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http://dx.doi.org/10.4332/KJHPA.2014.24.4.322

A Comparative Study of the Disease Codes between Korean National Health Insurance Claims and Korean National Hospital Discharge In-Depth Injury Survey  

Bae, Soon-Og (Department of Health Information and Management, Chungbuk National University College of Medicine)
Kang, Gil-Won (Department of Health Information and Management, Chungbuk National University College of Medicine)
Publication Information
Health Policy and Management / v.24, no.4, 2014 , pp. 322-329 More about this Journal
Abstract
Background: As most of people in Korea are covered by National Health Insurance (NHI), the disease information collected in NHI provides high availability for health policy. Nevertheless, the validity of disease codes in NHI data has been controversial till now. So we tried to evaluate the validity of them by comparing the NHI claims data with Korean National Hospital Discharge In-depth Injury Survey (KNHDIIS) data. Methods: We compared the NHI patients sample data (2009) with the KNHDIIS data (2009). We selected the inpatient data of KNHDIIS and NHI patients sample. The weighted number of patients from NHI patients sample was 5,551,210 and the number of patients from KNHDIIS was 5,559,874. We classified the disease codes into principal diagnoses and other diagnoses, and we compared as one, two, three unit level. Also we calculated the agreement rate of each of them. Results: In the comparison of principal diagnoses, NHI claims data had more C code than KNHDIIS data did, whereas KNHDIIS data had more Z code than NHI claims data did. In the comparison of other diagnoses, NHI claims data had 2, 3 more codes than KNHDIIS data did. The overall agreement rate at three unit level was 76.5% in principal diagnoses and 46.8% in other diagnoses. Conclusion: Considering the large difference between the two data, the validity of disease codes in NHI Claims data seems to be low. To increase the validity of them, the definite detail coding indicator, the reinforcement of coding education, and the reform of system are needed.
Keywords
Coding; Health insurance; National hospital discharge survey;
Citations & Related Records
Times Cited By KSCI : 2  (Citation Analysis)
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1 Health Insurance Review and Assessment Service. News letter of 2014. Seoul: Health Insurance Review and Assessment Service; 2014.
2 Statistics Korea. Coding guidance of Korean standard classification of diseases. Daejeon: Statistics Korea; 2012.
3 Lee GS. Diagnosis coding agreement between medical records and medical claim billing data [master's thesis]. Seoul: Seoul National University; 1995.
4 Shin JY. A Comparision study of diagnosis code in both medical records and medical claim bills for same discharge patient: focused on the inpatient 10 frequent diseases. J Eulji Univ 1996;16(1):121-136.
5 Park BJ, Suh SW, Sung JH, Paerk GD, Kim SH. Improvement plan for validity of health insurance disease code and establishment of data application plan, 2002. Seoul: Health Insurance Review Agency Research Service; 2003.
6 Shin E, Park YM, Park YG, Kim BS, Park KD, Meng KH. Estimation of disease code accuracy of national medical insurance data and the related factors. Korean J Prev Med 1998;31(3):471-480.   과학기술학회마을
7 Suh SW, Kim KH, Pu YK, Suh JS, Park WS, Yoon JY, et al. Evaluation of current coding practices in 3 university hospitals. J Korean Soc Qual Assur Health Care 2002;9(1):52-64.   과학기술학회마을
8 Park JK, Kim KS, Kim CB, Lee TY, Lee KS, Lee DH, et al. The accuracy of ICD codes for cerebrovascular diseases in medical insurance claims. Korean J Prev Med 2000;33(1):76-82.   과학기술학회마을
9 Lee KS, Park JH, Kang SH. A study on the principal diagnosis agreement in a general hospital. J Health Inf Manag 2008;18(9):127-151.
10 Cho EH, Cho HK, Kang SN. A comparative study on the coincidence rate of disease classification codes between medical record department and health insurance claim. J Health Inf Manag 2010;21(7):65-73.
11 Ahn JH. Analysis of agreement status between the diagnostic code of health insurance claim [master's thesis]. Busan: Inje University; 2002.
12 Health Insurance Review and Assessment Service. 2009 direction and primary objects of medical fee review [Internet]. Seoul: Health Insurance Review and Assessment Service: 2009 [cited 2014 Apr 20]. Available from: http://www.hira.or.kr/cms/notice/.
13 Im LY, Sakong J, Kim Y, Kim SR, Kim SK, Choe BH, et al. Developing the inpatient sample for the national health insurance claims data. Health Policy Manag 2013;23(2):152-161. DOI: http://dx.doi.org/10.4332/kjhpa.2013.23.2.152   과학기술학회마을   DOI
14 Moon OR, Kim CY, Kim MK. Individual variations in the code of the international classification of disease for similar outpatient conditions among general practitioners. Korean J Health Policy Admin 1992;2(1):66-79.   과학기술학회마을
15 Bae SO. Comparison of ago and after by principal diagnosis concordance elevation program enforcement in a general hospital discharge [master's thesis]. Daejeon: Chungnam National University; 2010.