Abstract
Objective Comparison is a key method in learning about what works in
health and healthcare. We discuss the importance of comparability in
cross-national health research using health insurance claims data, develop a
framework to systematically asses these threats and apply it to the German
(DaTraV) and Dutch (Vektis) national-level insurance claims datasets.
Methods We propose a framework of threats to the comparability of health
insurance claims databases, which includes three domains: (1) representation of
populations compared, (2) data sources and data processing and (3) database
contents and availability for research purposes. We apply the framework to
analyze the comparability of DaTraV and Vektis databases using publicly
available information (organization’s websites, scientific publications)
and our experiences from an interregional project on rare diseases (EMRaDi).
Results Both databases were created for the same purpose (morbidity-based
risk adjustment) and use the same underlying sources of data. Differences in
population representation and uncertainty about data processing procedures
represent potential sources of incomparability. Access for research purposes is
feasible in both databases but may be subject to long processing time.
Conclusions We find important threats to the comparability of the Dutch
and German national insurance claims databases and by extension to validity of
any comparative health studies that rely on them. Standard adjustment
techniques, making more information available about data collection and
processing procedures and adding more diagnosis-related descriptors offer ways
to overcome the identified threats to comparability.