Journal of the National Institute of Public Health2013 Vol.62 No.1 p.3−12

Topics：Strategic management of evidence-based health and medical care policy: How to use new Digital Big Data in health care system＜Review＞
Evaluation of demand for medical care services, quality of health careand health policy by using electronic claims data
Toshiro KUMAKAWA, Koichi OTSUBO, Yoshimune HIRATSUKA, Etsuji OKAMOTO
Department of Health and Welfare Service, National Institute of Public Health
Abstract
The primary purpose of receipts are for use in insurance claims, and recently electronic healthinsurance receipts are being used for insurance claims. Electronic claims data include personal
information such as the patient’s name, gender, and date of birth, patient health insurance information,
the name of the medical institution sending the bill, the department, the name of the disease, and points
on medication, injection, procedures, surgeries, examinations, imaging, rehabilitation, and so on. It is
technically possible to evaluate demand for medical care services by the field, quality of health care, andhealth policy by using electronic claims data. Although such infrastructure needs to be systematic andefficient to be capable of supporting linkages among data sources and to provide appropriate protectionof the privacy and confidentiality of health information, we have to embrace the new electronic big datain order to promote evidence-based health policies and planning and to improve the quality of healthcare.
keywords: electronic claims date, big date, demand for medical care services, guality of health care,health policy(accepted for publication, 28th December 2012)I.

The Japanese Health Care System and
Health care policy

The central concerns of the Japanese health care system
immediately after the end of World War II in 1945 were
infections and other acute diseases, and the Medical
Service Act was therefore passed in 1948. The initial aim of
this law was to ensure the existence of a sufficient numberof hospitals, especially public hospitals and other public
medical institutions [1].
The Japanese health insurance system was established in1961 with a free-access system, allowing anyone withinsurance to be examined and treated at any medical
institution in Japan. In addition, the payment rate of Japan’snational health insurance increased (i.e. the proportion of
medical expenses that people had to pay themselves

decreased), facilitating examination and treatment at
medical institutions. The system also allowed medical
institutions to be opened freely. At the same time as thesedevelopments, the Japanese economy greatly expanded,and there was therefore a great increase in the numbers ofboth public and private medical institutions [1].
In 1973 a policy of free health care provision for elderly
people was established, and the rate of treatment of elderly
people then greatly increased, which, together with theaging of society, has resulted in a marked increase in the
proportion of Japanese medical expenses taken up by theelderly. The nursing care system for supporting elderly
people to lead independent lives is quantitatively
insufficient, and furthermore, nursing care is provided inaccordance with a placement system; as a result of this,between 1975 and 1985 the number of hospitals and clinics
treating elderly people whose families found it difficult to

Corresponding author: Toshiro Kumakawa
2-3-6, Minami, Wako-shi, Saitama, 351-0197, Japan.
Fax: +81-48-468-7985
E-mail: kuma@niph.go.jp

J. Natl. Inst. Public Health, 62（1）: 20133

Toshiro KUMAKAWA, Koichi OTSUBO, Yoshimune HIRATSUKA, Etsuji OKAMOTO

look after them, including people for whom hospitaltreatment was not really necessary, increased.
Despite the marked increase in the number of hospitals,
no system previously existed to control the location of
hospitals, and there was a tendency for hospitals to beconcentrated in prefectural capitals and other large cities.
However, in the first reform of the Medical Service Act in
1985, a prefectural health care planning system wasintroduced, including a hospital-bed regulation system. In
this system, in principle, new hospitals could not be opened
in regions that already had more than a specified number ofhospital beds. This put an end to the previous frantic rush
to increase the number of hospital beds and has acted as abrake on the increase in the number of hospitals andhospital beds.
The second, third, and fourth reforms of the Medical
Service Act, in 1992, 1997, and 2000, respectively, extended
the specialization of and cooperation between health carefunctions. The second reform involved establishment of a
specific-function hospital system as well as long-term carewards; the third reform involved abolition of the general
hospital system and establishment of the regional-medicinesupport hospital system; and the fourth reform involved
categorization of hospital beds as being for either generaluse or long-term care. In addition, on the basis of changes
in Japanese people’s ideas about medical treatment, therules about advertising have been relaxed, and issues suchas the relationship to laws about informed consent havebeen reconsidered from patients’ points of view.
The WHO’s World Health Report adopted “The Health
System” as its theme for 2000. The report compared andranked health systems in 191 WHO member nations using

