title: Medical claims profiles of subjects with temporomandibular joint disorders.
abstract: The primary goal of this study was to evaluate the claims profiles of subjects with TMJ disorders relative to a control group without the disorders and to provide a characterization of the type of healthcare services received and the associated costs of healthcare for patients with TMJ disorders. The administrative data base of a major medical insurer was used to compare the claims history of 1,819 patients diagnosed with TMJ disorders to matched controls. The analysis was based only on medical claims. The study found that total medical claim payments for the patients with TMJ disorders were double that of the subjects without TMJ disorders, and similarly, the utilization of institutional and professional care services was found to be approximately twice as high, though not uniformly distributed across all Major Diagnostic Categories, physician specialties or types of service. The level and nature of the differences in the quantity and costs of healthcare between subjects with and without TMJ disorders were unexpectedly large. The majority of these differences were attributed to conditions that were not usually considered related to TMJ disorders. These utilization and cost differences extended, in varying degrees, over a wide range of diagnostic and healthcare provider categories.
authors.affiliation: Management Science & Information Dept., University of Massachusetts, Boston 02125, USA.
authors.forename: D G
authors.initials: DG
authors.lastname: Shimshak
authors.forename: R L
authors.initials: RL
authors.lastname: Kent
authors.forename: M
authors.initials: M
authors.lastname: DeFuria
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D054598:Blue Cross Blue Shield Insurance Plans; D002648:Child; D017281:Cost of Illness; D005260:Female; D017048:Health Care Costs; D006268:Health Facilities / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D013705:Temporomandibular Joint Disorders / Q000191:economics*