Medical Charges Research Articles

The Role of the Psychosocial Dimension in the Improvement of Quality of Care: A Systematic Review.

The aim of our systematic review was to analyse the published literature on the psychosocial dimension of care in family medicine and its relationship with quality of care. We wanted to find out whether there is any evidence on the psychosocial approach in (family) medicine. The recommended bio-psycho-social approach, besides the biomedical model of illness, takes into account several co-influencing psychological, sociological and existential factors. An online search of nine different databases used Boolean operators and the following selection criteria: the paper contained information on the holistic approach, quality indicators, family medicine, patient-centred care and/or the bio-psycho-social model of treatment. We retrieved 743 papers, of which 36 fulfilled our inclusion criteria. Including the psychosocial dimension in patient management has been found to be useful in the prevention and treatment of physical and psychiatric illness, resulting in improved social functioning and patient satisfaction, reduced health care disparities, and reduced annual medical care charges. The themes of patient-centred, behavioural or psychosocial medicine were quite well presented in several papers. We could not find any conclusive evidence of the impact of a holistic bio-psycho-social-approach. Weak and variable definitions of psychosocial dimensions, a low number of well-designed intervention studies, and low numbers of included patients limited our conclusions.

Randomized Controlled Trial of Electronic Care Plan Alerts and Resource Utilization by High Frequency Emergency Department Users with Opioid Use Disorder.

IntroductionThere is a paucity of literature supporting the use of electronic alerts for patients with high frequency emergency department (ED) use. We sought to measure changes in opioid prescribing and administration practices, total charges and other resource utilization using electronic alerts to notify providers of an opioid-use care plan for high frequency ED patients.MethodsThis was a randomized, non-blinded, two-group parallel design study of patients who had 1) opioid use disorder and 2) high frequency ED use. Three affiliated hospitals with identical electronic health records participated. Patients were randomized into “Care Plan” versus “Usual Care groups”. Between the years before and after randomization, we compared as primary outcomes the following: 1) opioids (morphine mg equivalents) prescribed to patients upon discharge and administered to ED and inpatients; 2) total medical charges, and the numbers of; 3) ED visits, 4) ED visits with advanced radiologic imaging (computed tomography [CT] or magnetic resonance imaging [MRI]) studies, and 5) inpatient admissions.ResultsA total of 40 patients were enrolled. For ED and inpatients in the “Usual Care” group, the proportion of morphine mg equivalents received in the post-period compared with the pre-period was 15.7%, while in the “Care Plan” group the proportion received in the post-period compared with the pre-period was 4.5% (ratio=0.29, 95% CI [0.07–1.12]; p=0.07). For discharged patients in the “Usual Care” group, the proportion of morphine mg equivalents prescribed in the post-period compared with the pre-period was 25.7% while in the “Care Plan” group, the proportion prescribed in the post-period compared to the pre-period was 2.9%. The “Care Plan” group showed an 89% greater proportional change over the periods compared with the “Usual Care” group (ratio=0.11, 95% CI [0.01–0.092]; p=0.04). Care plans did not change the total charges, or, the numbers of ED visits, ED visits with CT or MRI or inpatient admissions.ConclusionElectronic care plans were associated with an incremental decrease in opioids (in morphine mg equivalents) prescribed to patients with opioid use disorder and high frequency ED use.

Abstract 12261: Improving Discharge Timeliness on a Pediatric Inpatient Cardiology Unit Through the Implementation of Medical Discharge Criteria Decreases Length of Stay and Reduces Hospital Charges

