Abstract
Health insurance claims data were almost fully computerized. The focus of interest has shifted from computerization to effective utilization of accumulated data. Unfortunately, however, the data format of health insurance claims remains as it was when health insurance claims were processed manually in paper form. Such obsolete data format has been a hindrance to effective utilization of the data. We examined the possibility to reform the present data format to better suit for data analysis. First, we propose a common format unifying medical, dental, pharmaceutical and DPC claims with each record including a patient ID as well as a provision date. Secondly, we propose a one-record format for clinical procedures, which consists of multiple records covering both procedure codes and extra-charge codes. In case of pharmaceutical claims, the dispensing data can be improved by expressing in drug units. Through our proposed revision of health insurance claims data format, the data will be suitable for effective analysis. This will enable the effective use of health insurance claims data for the fields already practiced in Korea. Some of Koreans' achievements such as measurement of health care quality as well as medical researches published in major international journals.
