국내 건강보험 청구자료의 활용 촉진을 위한 현안 및 개선방안

Abstract

While health insurance claims data in Korea have the potential as evidence for drug regulatory decision-making, its effective utilization remains limited. This study aims to identify the challenges encountered by researchers in utilizing claims data and discuss improvement strategies. We summarized practical difficulties encountered by researchers who have experience using claims data from the National Health Insurance Service and the Health Insurance Review and Assessment Service. Challenges encountered by researchers included difficulties in acquiring drug data, delays in data provision, limited provision of information on specific conditions, drugs, and treatments, small data capacity, short data usage periods, and spatiotemporal considerations when accessing data. To maximize the utility of claims data in drug regulatory decision-making, continuous communication between researchers and data providers is necessary for addressing these challenges. (PeRM 2024;16:1-10)