2023 Volume 42 Issue 5 Pages 217-225
Accurate identity verification is important for utilizing claim information. Identification is essential to reliable research using claim database. In this study, we have developed a new logic that enables accurate identity verification not affected by the change of insurers without the use of name-based IDs. We used the KDB data of Nara Prefecture covering 7 years of health insurance claims for hospitalization, outpatient and DPC. We have generated “New ID”, which is the combination of birth year/month, sex, diagnosis-related codes, and diagnosis dates. The ledger ID based on the insurer ledger held by the Nara Prefectural National Insurance Association was used for the validation of this logic. The personal IDs linked to other personal IDs by the ledger ID and have outpatient claims from the same medical institution were validated. The number of the target ledger IDs was 69,988 and the total number of possible combinations of personal IDs was 9,796,570,300. The number of true positives was 62,643 and the number of false negatives was 7,345. The validation resulted in a sensitivity of 0.90, a specificity of 1.00, a positive predictive value of 0.99, and a negative predictive value of 1.00. In addition, the number of incorrect identification cases was 0.47 per billion. In the future, even if new medical IDs are established, this logic can identify the same individuals not given the new IDs from accumulated claim data.