five criteria: (1) healthy life expectancy and (2) regional
difference in the infant mortality rate, concerning “Health
Attainment,” (3) health care satisfaction level and (4)fairness in access, concerning “Responsiveness to Public
Expectation,” and (5) fairness in financial contribution.
Japan’s health system won first place in the overall ranking
of 191 WHO member nations [2].
The fifth reform of the Medical Service Act in 2006
involved reevaluation of the health care planning system inorder to progress with the liaison system for regional
health care, and it also involved disclosure of information
relating to the functions of medical institutions. There is no
doubt from a global perspective that the Japanese healthcare system and health care policy had efficiently achieved
significant results in the late 20th century (see fig. 1).

II. Characteristics of the Japanese healthcare system
The health care system is divisible into two structures:finance (the medical insurance system), for resourcing
costs and making payments; and delivery (the medical
service regime), for delivering services [3].
The medical finance system of major nations is broadly
divided into three systems: First, the type in which medical
costs are covered by a social insurance system; Japan,
Germany, and France fall into this category. Second, thetype in which the public sector directly delivers medical
services financed by taxes; the United Kingdom andSweden are in this category. Third, the type in which thedispersion of medical-cost risk is basically covered by a
private insurance system; a prime example of this is theFig. 1 Japanese Health Care System and Health care policy

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Evaluation of demand for medical care services, quality of health care and health policy by using electronic claims data

United States. In the United States, they do not have apublicly operated health care cost security plan, except for
Medicare, which is for the elderly, and Medicaid, for lowincome earners [4].
In Japan, the health-insurance system that covers all
citizens is put into practice in a dual system: employees’
health insurance and regional social insurance. The
country’s system works this way: under the National Health
Insurance Act, anyone who resides in a municipality musttake out National Health Insurance on a mandatory
basis, and their insurer is their municipal government;
people who can be insured by employees’ insurance are
exempted [3, 5].
Most medical institutions in Japan consist of privatesector corporations. Publicly operated institutions, such as
national and public hospitals and public medical facilities,
account for only 30.3% of all the beds for patients and 14.6%
of all the facilities as of 2011 [6]. European and American
hospitals are generally large in scale, and the clinics usually
do not have beds, but in Japan the scale of facilities varies ina continuous manner-large hospitals, small and mediumsize hospitals, clinics with beds, and clinics with no beds
[6]. Another special characteristic of the Japanese healthcare system is an unrestrained private-practice system for
doctors, a free-access system with no gatekeepers forpatients, and a fee-for-service system [7].
Each factor of the characteristics of the Japanese healthcare system works toward the direction of expansion andthe spread of medical costs: universal health insurance
coverage, an unrestrained private-practice system, a freeaccess system to any health care facility, and a fee-forservice system. Nevertheless, the portion of GDP

accounted for by medical costs has been small among theadvanced nations. The OECD average of total medical
expenditure as a percentage of GDP was 9.5%, and in 2010that of Japan was the same, 9.5% [8, 9]. This is due touniversal health insurance coverage and the medical
service fees system.
Medical service fees are the fees received by medical
institutions and pharmacies serving an insured person as
the price of insured medical services. Those aredetermined by the Minister of Health, Labour, and Welfare
based on discussions of the Central Social Insurance
Medical Council (appointed by the Minister of Health,Labour, and Welfare). Contents of medical service fees arean evaluation of technologies and services and anevaluation of the price of materials [10]. In Japan, 99% of thehealth care facilities are authorized insurance medical
institutions, and in particular most private hospitals depend
solely on the medical services fees paid by the insurance
system for their management funds. Therefore, revising therate of an amount paid for a medical service fee can make itpossible to control the overall sum of health care costs.
This is a kind of quasi-budgetary system.

