Health care utilization research using secondary data

Abstract

In the last 20 years, administrative data (‘secondary data’ and ‘claims data’) from German statutory health insurances (SHIs) were made available for health, especially utilization research. These data cover information from all services billed by the SHI: outpatient and inpatient care, drug prescription, prescriptions of non-pharmaceutical therapies and technical aids, and data on incapacity to work. Several examples of secondary data analysis with SHI data were given: sector-based analyses, estimates of morbidity and costs of specific diseases, analyses of specific groups of insured members, evaluating quality of care, small-area analyses, and evaluation of new health services models. SHI’s secondary data are updated regularly, complete, unbiased, and of high quality. They also have a clear reference to population and region. Good Practice in Secondary Data Analysis (GPS) set up specific methodological standards. On the other hand, limitations of using claims data arise from the absence of patient individual risk factors as well as clinical information. Special problems arose from validity of diagnostic information and the external validity of results of secondary data. In the future, these limitations may be overcome by individual linking of primary and secondary data in utilization research. With this approach, the Andersen model of utilization may be evaluated to a higher degree than by using primary or secondary data alone.