Background: Prior improvement work integrating standardized medical discharge criteria in general pediatric inpatients led to improved discharge timeliness and reduced length of stay (LOS). Our aim was to develop standardized medical discharge criteria on a quaternary pediatric cardiology unit in an effort to improve the timeliness of discharge. We hypothesized that timely discharge would lead to cost savings and a reduced LOS. Methods and Results: Over 18 months (Jan. 2014 - June 2015), a multi-disciplinary team worked toward the quality improvement aim of increasing the percentage of pediatric cardiology inpatients discharged within 2 hours of achieving medical discharge criteria. We established preset ‘medically ready’ discharge criteria in our hospital EMR, initiated upon admission for all inpatients and modified daily as needed. We organized criteria into 7 categories (congenital heart disease (CHD) medical, CHD post-operative, heart failure/transplant medical, transplant post-operative, electrophysiology (EP) medical, EP post-procedure, and catheterization post-procedure). The median percentage of patients discharged within 2 hours of meeting criteria increased steadily from 35% to 78% over the project period. Concurrently, the median number of patients discharged before noon increased from 18% to 31%. Physician and nursing compliance with necessary process measures was 87% and 89%, respectively. LOS decreased by 8% (3.6 to 3.3 days) from the first 6 months of work to the last 6 months. All-cause readmission remained stable at 15% over the improvement time frame. Review of inpatient charges between Oct. 2014 and June 2015 demonstrated 169 patients (190 discharges) who experienced a delayed discharge based on the set criteria. The sum of charges from care provided after meeting criteria was $231,201 (average of $1,217 per delayed discharge). Conclusions: Discharge timeliness in pediatric cardiology patients can be improved by standardizing medical discharge criteria. We demonstrate that this can be achieved across all subcategories of pediatric cardiology without increasing the rate of readmission. Improved discharge timeliness not only reduces LOS; it provides an opportunity to substantially decrease medical charges.

병원서비스지역 내 병원자원과 의료서비스 이용 간의 관련성 분석

Background: This study explored the relationship between hospital resources and services uses in outpatient/inpatient-based hos-pital service area (HSA) in Korea.Methods: Study hospitals included all acute care hospitals except tertiary hospitals. Inpatient and outpatient hospital claims from the Korean National Health Insurance (NHI) program in 2010 were used to identify the service uses. Hospital resources and the de-gree of insurance premium in study areas were identified with the NHI corporation data. Study variables were computed by sum-ming the service uses or hospital resources of study hospitals in each HSA. Service uses were represented by the total medical charges and number of visits/inpatient days. Hospital resources were measured by number of beds, number of doctors, and num-ber of computed tomography (CT). The economic status of NHI enrollees in each HSA was controlled by the average monthly pre-mium of NHI program per household in each HSA. The degree of using local hospitals was controlled with the localization index.Results: Analysis results showed that hospital resources such as beds, CT were statistically related to the service uses. And also local-ization index was found to have positive significant relationships with service uses.Conclusion: Hospital resources such as beds, CT had not only positive impacts on inpatient service uses, but also influences on the outpatient setting. Health policy makers will require monitoring and assessing the hospital resources in Korea.Keywords: Hospital service area; Health care utilization; Health resources; Localization index

Editor's Spotlight/Take 5: What Drives Variation in Episode-of-care Payments for Primary TKA? An Analysis of Medicare Administrative Data

High hospital and medical charges are good fodder for outraged commentary [6]. In fact, a Google search for “ridiculous hospital charges” yields more than 6 million hits. It is hard to argue that extreme charges are justified, but what about actual costs? Presumably, a standard high-volume procedure with no complications should cost about the same, whether it is performed in Seattle, WA, USA or Santa Fe, NM, USA. This is particularly true if the payer is the federal government, which has the power to dictate terms to providers.

Patient dissatisfaction in China: What matters

Patient satisfaction is a focal concern of health-care delivery and an expected outcome of medical care. Recently, the violent conflict between doctors and patients in China has intensified. Patient dissatisfaction has been recognized as an important concern and an urgent issue in the reform of China's health care. The objectives of this study are to investigate the determinants of patient dissatisfaction attributed to patient, hospital, and health-care market characteristics, as well as to explore the major determinants in the context of China. Data from 2007 to 2010 Urban Resident Basic Medical Insurance Survey (URBMIS) are used in this study. A total of 13,336 patients are selected conditional on health-care utilization. Analysis of satisfaction is based on outpatient utilization (last 2 weeks' reference, 6393 individuals) and inpatient utilization (last 1-year reference, 6943 individuals). Satisfaction was measured as ordinal variables (scales 1–5). Ordinary least squares (OLS) regression and an ordered probit model are applied to investigate the determinants. Blinder–Oaxaca decomposition is further employed to detect the proportion each predictor's contribution. The results indicate that patients' gender, education, and insurance status are significantly related to patient satisfaction. Higher-level hospitals are found to negatively correlate with patient satisfaction. Lower competition in providers' market and a higher market share of private hospitals are found to positively correlate with patient dissatisfaction. Meanwhile, the survey indicates that “medical charges too expensive” is chiefly responsible for patient dissatisfaction. Our study provides empirical evidence on the determinants of patient dissatisfaction in China. In particular, the results indicate that establishing a high competition among various providers in the health-care market will act as a “double-edged sword,” with great policy implications.

