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BMC Health Serv Res. 2013 Jan 3;13:1. doi: 10.1186/1472-6963-13-1.

Official statistics and claims data records indicate non-response and recall bias within survey-based estimates of health care utilization in the older population.

Author information

1
Helmholtz Zentrum M├╝nchen, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Ingolst├Ądter Landstr, 1, Neuherberg, 85764, Germany. matthias.hunger@helmholtz-muenchen.de

Abstract

BACKGROUND:

The validity of survey-based health care utilization estimates in the older population has been poorly researched. Owing to data protection legislation and a great number of different health care insurance providers, the assessment of recall and non-response bias is challenging to impossible in many countries. The objective of our study was to compare estimates from a population-based study in older German adults with external secondary data.

METHODS:

We used data from the German KORA-Age study, which included 4,127 people aged 65-94 years. Self-report questions covered the utilization of long-term care services, inpatient services, outpatient services, and pharmaceuticals. We calculated age- and sex-standardized mean utilization rates in each domain and compared them with the corresponding estimates derived from official statistics and independent statutory health insurance data.

RESULTS:

The KORA-Age study underestimated the use of long-term care services (-52%), in-hospital days (-21%) and physician visits (-70%). In contrast, the assessment of drug consumption by postal self-report questionnaires yielded similar estimates to the analysis of insurance claims data (-9%).

CONCLUSION:

Survey estimates based on self-report tend to underestimate true health care utilization in the older population. Direct validation studies are needed to disentangle the impact of recall and non-response bias.

PMID:
23286781
PMCID:
PMC3545728
DOI:
10.1186/1472-6963-13-1
[Indexed for MEDLINE]
Free PMC Article
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