Spatial Sufficiency of 5% Medicare Standard Analytic Files

Spatial Demography
Lee R Mobley

Abstract

The 5% Medicare Standard Analytic Files (SAF) are random samples used to analyze national trends in medical treatments, expenditures, and outcomes. Their utility in small-area or multilevel analyses is unknown. To demonstrate possible limitations of the 5% SAF for analysis of health behaviors in small areas. We use descriptive Chi-square goodness-of-fit tests and mapping to explore consistency in the 5% representation of the 100% population in states and counties. We conduct multilevel modeling of individual utilization of mammography or endoscopy services for cancer screening and contrast findings across the 5% and 100% files. Subjects are enrolled in both parts A and B Medicare coverage and ages 65-104, alive and residing in the same state, with no gaps in coverage during the study period. Identically defined groups are drawn from the 5% SAF and 100% population claims and denominator files. The Chi-square tests of homogeneous population subgroups in 5% and 100% files exhibit significant differences in 7 of 8 states. Maps confirm this among states' counties and find that one state is generally under-represented by the 5% SAF, while others show areas with variable representation. Multilevel modeling results are largely consiste...Continue Reading

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