J Rheum Dis.  2021 Jul;28(3):119-125. 10.4078/jrd.2021.28.3.119.

Clinical Study Using Healthcare Claims Database

• Park JS
• Lee CH

• KMID: 2516947
• DOI: http://doi.org/10.4078/jrd.2021.28.3.119

Abstract

The healthcare claims database is a database created using claims data accumulated while operating the government’s health insurance system. The National Health Insurance Service (NHIS) provides benefits for health promotion, prevention, diagnosis, and disease and injury treatment, as well as for rehabilitation, birth, and death. Ninety-seven percent of the total population is enrolled in the NHIS; individuals pay a monthly insurance contribution to the system, and the NHIS pays a portion of the cost of reimbursement items to the medical institution when the subscriber receives medical services. In this process, the NHIS and Health Insurance Review Agency (HIRA) decide on payment, and claims data are documented items that medical institutions claim to these government agencies. The NHIS and HIRA have established a database to support policy and academic research, and they provide this database to researchers. Health claims data are representative of the nation, reflecting the actual medical environment. They also shorten the time and cost required for research and have several advantages as research data. However, studies should be conducted with an understanding of the limitations of claims data, a sufficient understanding of the characteristics of the Korean insurance system, and criteria for providing reimbursed services. Moreover, validating the healthcare claims database will facilitate more useful and reliable research.

Keyword

National health insurance; Rheumatology; Republic of Korea

Figure

• 

  Figure 1 The operational structure of the National Health Insurance system. MOHW: Ministry of Health and Welfare, NHIS: National Health Insurance Service, HIRA: Health Insurance Review and Assessment.

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  Figure 2 Publications of research using the health claims database. (A) Year-specific number of publications using the NHIS (2011∼2020) and Health Insurance Review and Assessment (HIRA) databases (2014∼2020). (B) Rheumatologic disease-specific number of publications using the NHIS (2011∼2020) and HIRA databases (2014∼2020). NHIS: National Health Insurance Service, RA: rheumatoid arthritis, AS: ankylosing spondylitis, OA: osteoarthritis, SJS: Sjögren’s syndrome.

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