance between claims records in the National Health Insurance Research Database and patient self-reports in the Taiwan National Health Interview Survey was moderate for clinical diagnosis and substantial for both medication use and health system utilization.

Suggested Citation

  • Chi-Shin Wu & Mei-Shu Lai & Susan Shur-Fen Gau & Sheng-Chang Wang & Hui-Ju Tsai, 2014. "Concordance between Patient Self-Reports and Claims Data on Clinical Diagnoses, Medication Use, and Health System Utilization in Taiwan," PLOS ONE, Public Library of Science, vol. 9(12), pages 1-16, December.
    • Handle: RePEc:plo:pone00:0112257
    DOI: 10.1371/journal.pone.0112257
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    References listed on IDEAS

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    1. Liu, Tsai-Ching & Chen, Chin-Shyan, 2002. "An analysis of private health insurance purchasing decisions with national health insurance in Taiwan," Social Science & Medicine, Elsevier, vol. 55(5), pages 755-774, September.
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    8. Geng-He Chang & Ang Lu & Yao-Hsu Yang & Chia-Yen Liu & Pey-Jium Chang & Chuan-Pin Lee & Yao-Te Tsai & Cheng-Ming Hsu & Ching-Yuan Wu & Wei-Tai Shih & Ming-Shao Tsai, 2021. "High Risk of Peritonsillar Abscess in End-Stage Renal Disease Patients: A Nationwide Real-World Cohort Study," IJERPH, MDPI, vol. 18(13), pages 1-10, June.
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