III. Evaluation of demand for medical careservices by using electronic claims data
The City of Sapporo had a population of 1,904,903 as ofApril 2010, of whom 461,426 are beneficiaries of the city’s
National Health Insurance program of the city (those underage 75), and 183,772 of whom are beneficiaries of the
Health Care System for the Elderly, who are either age 75
or older plus those age 65 to 74 with a disability (such as

Table １ Ｎumber of the patients visited medical institutions (April, 2010)

J. Natl. Inst. Public Health, 62（1）: 20135

Toshiro KUMAKAWA, Koichi OTSUBO, Yoshimune HIRATSUKA, Etsuji OKAMOTO

renal failure). There were a total of 13,835 hospitalization
episodes reimbursed by DPC and 96,206 hospitalization
episodes of non-DPC (these counts overlap because somepeople are hospitalized more than once in a year). There
were a total of 685,300 unique numbers of beneficiaries who
visit hospitals or clinics at least once in a year.
Electronic outpatient medical claims were analyzed using
the diagnostic records (SY records). Since health insurance
claims typically contain multiple diagnoses, one insurance
claim contains more than one SY record. SY records also
contain flags for primary diagnoses and rule-out diagnoses.
In this analysis, rule-out diagnoses were excluded, andthose designated as primary diagnoses were used. Only
one primary diagnosis should be assigned in a claim.
However, there were some claims in which more than one
diagnosis were designated as primary diagnoses. Hencethe number in the table has duplicate counts. Sapporo has
10 wards. Table 1 shows the number of patients who visited
medical institutions in April 2010 according to area [11].
The situation within the medical care cooperation area inthe region (within a city, ward, etc.), that is, the areas
where people live and where medical institutions thatpeople visit and are located, along with an indication of thesatisfaction with the service (self-sufficiency rate) within
the area where patients live, can be presented byintegrating and analyzing medical institution information(the medical institution’s address), insurer information (thepatient’s address), and treatment information, which areincluded in electronic claims.
Figure 2 shows the medical institution’s address, thepatient’s address, and self-sufficiency percentage forpediatric patients who were admitted to hospital, and figure
3 shows those for pediatric patients who were visited as
outpatients in April 2010. The same table can be created forother different diseases [11]. This study was conducted bycontract with the City of Sapporo in accordance with its
Privacy Protection Ordinance. Personal identifiers werecoded by the city and released to the authors under asecurity agreement.

Fig. 2 Admission to hospitals of pediatric patients (April, 2010)

Fig. 3 Outpatient visits of pediatric patients (April, 2010)

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J. Natl. Inst. Public Health, 62（1）: 2013

Evaluation of demand for medical care services, quality of health care and health policy by using electronic claims data

IV. Evaluation of the quality of health careby using electronic claims data
The October 2010 Meeting of Health Ministers and Forumon Health Care Quality included discussion of theimportance of well-functioning national information
infrastructure to improve indications of health care quality.
In December 2010 the health committee endorsed further
work to support development of health information systems
to provide internationally comparable measures of healthcare quality.
In May 2011 the HCQI Expert Group agreed toundertake two studies. The first explored the potential, thebarriers, and good practices in the linkage of personal
health data for public health and health service research.
The second explored national electronic health record(HER) systems designs and implementation that enable
HER data to produce health care quality indicators [12].
Six indicators of the quality of prescribing in primarycare are proposed: 1 (a) overall volume of antibiotics
prescribed, 1 (b) volume of cephalosporins and quinolones
as a proportion of all antibiotics prescribed, 2 (a) adequate
use of cholesterol-lowering treatments in diabetic patients,
2 (b) use of recommended antihypertensives in diabetic
patients, 3 (a) chronic use of benzodiazepines in adults overage 65, and 3 (b) use of long-acting benzodiazepines inadults over age 65 [13].
The overall volume of antibiotics prescribed and thevolume of cephalosporins as a proportion of all antibiotics
prescribed were evaluated by using electronic claims dataof the City of Mishima in Shizuoka Prefecture. The City ofMishima had a population of 112,000 as of April 2012, ofwhom 32,500 are beneficiaries of the city’s National Health
Insurance program (those under age 75).

