Having high quality health care and health insurance data readily available – and knowing how to use it for planning and decision-making – are key goals for countries working toward universal health coverage (UHC).
From April 4-6, 2018, 30 practitioners from 10 countries across Africa, Asia and the Americas gathered in Seoul, South Korea for the second Data Foundations collaborative workshop. The Data Foundations collaborative is part of the JLN’s Information Technology (IT) initiative.
This workshop created a space for participants to engage in joint learning focused on best practices and challenges related to data governance and data use. Hosted by South Korea’s National Health Insurance Service (NHIS) and Health Insurance Review & Assessment Service (HIRA), and co-facilitated by PATH and Wipro, the workshop included visits to NHIS and HIRA headquarters in Wonju, where participants visited the organizations’ data centers and listened to presentations from health care data experts.
Use of data is a foundational building block for improved health system performance and health outcomes and refers to the process of turning data into information that supports evidence-based action. The pathway for achieving effective use of health care data – and how it leads to improved population health outcomes – is furthered demonstrated in PATH’s Data Use Partnership Theory of Change.
The workshop centered around three specific health care data use topic areas: (1) health care financial management; (2) chronic disease management; and (3) health insurance claims data utilization. Experts from NHIS and HIRA provided an introduction to each data use topic and shared their data systems and learnings supporting each area.
To gather additional insights on best practices for data use in the three topic areas, workshop participants engaged in a series of one-on-one interviews to learn about the data challenges and successes in each other’s countries.
The interactions and group discussions at the workshop pointed to some common themes:
- Financial management
Accurate data on the population and their usage of health care services, as well as the cost, is critical for financial planning and expanding UHC. Government ministries use the available data to determine the annual budget for national insurance programs, conduct real-time financial management and manage financial risk. The knowledge exchange at the workshop found that while all countries strive to have a “real-time” system to monitor health expenditures and ensure actual costs are in line with budget estimates, each country has different definitions of a real-time system. Based on the country, the current target for real-time data could be quarterly, monthly or weekly updates on income and expenditures.
- Chronic disease management
Chronic diseases, such as diabetes and hypertension, are a growing burden for health care systems around the world, especially as many countries simultaneously face intermittent or ongoing communicable disease challenges. Electronic data systems can help health workers manage this burden by tracking citizens who have obtained basic health screenings and their health indicators – such as blood pressure, weight, and cholesterol – and which people should be referred for additional services based on their health indicators. Electronic data systems also can easily identify citizens who have not received a preventive health screening and should be contacted for follow-up. Data systems that are based on mobile devices, such as tablets, allow health workers in some countries to conduct health screenings through home visits and record collected health information. This rather time-intensive process of sending health workers door-to-door is seen as an important factor in countries, such as Indonesia, in reaching average citizens and spreading the word about the importance of receiving regular preventive health screenings.
- Health insurance claims data utilization
Electronic claims data systems provide numerous benefits for national health insurance agencies. The workshop revealed that country participants have a strong interest in how claims data can be used to detect potential fraudulent billing. HIRA discussed how their claims data software platform uses a variety of indicators to identify if a health care provider should be investigated for fraud. For example, the platform flags health insurance claims that are submitted while a provider is scheduled to be on vacation, or claims that come from patients residing far from the provider’s office or those submitted after regular office hours. Learning from South Korea’s advanced fraud detection system during the visit to HIRA headquarters provided inspiration and learnings for the other participants whose countries are in the earlier stages of developing policies and processes for how to use claims data.
Workshop participants volunteered to join subgroups for the three data use topic areas. These groups will meet virtually in the coming months to review and finalize a short case study focused on their chosen topic area. These case studies, emerging from joint learning, will cover best practices and learnings from South Korea’s data systems and data use practices and the practical insights from countries shared by the collaborative team members.
The case studies from Data Foundations collaborative will be released publicly in fall 2018, along with a webinar to share and promote the collaborative’s learnings.