Healthc Inform Res.  2015 Jul;21(3):184-190. 10.4258/hir.2015.21.3.184.

Healthcare Utilization Monitoring System in Korea

• Shin HC
• Park YT
• Lee YT
• Jo EC

• KMID: 2125187
• DOI: http://doi.org/10.4258/hir.2015.21.3.184

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.

Keyword

Health Care Costs; Health Services Research; Informatics; Medical Informatics

MeSH Terms

Delivery of Health Care*
Health Care Costs
Health Care Sector
Health Services Research
Humans
Informatics
Insurance, Health
Korea*
Medical Informatics
Republic of Korea

Figure

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  Figure 1 System structure. HUMS: Healthcare Utilization Monitoring System, OLAP: online analytical processing.

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  Figure 2 Network structure. HUMS: Healthcare Utilization Monitoring System, OLAP: online analytical processing.

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  Figure 3 Main search screen format of Healthcare Utilization Monitoring System (HUMS).

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  Figure 4 A main screen of Healthcare Utilization Monitoring System (HUMS).

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  Figure 5 Healthcare costs by the three-digit disease codes.

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  Figure 6 Total amount of healthcare costs by the type of care facilities.

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  Figure 7 Output results of total healthcare monitoring screen of Healthcare Utilization Monitoring System (HUMS).

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