Administrative Claims Datasets in South Korea and Japan: A Comparative Assessment Based on Extensive Practical Experience
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The administrative claims datasets refer to the data that occurs when healthcare providers claim ser- vices and items of care rendered to patients from payers. The purpose of this study is to review and compare the characteristics and differences of the administrative claims data in South Korea and Ja- pan. We compared the differences of claims data and examined the utilization of the data based on the hands-on experience of analyzing the data in both countries. The structure of claims data of both countries are comparable since they originated from similar health insurance systems in general. However, there also exist some differences: 1) institution in charge of managing claims data, 2) data access, and 3) data component. First, while the claims data in South Korea are only constructed and operated by National Health Insurance Service and Health Insurance Review and Assessment Ser- vice, those in Japan are constructed not only Ministry of Health, Labor and Welfare but also local governments, academic societies or private entities. Second, in Japan, only government officials or academic societies members can have access to the claims data while other stakeholders can access data that are constructed by private entities but not nationally representative. However, private sector is allowed to access the claims data with public Institutional Review Boards in South Korea. Lastly, unlike Korea, the Diagnosis Procedure Combination database in Japan has a unique characteristic that contains important clinical outcomes and can be analyzed together with claims data. Generating robust research using real-world datasets such as claims, clinical and Electronic Medical Records data is emerging. Based on the review of this study, to enable researchers to perform extensive re- search projects, policies on the use and management of medical big data need to be developed and strengthened.
Abstract
The administrative claims datasets refer to the data that occurs when healthcare providers claim ser- vices and items of care rendered to patients from payers. The purpose of this study is to review and compare the characteristics and differences of the administrative claims data in South Korea and Ja- pan. We compared the differences of claims data and examined the utilization of the data based on the hands-on experience of analyzing the data in both countries. The structure of claims data of both countries are comparable since they originated from similar health insurance systems in general. However, there also exist some differences: 1) institution in charge of managing claims data, 2) data access, and 3) data component. First, while the claims data in South Korea are only constructed and operated by National Health Insurance Service and Health Insurance Review and Assessment Ser- vice, those in Japan are constructed not only Ministry of Health, Labor and Welfare but also local governments, academic societies or private entities. Second, in Japan, only government officials or academic societies members can have access to the claims data while other stakeholders can access data that are constructed by private entities but not nationally representative. However, private sector is allowed to access the claims data with public Institutional Review Boards in South Korea. Lastly, unlike Korea, the Diagnosis Procedure Combination database in Japan has a unique characteristic that contains important clinical outcomes and can be analyzed together with claims data. Generating robust research using real-world datasets such as claims, clinical and Electronic Medical Records data is emerging. Based on the review of this study, to enable researchers to perform extensive re- search projects, policies on the use and management of medical big data need to be developed and strengthened.
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