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How Insurance Claim Data Can Help in Health Outcomes Research: an Indian Perspective

      Background

      Treatments associated with excellent outcomes in a research setting in randomised controlled trials (RCTs) may not be beneficial in the real-world settings which has a different spectrum of patients in different clinical situations. Therefore, healthcare providers are looking for evidence in the real-world setting in addition to RCTs. In this background, health insurance claims data are a source of invaluable real-world data. Claims data are increasingly being used for pharmacoeconomic and outcomes researchin regions like North America, Europe, Australia, and New Zealand. The major advantages of claims data over RCT data include: (a) health outcomes can be evaluated in real-world settings; (b) analysis results can be generalised to a broader population; (c) relatively inexpensivethan RCTs; (d) provide wide range of information about various conditions and procedures from a large number of patients, belonging to varied demographics; (e) data availability over extended periods of time allow retrospective cohort studies; (f) unaffected by recall bias; (g) large sample size will make the statistical methods more consistent. However, there are some limitations as well, such as incomplete diagnostic and provider identification data, and the fact that the population characteristics are largely influenced by the insurance plan, plan benefit design, and the variables of the database. Claims data in India are insufficiently used for health outcomes research. An important reason for this is that the penetration of health insurance is not up to the mark in India. It is expected that health insurance will become more popular in India, since (a) Indian health care expenditure is predominantly out-of-pocket, and (b) the healthcare costs are escalating day-by-day. RECOMMENDATIONS: With the increased penetration of health insurance in India, appropriate analysis of the resulting claims data can provide invaluable insights into demographics, disease trends, efficacy and effectiveness, and real-world information, from the Indian perspective.