Drug records (designated as IY, for iyakuhin) anddispensing records (designated/as CZ, for chozai) of
pharmacy claims covering 12 months (November 2011October 2012) were used. IY records contain drug codesand dosage, and CZ records contain the number of days
dispensed for one prescription. For example, in the case oforal medication, for a prescription that 3 tablets of drug A
should be taken daily for two weeks, IY records contain the
drug code of drug A and “3” as the dosage, and CZ records
contain “14” as the number of days dispensed. IY records
and CZ records were merged for the same patient and thesame prescription, and the number of days was totaled. For
example, if a patient gets two series of the sameprescription from the same pharmacy, the number of days
dispensed were totaled as “28.”IY records are joined with the drug master file containing
drug prices, the Yakka Kijun code (called YJ code). The
first four digits of the YJ code-designated drug classificationof the Japan Standard Commodity Classification systemwere used for analysis. Cephem antibiotics were designated“6132.” The drug amount was calculated by multiplying thedosage by the number of days. In the case above, 3×28 =84, the number of tablets the patient was dispensed by thepharmacy in a given month. Drug cost was calculated bymultiplying the drug amount by the drug price taken fromthe drug master file. If the price of drug A is 10 yen pertablet, then the drug cost of this pharmacy claim iscalculated as 84×10 = 840 yen. The drug amount and drug
cost were calculated by adding the amount and cost by eachdrug class.
Table 2 and figure 4 show the overall volume ofantibiotics prescribed and the volume of cephalosporins as
a proportion of all antibiotics prescribed for one year in theCity of Mishima. Table 3 and figure 5 show the overall costof antibiotics prescribed and the volume of cephalosporins

Table 2 Overall volume of antibiotics prescribed
CephemAntibiotics%Cephem/AB

Nov-11

245,314

1,429,558

17.2%

Dec

271,448

1,179,825

23.0%

Jan-12245,591

1,385,668

17.7%

Feb

311,998

1,288,631

24.2%

Mar

302,461

1,508,676

20.0%

Apr

227,913

1,067,361

21.4%

May

319,579

1,383,410

23.1%

Jun

233,232

1,203,022

19.4%

Jul

266,510

1,261,398

21.1%

Aug

245,877

1,353,413

18.2%

Sep

265,289

1,269,488

20.9%

Oct

296,293

1,491,941

19.9%

J. Natl. Inst. Public Health, 62（1）: 20137

Toshiro KUMAKAWA, Koichi OTSUBO, Yoshimune HIRATSUKA, Etsuji OKAMOTO

as a proportion of all antibiotics prescribed for one year in
the City of Mishima. This study was conducted by contract
with the City of Mishima in accordance with its Privacy

Protection Ordinance. Personal identifiers were coded by
the city and released to the authors under a security
agreement.

Table 3 Overall cost of antibiotics prescribed
CephemAntibiotics%Cephem/AB

Nov-11

461,975

2,784,202

16.6%

Dec

544,960

2,364,598

23.0%

Jan-12

482,196

2,710,312

17.8%

Feb

577,487

2,910,876

19.8%

Mar

551,245

3,032,809

18.2%

Apr

420,5032,204,858

19.1%

May

531,4942,598,525

20.5%

Jun

394,9392,443,219

16.2%

Jul

476,001

2,207,281

21.6%

Aug

420,280

2,512,736

16.7%

Sep

464,0632,546,558

18.2%

Oct

567,038

2,794,437

20.3%

Fig. 4 Changes of the volume of the cephem antibiotic prescribed

Fig. 5 Changes of the cost of the cephem antibiotic prescribed

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Evaluation of demand for medical care services, quality of health care and health policy by using electronic claims dataV.

