DOI QR코드

DOI QR Code

입원 환자 표본 개발에 관한 연구: 국민건강보험 청구자료를 중심으로

Developing the Inpatient Sample for the National Health Insurance Claims Data

  • 김록영 (건강보험심사평가원) ;
  • 사공진 (한양대학교 경제학부) ;
  • 김윤 (건강보험심사평가원) ;
  • 김세라 (건강보험심사평가원) ;
  • 김수경 (건강보험심사평가원) ;
  • 최병호 (한국보건사회연구원) ;
  • 정형선 (연세대학교 보건행정학과) ;
  • 이태림 (한국방송통신대학교 정보통계학과)
  • Kim, Logyoung (Health Insurance Review and Assessment Service) ;
  • Sakong, Jin (Department of Economics, Hanyang University) ;
  • Kim, Yoon (Health Insurance Review and Assessment Service) ;
  • Kim, Sera (Health Insurance Review and Assessment Service) ;
  • Kim, Sookyeong (Health Insurance Review and Assessment Service) ;
  • Tchoe, Byongho (Korea Institute for Health and Social Affairs) ;
  • Jeong, Hyoungsun (Department of Health Administration, Yonsei University) ;
  • Lee, Taerim (Department of Information Statistics, Korea National Open University)
  • 투고 : 2013.02.27
  • 심사 : 2013.04.20
  • 발행 : 2013.06.30

초록

Korea has a single National Health Insurance program and all citizens are covered under this program, accounting 97% of the population, approximately 50 million people. Claims submitted by Health care providers are reviewed by Health Insurance Review and Assessment (HIRA) for the reimbursement. HIRA database contains not only individual beneficiary's information, but also healthcare service information such as diagnosis, procedures, prescriptions and tests for them. HRA database has gained attention as importance source for research due to its rich healthcare information and the demand of HIRA database has increased. Due to its tremendous size, however, researchers have had problems in accessing the database to conduct research. To meet this demand, we conducted a study to develop the inpatient sample data from HIRA database for research. This study has two purposes: 1) to determine a needed sample size; 2) to test reliability and validity of the sample data. We determined an adequate sample size to ensure representativeness and generality with additional consideration for convenience of calculation. The minimum sample size was 729,904 for the generality, and 488,861 for representativeness. After considering the convenience of calculation, our final sample size was 13% of the population, which was about 7.7 million beneficiaries. Age (5 years interval) and gender were used as stratification variables for sampling. In order to examine whether this sample data appropriately reflect population, we tested the reliability and validity of the sample data. From the sample data, we computed average expenditure of total claims per inpatient for 2011, frequency of top 30 disease, estimation of the number of stroke patients from the sample data, and then compared them to those from the population. Results confirmed reliability and validity of the sample data.

키워드

참고문헌

  1. National Health Research Institutes. Researches of National Health Insurance claim database [Internet]. Miaoli County: National Health Research Institutes [cited 2013 May 20]. Available from: http://www.nhri.org.tw.
  2. Agency for Healthcare Research and Quality. Design of the nationwide inpatient sample (NIS). Rockville (MD): Agency for Healthcare Research and Quality; 2005.
  3. Agency for Healthcare Research and Quality. Introduction to the HCUP nationwide inpatient sample (NIS). Rockville (MD): Agency for Healthcare Research and Quality; 2007.
  4. Health Insurance Review and Assessment Service. Guidelines for review and assessment for healthcare services of 2011. Seoul: Health Insurance Review and Assessment Service; 2011.
  5. Health Insurance Review and Assessment Service. Manual: management of healthcare providers. Seoul: Health Insurance Review and Assessment Service; 2011.
  6. Kim JY, Im JH, Kim HY. Development of risk adjustment and prediction methods for care episodes using National Health Insurance database. Seoul: Health Insurance Review and Assessment Service; 2007
  7. Park BJ, Seong JH, Park GD Seo SW Kim SH, Studying on improving diagnosis codes in National Health Insurance claims data. Seoul: Health Insurance Review and Assessment Service; 2003.
  8. Namkung P. Design and analysis of sample survey. 2nd ed. Seoul: Tamjin; 2007.

피인용 문헌

  1. Dramatic decrease in fluoroquinolones in the pediatric population in Korea vol.23, pp.12, 2014, https://doi.org/10.1002/pds.3696
  2. Prevalence and Predictors of Polypharmacy among Korean Elderly vol.9, pp.6, 2014, https://doi.org/10.1371/journal.pone.0098043
  3. Comparison of the Prescribing Pattern of Bisphosphonate and Raloxifene in Korean Women with Osteoporosis: From a National Health Insurance Claims Database vol.10, pp.6, 2015, https://doi.org/10.1371/journal.pone.0127970
  4. Finding the Primary Care Providers in the Specialist-Dominant Primary Care Setting of Korea: A Cluster Analysis vol.11, pp.8, 2016, https://doi.org/10.1371/journal.pone.0161937
  5. Pediatric fluoroquinolone prescription in South Korea before and after a regulatory intervention: A nationwide study, 2007-2015 vol.12, pp.5, 2017, https://doi.org/10.1371/journal.pone.0176420
  6. The Prevalence of Depression among Patients with the Top Ten Most Common Cancers in South Korea vol.14, pp.5, 2017, https://doi.org/10.4306/pi.2017.14.5.618
  7. Role of Preemptive Genotyping in Preventing Serious Adverse Drug Events in South Korean Patients vol.40, pp.1, 2017, https://doi.org/10.1007/s40264-016-0454-5
  8. High rate of systemic corticosteroid prescription among outpatient visits for psoriasis: A population-based epidemiological study using the Korean National Health Insurance database vol.44, pp.9, 2017, https://doi.org/10.1111/1346-8138.13862
  9. Benzodiazepine Use among Patients with Schizophrenia in Korea: Analysis of Database of Health Insurance Review Agency vol.56, pp.4, 2017, https://doi.org/10.4306/jknpa.2017.56.4.168
  10. Epidemiology and comorbidities of patients with chronic urticaria in Korea: A nationwide population-based study pp.03852407, 2017, https://doi.org/10.1111/1346-8138.14075
  11. Eleven-year Cumulative Incidence and Estimated Lifetime Prevalence of Urolithiasis in Korea: a National Health Insurance Service-National Sample Cohort Based Study vol.33, pp.2, 2018, https://doi.org/10.3346/jkms.2018.33.e13
  12. Evidence of a Broken Healthcare Delivery System in Korea: Unnecessary Hospital Outpatient Utilization among Patients with a Single Chronic Disease Without Complications vol.29, pp.12, 2014, https://doi.org/10.3346/jkms.2014.29.12.1590
  13. Prevalence of Antibiotic Use for Pediatric Acute Upper Respiratory Tract Infections in Korea vol.30, pp.5, 2015, https://doi.org/10.3346/jkms.2015.30.5.617
  14. Medical and Psychiatric Comorbidities in Korean Children and Adolescents with Attention-Deficit/Hyperactivity Disorder vol.14, pp.6, 2017, https://doi.org/10.4306/pi.2017.14.6.817
  15. Risk factors for relapse in patients with first-episode schizophrenia: Analysis of the Health Insurance Review and Assessment Service data from 2011 to 2015 vol.12, pp.1, 2018, https://doi.org/10.1186/s13033-018-0187-1
  16. Parkinson’s Disease as Risk Factor in Osteoporosis and Osteoporotic Vertebral Fracture : Prevalence Study Using National Inpatient Sample Database in Korea vol.62, pp.1, 2019, https://doi.org/10.3340/jkns.2018.0012