How Healthcare Studies Use Claims Data

Claims data have become common during the past two decades. The electronic records include information entered on bills (claims) submitted by healthcare providers to third-party payers. They are an attractive data source; however, they contain limitations that threaten the validity of studies that use them. We reviewed 168 studies that employed claims data, published during 2000-2005 in five healthcare journals, to investigate how claims data are being used and whether their use is appropriate. Healthcare studies in our sample used claims data to select a sample, to establish healthcare costs, to determine whether specific treatments or procedures had been provided, to ascertain the cost- effectiveness of services, and to establish their accuracy as a stand-in for other measures. Most studies appropriately used claims data; however, there was a sizable percentage that used claims data in an inappropriate or questionable fashion.