Based on the Fee-For-Service tariff system, Japan has developed the National Database (NDB) that registers all health care insurance claims. Compared with the similar databases of other countries, NDB has more detailed data, i.e., insurer’s code, insured ID number, diagnoses, age, sex, date of consultation for out-patient service, date of admission, date of discharge, procedures and drugs provided with information of date, volume and tariff. Annually more than 1,700 million records are registered into NDB. In this article, the authors will explain the detail of NDB and its future.

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In Japan, Regional Health Care Plan (RHCP) is established every 5 years that defines health care region, regulates the health resources and intends to coordinate the health services. It requires the concrete data for actual and future situation. In order to ameliorate the quality of RHCP, we have tried to describe the actual situation of health service delivery for cerebral infarction in Fukuoka prefecture, based on the nationally accumulated claim database, so called National Database (NDB). For this analysis, we have used the one month data (October, 2010) of Fukuoka prefecture. This dataset contains the about 1,500,000 claim data. The ID number was hashed twice in order to make it anonymous. Using this dataset, we have conducted in- and out-flow analyses of the cerebral infarction patients for each of 13 HCRs of Fukuoka. In the case of acute in-patient care, six HCRs (Fukuoka-Itoshima, Nogata-Kurate, Kitakyushu, Chikushi, Yame-Chikugo and Ariake) showed more than 80% self-completion rate, that is, more than 80% of patient who live in these areas receive the acute in-hospital services at the hospital of their residential areas. On the other hand, sub-acute care beds were in shortage in some HCR such as Iizuka. The present study has clarified the usefulness of NDB for describing the disease structure of each HCR. Using this kind of information, policy makers can formulate a more practical health care plan.

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In order to construct an appropriate health care region for the psychiatric medicine, we have analyzed the care received area of psychiatric patients of Fukuoka prefecture based on the National database that the Ministry of Health, Labour and Welfare has constructed using all the claim data. We have used 56,743 psychiatric cases from 1,288,273 claim data of July 2010 of Fukuoka prefecture. After converting the insurer’s code and institution code to health care region number (corresponding to patients living area and institution’s location, respectively), we have analyzed the care received area of patients stratified by in- and out-patient services and age category. In addition, the care received area was analyzed for psychiatric emergency care and home care, respectively. The present analysis clarified that the both in- and out-patient psychiatric care were provided within the health care region in most of the cases. However, the psychiatric emergency care was not self-completed. In order to construct an appropriate health care plan for psychiatric care, the national database is the important information.

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Based on the aggregate indicators extracted from the National Database (NDB) that is constructed by the Ministry of Health, Labour and Welfare (MHLW) based on all the claim data of health insurance, we have investigated factors associated with mortality of cerebral infarction in Japan. According to the result of multiple regression analysis, SCR of ICU care (regression coefficient = −0.012), number of neuro-surgeon per 100,000 inhabitants (coefficient = −0.356), number of physiotherapist per 100,000 inhabitants (−0.043) and average emergency transfer distance of cerebral infarction case (0.449) have been detected as factors with statistical significance. The finding has indicated that the health care delivery condition might influence the mortality of cerebral infarction. If it is true, the health policy makers and health care providers must do effort in order to ameliorate this situation. It is an important challenge how to strengthen the effectiveness of Regional Health Care Plan.

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