Multiple causes of death analysis of chronic diseases: the example of diabetes.

BackgroundIdentifying a single disease as the underlying cause of death (UCOD) is an oversimplification of the clinical-pathological process leading to death. The multiple causes of death (MCOD) approach examines any mention of a disease in death certificates. Taking diabetes as an example, the study investigates: patterns of death certification, differences in mortality figures based on the UCOD and on MCOD, factors associated to the mention of diabetes in death certificates, and potential of MCOD in the analysis of the association between chronic diseases.MethodsThe whole mortality archive of the Veneto Region-Italy was extracted from 2008 to 2010. Mortality rates and proportional mortality were computed for diabetes as the UCOD and as MCOD. The position of the death certificate where diabetes was mentioned was analyzed. Conditional logistic regression was applied with chronic liver diseases (CLD) as the outcome and diabetes as the exposure variable. A subset of 19,605 death certificates of known diabetic patients (identified from the archive of exemptions from medical charges) was analyzed, with mention of diabetes as the outcome and characteristics of subjects as well as other diseases reported in the certificate as predictors.ResultsIn the whole mortality archive, diabetes was mentioned in 12.3 % of death certificates, and selected as the UCOD in 2.9 %. The death rate for diabetes as the UCOD was 26.8 × 105 against 112.6 × 105 for MCOD; the UCOD/MCOD ratio was higher in males. The major inconsistencies of certification were entering multiple diseases per line and reporting diabetes as a consequence of circulatory diseases. At logistic regression the mention of diabetes was associated with the mention of CLD (mainly non-alcohol non-viral CLD). In the subset of known diabetic subjects, diabetes was reported in 52.1 %, and selected as the UCOD in 13.4 %. The probability of reporting diabetes was higher with coexisting circulatory diseases and renal failure and with long duration of diabetes, whereas it was lower in the presence of a neoplasm.ConclusionsThe use of MCOD makes the analysis of mortality data more complex, but conveys more information than usual UCOD analyses.

Prevalence of diabetes across different immigrant groups in North-eastern Italy

Background and aimsType 2 diabetes, one of the most important non-communicable diseases, represents a major health problem worldwide. Immigrants may contribute relevantly to the increase in diabetes. The aim of the study was to investigate variability in diabetes prevalence across different immigrant groups in the Veneto Region (northeastern Italy). Methods and resultsDiabetic subjects on January 2013 were identified by record linkage of hospital discharge records, drug prescriptions, and exemptions from medical charges for diabetes. Immigrant groups were identified based on citizenship. Age-standardized prevalence rates were obtained for residents aged 20–59 years by the direct method, taking the whole regional population as reference. Prevalence rate ratios (RR) with 95% Confidence Intervals (CI) were computed with respect to Italian citizens.Among residents aged 20–59 years, 45280 Italian and 7782 foreign subjects affected by diabetes were identified. Prevalence rates were highest among immigrants from South-East Asia, RR 4.9 (CI 4.7–5.1) among males, and 7.6 (7.2–8.1) among females, followed by residents from both North and Sub-Saharan Africa. Citizens from Eastern Europe (the largest immigrant group) showed rates similar to Italians. Most South-Asian patients aged 20–39 years were not insulin-treated, suggesting a very high risk of early onset type 2 diabetes in this ethnic group. ConclusionLarge variations in diabetes prevalence by ethnicity should prompt tailored strategies for primary prevention, diabetes screening, and disease control. An increased demand for prevention and health care in selected population groups should guide appropriate resource allocation.

