Understanding healthcare cost per patient

[sestes6]

Hello,
My question involves the Healthcare_Expenses and Healthcare_Coverage fields in the patients.csv file here. I thought that I could sum up the healthcare costs of a patient in some of the other tables and reproduce this number. In particular, it seems that just about every medical/healthcare-related event for a patient is listed in the encounters.csv file. So I thought that I could just sum up the total_claim_cost from every encounter a patient had and that should equal the sum of those two quantities (healthcare expenses and coverage fields). The sum of the total claim cost seems to be lower for every patient (in some cases by a factor of 10 or more). This is confusing to me. I would have thought that the sum of these numbers represents the cost of all medical events throught the patient's life. Is this not correct? Or are the other tables not comprehensive and there are some "hidden costs" throughout the patient's lifetime that don't appear in the encounters.csv table? I hope this question makes sense. I would really appreciate any help that the community can provide. Thanks!

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[jawalonoski]

@sestes6 the summation may not match depend on the years of history you've exported (default is 10 years, with some exceptions: for example, active diagnoses, devices, prescriptions, and so forth that are older than the filter may be included).

If some of the data was filtered as too old, the total in the patient file would be higher than the remaining individual items that you would add together.

See src/main/resources/synthea.properties:

# number of years of history to keep in exported records, anything older than this may be filtered out
# set years_of_history = 0 to skip filtering altogether and keep the entire history
exporter.years_of_history = 10

[sestes6]

Ah thank you so much, that is very helpful! In particular, the data I'm working with comes from the 100 patient sample here. I'm guessing that this dataset was generated with the default value of 10 that you mentioned. Is that correct?

[jawalonoski]

Yes, the samples are generated with default values.

[sestes6]

Thank you!