Evaluation of health policy by using
electronic claims data

For the purpose of reducing drug costs throughencouraging generic prescriptions, the “generic nameprescription surcharge” was introduced as part of therevision of the national uniform fee schedule in April 2012.
Prescription by generic name is not mandatory. The
premium is applicable when one of the drug items isprescribed with the generic name. The cost-effectiveness ofthe newly introduced generic name prescription surcharge
was evaluated using electronic health insurance claims.
Drug records (designated as IY, for iyakuhin) anddispensing records (designated as CZ, for chozai) of
pharmacy claims covering 12 months (November 2011October 2012) were used. Table 4 shows the number ofgeneric drugs prescribed, and figure 6 shows the changes
in the number of generic drugs prescribed. Table 5 shows
the cost of generic drugs prescribed, and figure 7 shows
the changes in the cost of generic drugs prescribed.
Medical and pharmacy claims submitted to the City ofMishima for services rendered in March and April 2012were matched by coded personal identifier as well as
provider’s ID. Patients for whom the generic nameprescription surcharge was claimed and dispensing receipts
based on prescriptions from medical institutions werecompared between March and April 2012 to analyze costeffectiveness. For the period of two months, March andApril 2012, a total of 6,958 patients were treated at 135
medical institutions. The generic name prescription
surcharge was claimed 7,954 times in 7,938 medical claims.
The submission date of receipts for treatment in theprevious month is specified as the 5th or 10th of theTable 4 Number of Generic drug prescribed
Total

Generic%GE

Nov-11

3,018,097

847,732

28.1%

Dec

3,195,455

923,118

28.9%

Jan-12

2,688,144

791,052

29.4%

Feb

2,808,098

824,628

29.4%

Mar

3,118,977

921,069

29.5%

Apr

3,064,671

972,270

31.7%

May

3,095,443

992,578

32.1%

Jun

2,942,333

956,343

32.5%

Jul

3,178,616

1,038,433

32.7%

Aug

3,174,958

1,036,265

32.6%

Sep

2,807,315

926,518

33.0%

Oct

3,414,062

1,120,559

32.8%

Table 5 Cost of Generic drug prescribed
Total

Generic%GE

Nov-11

172,386,453

15,895,786

9.2%

Dec

180,875,741

18,106,388

10.0%

Jan-12

153,040,019

16,180,068

10.6%

Feb

162,801,186

17,469,130

10.7%

Mar

183,152,613

20,064,931

11.0%

Apr

177,673,349

21,749,364

12.2%

May

177,901,939

22,348,410

12.6%

Jun

168,285,402

21,643,038

12.9%

Jul

183,737,081

23,665,115

12.9%

Aug

183,267,319

23,492,672

12.8%

Sep

159,755,605

21,282,155

13.3%

Oct

197,588,058

25,830,790

13.1%

J. Natl. Inst. Public Health, 62（1）: 20139

Toshiro KUMAKAWA, Koichi OTSUBO, Yoshimune HIRATSUKA, Etsuji OKAMOTO

Fig. 6 Changes of number of Generic drug prescribed

Fig. 7 Changes of cost of Generic drug prescribedfollowing month (the 10th for social insurance, and the 5th
for the National Health Insurance Organization). The
analysis of electronic claims in March and April 2012enabled an accurate analysis in June of that year of the costeffectiveness of the generic name prescription surcharge,
which had been newly established in April 2012.

