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Base principale du SNDS - National healthcare data system (France, holder: Caisse nationale d'Assurance maladie, CNAM): The only one of its kind in Europe, if not the world, the SNDS was created by the law modernising our healthcare system (law no. 2016-41 of 26 January 2016, available on the Legifrance website) in order to develop the use of healthcare data, and represents a major step forward for conducting studies in the field of healthcare.
Set up by the Caisse Nationale de l'Assurance Maladie (CNAM), the SNDS is based on the national inter-regime health insurance information system (SNIIIRAM), which contains :
reimbursement data from compulsory health insurance schemes ;
hospital data (based on the PMSI programme for the medicalisation of information systems);
New components have also been added:
databases on medical causes of death (database of the Centre for Epidemiology of Medical Causes of Death of the French National Institute of Health and Medical Research - Inserm CépiDc);
data relating to disability (from the maisons départementales des personnes handicapées - MDPH - data from the caisse nationale de solidarité pour l'autonomie - CNSA);
and Covid-19 data extracted from the Vaccin Covid and SI-DEP (information and screening system) databases.
These main components of the SNDS are made available by CNAM on its portal.
The 2019 law on the organisation and transformation of the healthcare system (law no. 2019-774 of 24 July 2019, available on the Legifrance website) extends the scope of the SNDS to include additional categories of data, such as health surveys, medical biology and radiology results, maternal and child protection data, etc.
Today, the SNDS is a database that provides an overview of the healthcare pathways of the entire population, with a maximum historical depth of 20 years.
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RAC - Reste A Charge, database on healthcare expenditure and out-of-pocket expenses (France, holder: Direction de la recherche, des études, de l'évaluation et des statistiques, DREES): Knowledge of the distribution of healthcare expenditure and the out-of-pocket expenses incurred by patients is an important factor in the management of healthcare policies. To meet this need, DREES has created the RAC database, a simplified database of expenditure and out-of-pocket expenses after reimbursement by the compulsory health insurance scheme (RAC AMO), but before coverage by supplementary health insurance.
The RAC database groups together, by item of care, the healthcare expenditure and out-of-pocket expenses after AMO of people insured under all the health insurance schemes[1], who have received care at least once on French territory during the year in question (referred to as 'consumers'). It exhaustively covers individualisable expenditure, reimbursable and presented for reimbursement, in outpatient and inpatient care for all hospital disciplines (medicine, surgery and obstetrics [MCO], home hospital care [HAD], psychiatry, and follow-up and rehabilitation care [SSR]), for public and private health establishments. It does not cover expenditure in the medico-social field (e.g. USLD, EHPAD).
It includes one line per individual and per item of care, for the year to which it is indexed. The breakdown of expenditure by item of care is based on the grouping of services into broad categories of care, according to the nature of each service, the professional providing it and the place where it is provided. The RAC database contains information on the individual characteristics of consumers (age, gender, place of residence, ALD status, CMU-C status and ACS status), as well as expenditure and reimbursement indicators (amount of expenditure, reimbursement basis, expenditure reimbursed by AMO, RAC AMO with distinction between the opposable part and the freedom of pricing).
The RAC database was constructed by matching two sources from the National Health Data System (SNDS): the Simplified Inter-Scheme Consumption Datamart (DCIRS), managed by the National Health Insurance Fund (CNAM), and the Medicalisation of Information Systems Programme (PMSI), managed by the Technical Agency for Information on Hospitalisation (ATIH).
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GePaRD - German Pharmacoepidemiological Research Database (Germany, holder: Leibniz institute BIPS): Pharmacoepidemiological research is predominantly conducted on the basis of large routine databases (secondary data). These databases facilitate the investigation of the utilization and safety of drugs, including vaccines, in real-world healthcare settings and the investigation of rare or delayed adverse events. In so-called PAS studies (Post-Approval Safety Studies), these databases are used to investigate the utilization and safety of newly approved drugs. They also provide important data for research on other healthcare services. Since 2004, BIPS has been working on the establishment and maintenance of the German Pharmacoepidemiological Research Database (short GePaRD). GePaRD is based on claims data from four statutory health insurance (SHI) providers in Germany and currently includes information on approximately 25 million persons who have been insured with one of the participating providers since 2004 or later. In addition to demographic data, GePaRD contains information on drug dispensations as well as outpatient (i.e., from general practitioners and specialists) and inpatient services and diagnoses. Per data year, there is information on approximately 20% of the general population and all geographical regions of Germany are represented.
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ARS Toscana database - Tuscany healthcare and public health database (Italy, holder: Agenzia Regionale di Sanita, ARS)
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