Development of Integrated Analysis System of Medical and LTCI Claim Data in Japan

Abstract

As the Japanese health services are provided under the different scheme, it is relatively difficult to analyze the data by an integrated way. In order to ameliorate this situation, we have developed a model system for integrated analysis of health insurance claim, the long term care insurance claim and the disease management data. We used the National Health Insurance claim data (medical services and pharmaceuticals), the LTCI claim data and the lab-data of disease management program of a local town of Fukuoka prefecture. The data is one month’s data September 2009. We have developed a SQL program to combine above mentioned data by the individual client basis. Using a set of combined data, we have examined total expenditures stratified by age category, diagnosis, and existence of obesity. There are several interesting results obtained. Female dominantly used the LTCI services after 70 yr old but male always used health insurance covered services compared with those covered by the LTCI scheme. For the health insurance expenditures, neurological disorders were important for female and the respiratory disorders and the disorder of digestive system, hepato-billiary system and pancreas were dominant for male. The present study clarified the usefulness of integrated evaluating system of claim data. However there are some problems to be solved; creation of unique ID, coding of multiple diagnosis, and enrolment of nationally defined format of each claim.