VI. Future deployment
The formulation of a medical care plan by prefectural
governors was specified in the revision of the Medical Care
Act in 2006, and the first medical care plan was formulated
by prefectures in 2008. Prefectures must formulate thesecond medical care plan in 2013. With limited resources,
they are required to review disaster countermeasures,reflect regional characteristics, and formulate a medicalcare plan that contributes to the optimization of medical
expenses in Japan.
Medical care plans have so far been formulated utilizing
information such as the population census, conducted
every 5 years; patient surveys to clarify the actual

10

conditions of illnesses and injuries of patients who use
hospitals, clinics, and other facilities, conducted every 3
years; the Comprehensive Survey of Living Conditions,conducted every 3 years; and the statistics report on
regional public health. However, accurately understanding
regional characteristics from the above sources of
information has been difficult.
Data in the national database of information on receipts(claims) and specific health checkups, managed by theGeneral Affairs Division of the Health Insurance Bureau of
the Ministry of Health, Labour, and Welfare, haveexperimentally been provided to prefectures, research
institutions, and others from April 2011 to March 2013 [14].
These new data are updated monthly and are important
information reflecting the characteristics of regional
medical care. The utilization of their analysis results
enables the formulation of a more workable medical careplan in a region.
This receipt (claim) information, provided experimentally,is aimed at investigations and analyses for planning the
optimization of medical expenses, where it is used based on

J. Natl. Inst. Public Health, 62（1）: 2013

Evaluation of demand for medical care services, quality of health care and health policy by using electronic claims data

the Act on Assurance of Medical Care for Elderly People. It
is used by the General Affairs Division of the Health
Insurance Bureau of the Ministry of Health, Labour, andWelfare as well as by the prefectures. Outside the Act on
Assurance of Medical Care for Elderly People, it is used by(1) the Ministry of Health, Labour, and Welfare as well asother relevant ministries, agencies, and local governments,
where it is aimed at promoting policies based on accurate
evidence for improving the quality of medical services, forexample to formulate policy based on understanding theactual conditions of diseases such as infections; and (2)research institutions, where it is aimed at academic
research beneficial for the policies outlined above.
Basic procedures for handling the receipt information are
also stipulated, including (1) use of the information at
previously requested Japanese sites, (2) prohibition ofconnection to external networks, (3) prohibition of renting
it to the third parties, etc., (4) locking the storage site, and(5) identification and certification of the users. Moreover,use of receipt information is limited during theexperimental period because review by an expert
committee on the provision of receipt information andrelated matters as well as the decision by the Minister of
Health, Labour, and Welfare are needed to use theinformation.
The primary purpose of receipts is for use in insurance
claims. An electronic medical receipt or claim is a bill of
medical expenses for treatment to a patient that a medical
institution sends to insurers (municipalities, health insurance
associations, etc.). It includes personal information such as
the patient s name, gender, and date of birth, patient healthinsurance information, the name of the medical institution
submitting the bill, the department, the name of thedisease, and points for medication, injections, procedures,
surgeries, examinations, imaging, rehabilitation, and so onthat were performed during the treatment month. It iscreated by medical institutions for each insured patient on amonthly basis. A remuneration point for medical treatment
is defined for each medical practice. Medical institutions
add up the points and then bill insurers. Points, valued at 10
yen per point and defined for examinations, treatment, andso on performed by medical institutions, are written on the
medical bills.
The strength of electronic claims data is theircomprehensiveness and the capacity for patient linkage[15]. Technically, it is possible to grasp the overall state ofhealth care by linking health insurance electronic claims
with health checkups, electronic guidance data, and longterm care insurance claims. Such infrastructure needs to besystematic and efficient; to be capable of supporting
linkages among data sources; and to provide appropriate
protection of the privacy and confidentiality of healthinformation. However, we have to embrace the new big datain order to promote evidence-based health policies andplanning and to improve the quality of health care.

