HIRA

항생제 사례로 살펴본 건강보험청구자료 분석 시 고려사항

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Type
Perspective
Author(s)
김예슬채정미신지혜김유정조가영지승연김동숙
Issued Date
2023-11-30
Keyword
Health administrative dataHealth Insurance Review and Assessment ServiceDrugsAntibiotics
Abstract
The Health Insurance Review & Assessment Service (HIRA) collects and stores medical information of all citizens and medical institutions, including pharmaceutical claims data. Claims data including consultation notes and information about the medical institution are submitted to the HIRA by medical providers. Claims data have potential to offer a high quality for research, but various factors must be strongly considered in its analysis and interpretation. This study highlights various points to be considered while utilizing claims data. First, the time period between a claims review and loading of the data onto a data warehouse (DW) must be taken into account because over 99% of claims are available on DW for extraction after 5 months, according to an analysis of claims rate for pharmaceutical expenses. Second, over 50% of pharmaceutical claims data consists of reimbursable items, of which over 99% are antimicrobial medications. Accurate determination of the precise usage of nonreimbursable pharmaceuticals is limited to estimations based on the data on pharmaceutical supply declaration, which is only partially reported on claims statements as part of the comprehensive fees system. Finally, complete data on the use of pharmaceuticals during inpatient admission is unavailable. Due to the lack of requirement to input the administration time or to differentiate prescriptions on the day of discharge, it is difficult to accurately calculate the used amounts. These factors must be considered prior to analysis and interpretation of claims data from the HIRA. Hence, to ensure a higher research quality, we recommend considering these factors when conducting a claims data-based research.
Publisher
심사평가연구소
DOI
10.52937/hira.23.3.2.e5
URI
https://repository.hira.or.kr/handle/2019.oak/3178
Alternative Title
Considerations in Analyzing Health Insurance Claims Data Using Antibiotic Cases
Publisher
심사평가연구소
Location
KOR
p-ISSN
2765-6764
e-ISSN
2765-7353
Appears in Collections:
HIRA 발간 > 1. HIRA Research
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