Does Medical School Training Relate to Practice? Evidence from Big Data.

On April 2nd, 2014, the Department of Health and Human Services (HHS) announced a historic policy in its effort to increase the transparency in the American healthcare system. The Center for Medicare and Medicaid Service (CMS) would publicly release a dataset containing information about the types of Medicare services, requested charges, and payments issued by providers across the country. In its release, HHS stated that the data would shed light on “Medicare fraud, waste, and abuse.” While this is most certainly true, we believe that it can provide so much more. Beyond the purely financial aspects of procedure charges and payments, the procedures themselves may provide us with additional information, not only about the Medicare population, but also about the physicians themselves. The procedures a physician performs are for the most part not novel, but rather recommended, observed, and studied. However, whether a physician decides on advocating a procedure is somewhat discretionary. Some patients require a clear course of action, while others may benefit from a variety of options. This article poses the following question: How does a physician's past experience in medical school shape his or her practicing decisions? This article aims to open the analysis into how data, such as the CMS Medicare release, can help further our understanding of knowledge transfer and how experiences during education can shape a physician's decision's over the course of his or her career. This work begins with an evaluation into similarities between medical school charges, procedures, and payments. It then details how schools' procedure choices may link them in other, more interesting ways. Finally, the article includes a geographic analysis of how medical school procedure payments and charges are distributed nationally, highlighting potential deviations.

Supplier-Induced Demand for Chronic Disease Care in Japan: Multilevel Analysis of the Association between Physician Density and Physician-Patient Encounter Frequency

BackgroundThere are currently large regional variations in the frequency of physician-patient encounters for the treatment of chronic lifestyle diseases in Japan. These variations may be influenced by competition among physicians, and supplier-induced demand (SID) in health care can occur when physicians manipulate their patients’ demand for medical services to increase the use of health care. ObjectivesTo analyze patient data to investigate the presence of SID in the treatment of chronic diseases at the regional level in Japan. MethodsWe tested the hypothesis that clinic and hospital physicians in areas of high competition (high physician density) are more likely to recommend a sooner follow-up consultation than do those in areas of lower competition (lower physician density). Using random-effects multilevel models, we analyzed patient survey data and administrative claims data to estimate the effects of physician density on encounter frequency and medical charges. In the analysis of claims data, we used the mean drug administration period as a proxy for the frequency of physician-initiated encounters. ResultsOur analysis showed that encounter frequency was significantly associated with clinic physician density, but there were no consistent associations with hospital physician density. Increases in physician density were significantly associated with increases in both clinic and hospital medical charges, and these associations were independent from encounter frequency. ConclusionsThe results of our study indicate the presence of SID in Japan. Further studies should investigate whether more frequent physician-patient encounters provide clinical advantages to patients.

뇌졸중 환자의 결과지표에 영향을 주는 요인: 다변량 회귀분석과 다수준분석 비교

Background: The purpose of this study is comparison of the results between regression and multi-level analysis to find out factors influencing outcome indicators (in-hospital death, length of stay, and medical charges) of stroke patients.Methods: By using patient sample data of Health Insurance Review & Assessment Service, patients admitted with stroke were se-lected as survey target and 15,864 patients and 762 hospitals were surveyed.Results: For the results of existing regression analysis and multi-level analysis, models were assessed through model suitability index value and as a result, the value of results of multi-level analysis decreased compared to the results of regression, showing it is a bet-ter model.Conclusion: Factors influencing in-hospital death of stroke patients were analyzed and as a result, intra-class correlation (ICC) was 13.6%. In factors influencing length of stay, ICC was 11.4%, and medical charges, ICC was 17.7%. It was found that factors influenc-ing the outcome indicators of stroke patients may vary in every hospital. This study could carry out more accurate analysis than ex-isting research findings through analysis of reflecting structure at patient level and hospital level factors and analysis on random ef-fect.Keywords: Regression; Multilevel analysis; Stroke; Outcome indicators

Studies on the doctor-patient relationship in early Chinese missionary hospitals

During the 19th century, missionary hospitals were set up by the missionaries in China, establishing a new doctor-patient relationship with doctors at the dominant position. In the early Chinese missionary hospitals, the doctor-patient relationship was relatively good, which could be seen from Chinese people's feelings of gratitude to the medical missionaries. The early missionary hospitals were totally controlled by the western Christians during the 1820-1860. Such good doctor-patient relationship was the results of common action of multiple factors, including Christianity, free medical charges, management idea based on humanism, the idea of the hospitals to avoid medical risks, family concept in traditional Chinese culture and so on.

