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Open Access Research article

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

Matthias Hunger1*, Larissa Schwarzkopf1, Margit Heier2, Annette Peters2, Rolf Holle1 and KORA Study Group

Author Affiliations

1 Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Ingolstädter Landstr. 1, Neuherberg, 85764, Germany

2 Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Ingolstädter Landstr. 1, Neuherberg, 85764, Germany

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BMC Health Services Research 2013, 13:1  doi:10.1186/1472-6963-13-1

Published: 3 January 2013

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.

Keywords:
Health care utilization; Self-report; Validity; Survey; Response bias; Recall bias; Claims data