Development of Analysis System Connecting Healthcare and Long Term Care Insurance Claim Data and Specified Health Checkup Data

Shinya Matsuda and Yoshihisa Fujino
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Shinya Matsuda: Professor, Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health
Yoshihisa Fujino: Associate Professor, Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health

Public Policy Review, 2015, vol. 11, issue 5, 659-684

Abstract: In order to provide high-quality healthcare and long-term care services in a comprehensive manner despite constraints such as the aging of society coupled with the low birthrate and weak economic growth, it is essential to collect comprehensive information that enables systematic provision of such services. From this perspective, in Fukuoka Prefecture and other local governments in Japan, the authors have been building a system for analyzing claim data for national healthcare insurance (healthcare services and prescription), the healthcare system for people aged 75 or older (healthcare services and prescription), claim data for long-term care benefits and specified health checkup data by linking them with each other with regard to each insured individual. As example cases of use of this system, this paper introduces readers to a structural analysis of the costs of healthcare and long-term care benefits, the economic benefits of the use of generic drugs in place of patented drugs, the application of specified health checkup data to marketing and a cost-benefit analysis of a pneumococcus vaccine. Claim data submitted to insured persons by medical and long-term care institutions are excellent sources of medical information. As of April 2014, 99.9% of prescription claims were computerized. The computerization rate of medical service claim data came to 98.9% at hospitals and 96.9% at clinics. Claim data can be used as a source of big data containing detailed information concerning medical practices conducted in medical consultations and prescribed medication. This constitutes an important infrastructure that is useful when we consider the future of healthcare in an aged society, so there are high expectations for appropriate use of it.

Date: 2015
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