References[1] Kumakawa T. Restructuring Japanese Health Care
System and Health Promotion System in the Future:
Mechanical System and Complexity Adaptive System．
J. of Health Evaluation and Promotion. 2009;36(4):36571.
[2] WHO. The World Health Report 2000 Health Systems:
Improving Performance. Geneva: WHO; 2000.
[3] Overview of medical Service Regime in Japan.
http://www.mhlw.go.jp/bunya/iryouhoken/iryouhoken
01/dl/01_eng.pdf (accessed 2012-12-25)[4] A comparison of health care systems among major
nations.
http://www.mhlw.go.jp/bunya/iryouhoken/iryouhoken
11/dl/02.pdf (in Japanese) (accessed 2012-12-25)[5] Meaning of the Universal health Insurance Coverage
System.
http://www.mhlw.go.jp/bunya/iryouhoken/iryouhoken
01/dl/01_eng.pdf (accessed 2012-12-25)[6] Medical-facilities investigation (2011).
http://www.mhlw.go.jp/toukei/saikin/hw/iryosd/11/dl/gaikyo.pdf (in Japanese) (accessed 2012-12-25)[7] Outline of Insured Medical treatment.
http://www.mhlw.go.jp/bunya/iryouhoken/iryouhoken
01/dl/01_eng.pdf (accessed 2012-12-25)[8] OECD health data 2012.
http://www.oecd.org/health/healthpoliciesanddata/
oecdhealthdata2012.htm (accessed 2012-12-25)[9] Status of Medical Expenditure of OECD Member
Countries(2010)
http://www.mhlw.go.jp/bunya/iryouhoken/iryouhoken
11/dl/03.pdf (accessed 2012-12-25)[10] Medical Service Fees System.
http://www.mhlw.go.jp/bunya/iryouhoken/iryouhoken
01/dl/01_eng.pdf (accessed 2012-12-25)[11] Analysis of the electronic claims. Expert committee forformulating Sapporo Health Care Plan (in Japanese)
http://www.city.sapporo.jp/eisei/tiiki/iryouplan/iinkai/documents/iryouplan04-03.pdf (accessed 2012-12-25)[12] Proposed work plan for the HCQI information
infrastructure project. Meeting of the HCQI Expert
Group, Oct 31, 2012.
[13] Room Document, Item18, For discussion in the HCQI
Experts’ Meeting. Paris; OECD Headquarters: 2012.
[14] National database of information on receipt/specifichealth checkups (in Japanese).
http://www.mhlw.go.jp/seisakunitsuite/bunya/kenkou_iryou/iryouhoken/reseputo/ (accessed 2012-12-25)[15] Fujimori K. Practical Use of E-Claim Data for Regional
Healthcare Planning. (in Japanese) Japanese Journal of
Hygiene. 2012; 67: 56-61.

J. Natl. Inst. Public Health, 62（1）: 201311

Toshiro KUMAKAWA, Koichi OTSUBO, Yoshimune HIRATSUKA, Etsuji OKAMOTO

電子レセプト分析による医療サービス需要，医療の質，医療政策の評価
抄録
本来レセプトは保険請求のために使用することを目的としており，最近ではほとんどのレセプトが電子化された形で使われている．電子化されたレセプトデータには，患者氏名，性別，生年月日といった個人情報，患者の健康保険加入情報，請求元の医療機関名，診療科，病名，診療月に行った薬，注射，処置，手術，検査，画像診断，リハビリ等の情報が含まれている．これらの電子化されたデー
タを活用することにより，地域の医療サービス需要，医療の質，医療政策を評価することが技術的に可能である．そのようなインフラストラクチャーを構築するためには，データ間の連携支援，個人情報および健康情報を保護するための，体系的かつ効率的に実施することが求められる．その取組みは容易なことではないが，私たちは根拠に基づいた保健医療政策および計画を促進し，かつヘルスケアの質を向上するためには，新たに電子化されたビッグデータに積極的に挑戦しなければならない．
キーワード：電子レセプト，ビッグデータ，医療サービス需要，医療の質，医療政策
熊川寿郎，大坪浩一，平塚義宗，岡本悦司
国立保健医療科学院医療・福祉サービス研究部

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J. Natl. Inst. Public Health, 62（1）: 2013