Studies of Health Insurance Claims Data in Japan: A Scoping Review

Maiko Suto¹, Takehiro Sugiyama^{2

3

4}, Kenjiro Imai⁴, Takashi Furuno², Mariko Hosozawa², Yuichi Ichinose⁵, Noriko Ihana-Sugiyama⁴, Tomoko Kodama⁶, Ryuji Koizumi⁷, Yuko Shimizu-Motohashi⁸, Shunsuke Murata⁹, Yayoi Nakamura¹⁰, Mariko Niino⁵, Misuzu Sato¹¹, Reina Taguchi^{11

12}, Misa Takegami⁹, Motoko Tanaka^{1

13}, Kota Tsutsumimoto¹⁴, Kentaro Usuda¹⁵, Kenji Takehara¹, Hiroyasu Iso²

Affiliations

¹ Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan.
² Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan.
³ Department of Health Services Research, Institute of Medicine, University of Tsukuba, Ibaraki, Japan.
⁴ Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.
⁵ Division of Health Services Research, Institute for Cancer Control, National Cancer Center, Tokyo, Japan.
⁶ Department of Public Health Policy, National Institute of Public Health, Saitama, Japan.
⁷ AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
⁸ Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.
⁹ Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
¹⁰ AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan.
¹¹ Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
¹² Institute for Health Economics and Policy, Tokyo, Japan.
¹³ Department of Health Care Policy and Management, Doctoral Program in Public Health, Degree Programs in Comprehensive Human Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.
¹⁴ Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan.
¹⁵ Department of Public Mental Health Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.

PMID: 37560376
PMCID: PMC10407298
DOI: 10.31662/jmaj.2022-0184

Studies of Health Insurance Claims Data in Japan: A Scoping Review

Maiko Suto et al. JMA J. 2023.

. 2023 Jul 14;6(3):233-245.

doi: 10.31662/jmaj.2022-0184. Epub 2023 Jun 19.

Authors

Affiliations

¹ Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan.
² Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan.
³ Department of Health Services Research, Institute of Medicine, University of Tsukuba, Ibaraki, Japan.
⁴ Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.
⁵ Division of Health Services Research, Institute for Cancer Control, National Cancer Center, Tokyo, Japan.
⁶ Department of Public Health Policy, National Institute of Public Health, Saitama, Japan.
⁷ AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
⁸ Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.
⁹ Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
¹⁰ AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan.
¹¹ Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
¹² Institute for Health Economics and Policy, Tokyo, Japan.
¹³ Department of Health Care Policy and Management, Doctoral Program in Public Health, Degree Programs in Comprehensive Human Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.
¹⁴ Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan.
¹⁵ Department of Public Mental Health Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.

PMID: 37560376
PMCID: PMC10407298
DOI: 10.31662/jmaj.2022-0184

Abstract

Background: Health insurance claims data are used in various research fields; however, an overview on how they are used in healthcare research is scarce in Japan. Therefore, we conducted a scoping review to systematically map the relevant studies using Japanese claims data.

Methods: MEDLINE, EMBASE, and Ichushi-Web were searched up to April 2021 for studies using Japanese healthcare claims data. We abstracted the data on study characteristics and summarized target diseases and research themes by the types of claims database. Moreover, we described the results of studies that aimed to compare health insurance claims data with other data sources narratively.

Results: A total of 1,493 studies were included. Overall, the most common disease classifications were "Diseases of the circulatory system" (18.8%, n = 281), "Endocrine, nutritional, and metabolic diseases" (11.5%, n = 171; mostly diabetes), and "Neoplasms" (10.9%, n = 162), and the most common research themes were "medical treatment status" (30.0%, n = 448), "intervention effect" (29.9%, n = 447), and "clinical epidemiology, course of diseases" (27.9%, n = 417). Frequent diseases and themes varied by type of claims databases. A total of 19 studies aimed to assess the validity of the claims-based definition, and 21 aimed to compare the results of claims data with other data sources. Most studies that assessed the validity of claims data compared to medical records were hospital-based, with a small number of institutions.

Conclusions: Claims data are used in various research areas and will increasingly provide important evidence for healthcare policy in Japan. It is important to use previous claims database studies and share information on methodology among researchers, including validation studies, while informing policymakers about the applicability of claims data for healthcare planning and management.

Keywords: Japan; health insurance claims; healthcare policy; scoping review; validation studies.

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Conflict of interest statement

None

Figures

**Figure 1.**
Study selection flowchart.

**Figure 2.**
Annual number of publications between 2010 and 2021 National Database of Health Insurance Claims (NDB); JMDC Claims Database (JMDC); Medical Data Vision EBM Provider (MDV); Diagnosis Procedure Combination Database (DPC); National Health Insurance (NHI), including Kokuho Database (KDB)/Latter-Stage Elderly Healthcare System (LSEHS); Japan Health Insurance Association (JHIA).

See this image and copyright information in PMC

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Studies of Health Insurance Claims Data in Japan: A Scoping Review

Affiliations

Studies of Health Insurance Claims Data in Japan: A Scoping Review

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

LinkOut - more resources

Full Text Sources

Miscellaneous