Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 May;32(5):718-728.
doi: 10.3346/jkms.2017.32.5.718.

Towards Actualizing the Value Potential of Korea Health Insurance Review and Assessment (HIRA) Data as a Resource for Health Research: Strengths, Limitations, Applications, and Strategies for Optimal Use of HIRA Data

Jee Ae Kim  1 , Seokjun Yoon  2 , Log Young Kim  1 , Dong Sook Kim  3
Affiliations
Review

Towards Actualizing the Value Potential of Korea Health Insurance Review and Assessment (HIRA) Data as a Resource for Health Research: Strengths, Limitations, Applications, and Strategies for Optimal Use of HIRA Data

Jee Ae Kim et al. J Korean Med Sci. 2017 May.

Abstract

Health Insurance and Review Assessment (HIRA) in South Korea, also called National Health Insurance (NHI) data, is a repository of claims data collected in the process of reimbursing healthcare providers. Under the universal coverage system, having fee-for-services covering all citizens in South Korea, HIRA contains comprehensive and rich information pertaining to healthcare services such as treatments, pharmaceuticals, procedures, and diagnoses for almost 50 million beneficiaries. This corpus of HIRA data, which constitutes a large repository of data in the healthcare sector, has enormous potential to create value in several ways: enhancing the efficiency of the healthcare delivery system without compromising quality of care; adding supporting evidence for a given intervention; and providing the information needed to prevent (or monitor) adverse events. In order to actualize this potential, HIRA data need to actively be utilized for research. Thus understanding this data would greatly enhance this potential. We introduce HIRA data as an important source for health research and provide guidelines for researchers who are currently utilizing HIRA, or interested in doing so, to answer their research questions. We present the characteristics and structure of HIRA data. We discuss strengths and limitations that should be considered in conducting research with HIRA data and suggest strategies for optimal utilization of HIRA data by reviewing published research using HIRA data.

Keywords: Claims Data; HIRA Data; Health Insurance Review and Assessment Service; Health Research; Healthcare Services; Korea; National Health Insurance.

PubMed Disclaimer

Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Flow of data generation of HIRA data. HIRA = Health Insurance and Review Assessment, DW = data warehouse.
Fig. 2
Fig. 2
Linkage of files. ID = identification.
See this image and copyright information in PMC

References

    1. Booth CM, Cescon DW, Wang L, Tannock IF, Krzyzanowska MK. Evolution of the randomized controlled trial in oncology over three decades. J Clin Oncol. 2008;26:5458–5464. - PMC - PubMed
    1. Dans AL, Dans LF, Guyatt GH, Richardson S Evidence-Based Medicine Working Group. Users’ guides to the medical literature: XIV. How to decide on the applicability of clinical trial results to your patient. JAMA. 1998;279:545–549. - PubMed
    1. Meyer RM. Generalizing the results of cancer clinical trials. J Clin Oncol. 2010;28:187–189. - PubMed
    1. Arana A, Rivero E, Egberts TC. What do we show and who does so? An analysis of the abstracts presented at the 19th ICPE. Pharmacoepidemiol Drug Saf. 2004;13:S330–1.
    1. Cook C, Sheets C. Clinical equipoise and personal equipoise: two necessary ingredients for reducing bias in manual therapy trials. J Manual Manip Ther. 2011;19:55–57. - PMC - PubMed