Disparities in preventive procedures: comparisons of self-report and Medicare claims data

BMC Health Serv Res. 2006 Sep 29;6:122. doi: 10.1186/1472-6963-6-122.


Background: Racial/ethnic disparities are assessed using either self-report or claims data. We compared these two data sources and examined contributors to discrepancies in estimates of disparities.

Methods: We analyzed self-report and matching claims data from Medicare Beneficiaries 65 and older who participated in the Medicare Current Beneficiary Survey, 1999-2002. Six preventive procedures were included: PSA testing, influenza vaccination, Pap smear testing, cholesterol testing, mammography, and colorectal cancer testing. We examined predictors of self-reports in the absence of claims and claims in the absence of self-reports.

Results: With the exception of PSA testing, racial/ethnic disparities in preventive procedures are generally larger when using Medicare claims than when using patients' self-report. Analyses adjusting for age, gender, income, educational level, health status, proxy response and supplemental insurance showed that minorities were more likely to self-report preventive procedures in the absence of claims. Adjusted odds ratios ranged from 1.07 (95% CI: 0.88 - 1.30) for PSA testing to 1.83 (95% CI: 1.46 - 2.30) for Pap smear testing. Rates of claims in the absence of self-report were low. Minorities were more likely to have PSA test claims in the absence of self-reports (1.55 95% CI: 1.17 - 2.06), but were less likely to have influenza vaccination claims in the absence of self-reports (0.69 95% CI: 0.51 - 0.93).

Conclusion: These findings are consistent with either racial/ethnic reporting biases in receipt of preventive procedures or less efficient Medicare billing among providers with large minority practices.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • African Americans / psychology
  • African Americans / statistics & numerical data
  • Aged
  • Aged, 80 and over
  • Confidence Intervals
  • Data Collection / methods
  • Diagnostic Tests, Routine / economics
  • Diagnostic Tests, Routine / statistics & numerical data*
  • Female
  • Health Care Surveys / methods*
  • Hispanic Americans / psychology
  • Hispanic Americans / statistics & numerical data
  • Humans
  • Insurance Claim Review*
  • Male
  • Medicare / statistics & numerical data*
  • Minority Groups / psychology
  • Minority Groups / statistics & numerical data*
  • Patient Acceptance of Health Care / ethnology*
  • Preventive Health Services / economics
  • Preventive Health Services / statistics & numerical data*
  • Self Disclosure*
  • Socioeconomic Factors
  • United States