Understanding the use of patient-reported data by health care insurers: A scoping review

Anne Neubert, Oscar Brito Fernandes*, Armin Lucevic, Milena Pavlova, Laszlo Gulacsi, Petra Baji, Niek Klazinga, Dionne Kringos

*Corresponding author for this work

Research output: Contribution to journalReview article (Academic Journal)peer-review

4 Citations (Scopus)
23 Downloads (Pure)

Abstract

Background Patient-reported data are widely used for many purposes by different actors within a health system. However, little is known about the use of such data by health insurers. Our study aims to map the evidence on the use of patient-reported data by health insurers; to explore how collected patient-reported data are utilized; and to elucidate the motives of why patientreported data are collected by health insurers. Methods The study design is that of a scoping review. In total, 11 databases were searched on. Relevant grey literature was identified through online searches, reference mining and recommendations from experts. Forty-two documents were included. We synthesized the evidence on the uses of patient-reported data by insurers following a structure-process-outcome approach; we also mapped the use and function of those data by a health insurer. Results Health insurers use patient-reported data for assurance and improvement of quality of care and value-based health care. The patient-reported data most often collected are those of outcomes, experiences and satisfaction measures; structure indicators are used to a lesser extent and often combined with process indicators. These data are mainly used for the purposes of procurement and purchasing of services, quality assurance, improvement and reporting, and strengthening the involvement of insured people. Conclusions The breadth to which insurers use patient-reported data in their business models varies greatly. Some hindering factors to the uptake of such data are the varying and overlapping terminology in use in the field and the limited involvement of insured people in a health insurer's business. Health insurers are advised to be more explicit in regard to the role they want to play within the health system and society at large, and accommodate implications for the use of patient-reported data accordingly.

Original languageEnglish
Article numbere0244546
Number of pages15
JournalPLoS ONE
Volume15
Issue number12
DOIs
Publication statusPublished - 28 Dec 2020

Bibliographical note

Funding Information:
The participation of AL, DK, LG, NK, OBF and PB occurred within a Marie Skłodowska-Curie Innovative Training Network (HealthPros - Healthcare Performance Intelligence Professionals) that has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement Nr. 765141 (https://healthpros-h2020.eu). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Publisher Copyright:
© 2020 Neubert et al.

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