The Use of Claims Data in Healthcare Research
September 23, 2021
Hundreds of medical research studies published during the past 25 years have relied on claims data. Claims data, also called billing or sometimes administrative data, have been used to study such diverse issues as the use of comorbidity indices to predict risk of death , antiretroviral therapy , psychotropic drug usage , children’s mental health services , substance use disorders , the cost effectiveness of lung-volume–reduction surgery , diabetes preventive services , and numerous other areas . Most recently, they have been used as data by health and life insurance companies to reach decisions about whether to cover specific individuals .
Claims databases, simply put, are electronic records of millions of transactions that are purported to have occurred between patients and healthcare providers. They include information entered on bills (claims) submitted by hospitals, clinics, nursing homes, pharmacies, individual providers, and other medical professionals to public (e.g. Medicare and Medicaid) and private (e.g. Blue Cross/Blue Shield) insurance entities.
