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Incorrect Disease Coding in Medical Insurance Claims and the Effect of Official Intervention: Based on Medical Insurance Claims of 6 Notifiable Acute Communicable Diseases.
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Yong Mun Park, Kwang Ho Meng, Euichul Shin, Kidong Park, Won Chul Lee, Sukil Kim, Jung Hee Jang
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Korean J Epidemiol. 1999;21(2):142-150.
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Abstract
BACKGROUND
Because of their large size and excellent computerized records of illness and services rendered, the importance of national insurance program is getting much attentions from the public health researchers and the national and local health authorities. In reality, however, most health records from medical insurance program suffer very much from inaccurate disease coding, and therefore, they are practically in no use.METHODS Pattern of incorrect disease coding of 6 Notifiable Acute Communicable Diseases that believed not to have been occurred in Korea lately was reviewed. The reasons of such incorrect codings in different level of medical institutions were studied. This study also attempted to see how an official intervention asking the medical institutions to correct their coding behavior works by comparing the frequencies of incorrect disease coding before and after the intervention.RESULTS Study results showed that more incorrect disease codings came from clinics than hospitals, and non-physician personnel in clinics and hospitals seemed to be responsible for most of the incorrect disease codings. Most frequent diseases coded incorrectly such as cholera and poliomyelitis were the ones that physicians and non-physician personnel in the clinics and hospitals had been familiar with for a long time period.CONCLUSION Even a simple official intervention asking the clinics and hospitals to correct their coding behavior was very effective : total number of incorrect disease codings before intervention (398 cases from 144 institutions) dramatically decreased (14 cases from 8 institutions) after intervention. Significant decrease in incorrect disease coding was found more in small institutions such as clinics and public health facilities than large institutions.
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Summary
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An Analysis on the Factors Associated with Cancer Screening in a City.
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Woon Nyung Roh, Won Chul Lee, Young Bok Kim, Yong Mun Park, Hong Jae Lee, Kwang Ho Meng
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Korean J Epidemiol. 1999;21(1):81-92.
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Abstract
This study is aimed at preparing basic data required for establishment of a cancer screening program by examining the status of cancer screenings performed by residents in a community and the factors that have an effect on determination for a cancer screening by residents.
Cervix, breast and stomach cancers were chosen as target cancers of the study due to the fact that merits of screening for these cancers have been proved by studies done in different countries.
In order to find out the status of cancer screening and the factors having an effect on the determination for a cancer screening, 10 Dongs and a total of 1988 people were selected as study area and subjects by a random cluster sampling method, and the subjects were questioned on different aspects by questionnaires. Additionally, in order to find out how cancer screening is performed at medical facilities and how cancer screening is recommended by doctors, medical facilities doing cancer screening were also questioned.
The results of the study are as follows: 1. In the case of the screening of the stomach cancer, 16.1% of male subjects and 25.6% of female subjects turned out to have had one or more screening for the cancer. In the cases of the breast and the cervical cancers, 21.6% and 62.6% of the subjects turned out to have had one or more screenings respectively.
2. As to the screening for the stomach cancer, there was a tendency that more of the subjects with lower level education, excepting those without education, had themselves screened for the cancer. Higher screening rates were shown by the subjects in higher ages, those who visited doctors regularly.
3. As to the screening rate by education levels, a high rate of screening was shown by the subjects with above-university education level and there was not a big difference between the screenings done for high school graduates and for those with lower education levels.
Regarding the rates of screening by age groups the screening rate turned out to be higher with the higher ages. Screening rates, checked on the basis of the income levels, did not show a big differences between income levels.
4. The highest rate of screening for the breast cancer was shown by the subjects with postgraduate level of education and regarding the rate by income level, a slightly higher level was shown by the subjects with the monthly income of the 2,010,000 won, but the difference between the rates of screening by subjects at different income levels was overall not significant.
5. The rates for selecting the health screening facilities were higher in orders of the reasons that 1) they were close: 2) service was excellent and 3) equipment and facilities were good.
Based on the above-mentioned results obtained by the study, it is anticipated that this study will play a vital role as basic data for the development and execution of cancer screening program for a community, and the analysis, done on the basis of the status of the cancer screening, of the factors related to the determination for the cancer screening showed that for the development of a cancer screening program, factors like income levels, education levels, whether people consult doctors regularly and the local government' care for health in a community should be considered, and in addition to which active participation of doctors in the program is also requested.
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