Healthcare Utilization Monitoring System in Korea / 대한의료정보학회지
Healthcare Informatics Research
; : 184-190, 2015.
Artigo
em Inglês
| WPRIM (Pacífico Ocidental)
| ID: wpr-34680
Biblioteca responsável:
WPRO
ABSTRACT
OBJECTIVES:
It is important to monitor the healthcare utilization of patients at the national level to make evidence-based policy decisions and manage the nation's healthcare sector. The Health Insurance Review & Assessment Service (HIRA) has run a Healthcare Utilization Monitoring System (HUMS) since 2008. The objective of this paper is to introduce HIRA's HUMS.METHODS:
This study described the HUMS's system structure, capacity, functionalities, and output formats run by HIRA in the Republic of Korea. Regarding output formats, this study extracted diabetes related health insurance claims through the HUMS from August 1, 2014 to May 31, 2015.RESULTS:
The HUMS has kept records of health insurance claim data for 4 years. It has a 14-terabyte hardware capacity and employs several easy-to-use programs for maintenance of the system, such as MSTR, SAS, etc. Regarding functionalities, users should input diseases codes, target periods, facility types, and types of attributes, such as the number of healthcare utilizations or healthcare costs. It also has a functionality to predict healthcare utilization and costs. When this study extracted diabetes related data, it was found that the trend of healthcare costs for the treatment of diabetes and the number of patients with diabetes were increasing.CONCLUSIONS:
HIRA's HUMS works well to monitor healthcare utilization of patients at the national level. The HUMS has a high-capacity hardware infrastructure and several operational programs that allows easy access to summaries as well as details to identify contributing factors for abnormality, but it has a limitation in that there is often a time lag between the provision of healthcare to patients and the filing of health claims.
Texto completo:
Disponível
Contexto em Saúde:
Agenda de Saúde Sustentável para as Américas
Problema de saúde:
Objetivo 4: Financiamento para a saúde
Base de dados:
WPRIM (Pacífico Ocidental)
Assunto principal:
Informática Médica
/
Custos de Cuidados de Saúde
/
Setor de Assistência à Saúde
/
Atenção à Saúde
/
Informática
/
República da Coreia
/
Pesquisa sobre Serviços de Saúde
/
Seguro Saúde
/
Coreia (Geográfico)
Tipo de estudo:
Estudo prognóstico
Aspecto:
Determinantes sociais da saúde
/
Pesquisa de implementação
Limite:
Humanos
País/Região como assunto:
Ásia
Idioma:
Inglês
Revista:
Healthcare Informatics Research
Ano de publicação:
2015
Tipo de documento:
Artigo