Seat Belt Use to Save Face: Impact on Drivers’ Body Region and Nature of Injury in Motor Vehicle Crashes

Background: Seat belt use is the single most effective way to save lives and reduce injuries in motor vehicle crashes. However, some case reports described seat belt use as a double-edged sword because some injuries are related to seat belt use in motor vehicle crashes. To comprehensively understand the effects of seat belt use, we systemically investigated the association between seat belt use and injuries based on anatomic body region and type of injury in drivers involved in motor vehicle crashes.Methods: The injury information was obtained by linking crash reports with hospital discharge data and categorized by using the diagnosis codes based on the Barell injury diagnosis matrix. A total of 10,479 drivers (≥15 years) in passenger vehicles involved in motor vehicle crashes from 2006 to 2011 were included in this study.Results: Seat belt use significantly reduced the proportions of traumatic brain injury (10.4% non-seat belt; 4.1% seat belt) and other head, face, and neck injury (29.3% non-seat belt; 16.6% seat belt) but increased the proportion of spine: thoracic to coccyx injury (17.9% non-seat belt; 35.5% seat belt). Although the proportion of spine: thoracic to coccyx injury was increased in drivers with seat belt use, the severity of injury was decreased, such as fracture (4.2% with seat belt use; 22.0% without seat belt use). Furthermore, the total medical charges decreased due to the change of injury profiles in drivers with seat belt use from a higher percentage of fractures (average cost for per case $26,352) to a higher percentage of sprains and/or strains ($1,897) with spine: thoracic to coccyx injury.Conclusion: This study provide a comprehensive picture for understanding the protective effect of seat belt use on injuries based on anatomic body region and type of injury in drivers involved in motor vehicle crashes.

DRGs(Diagnosis Related Groups)별 환자집중도 수준에 따른 입원진료비와 재원일수의 차이 분석

This study analyzes the effects of hospital caseload on medical charges and length of stay for inpatients. Hospital caseload, representing the level of concentration of patients, was measured with the Internal Herfindal Index for three diagnosis related group (DRG) codes (appendectomy, operations on anus, and operations on uterus and adnexa). Ordinary least squares regression was used for analysis. Results showed that medical charges per inpatient and average length of stay significantly differed with respect to hospital concentration indices, and that hospital caseload was inversely related to operational performance for appendectomy and operations on uterus and adnexa. The significant negative relationship between concentration index and length of stay may decrease the total medical charges. The results imply that the expansion of the DRG payment system to hospitals will have a negative influence on their gross sales.

Medical Expenditures in Division I Collegiate Athletics: An Analysis by Sport and Gender

Objective: Medical expenses for collegiate athletics include providing a training room with its supplies, equipment, personnel costs, and insurance coverage. Additional expenses beyond the training room include imaging, diagnostic testing, specialty consultations, and surgeries. We hypothesized that there would be no difference in average expenses or number of claims between male and female athletes over a 5-year period. Design: Prospective patient cohort. Setting: A sports medicine center serving athletes in Big 10 Conference intercollegiate sports. Assessment of Risk Factors: All medical claims and charges for 36 varsity teams were analyzed from 2005 to 2010. The teams were categorized into 3 groups: female-only teams, male-only teams, and coed teams. Analysis of sports with corresponding male and female teams was also performed. Main Outcome Measurements: Claims and charges for medical care for 36 intercollegiate athletic teams over 5 years. Results: Individual team claims and charges were stable over the study period. In 11 of the 14 sex-matched sports, the female teams had higher average annual charges. After normalizing for roster size in the sex-matched sports, females had 0.97 more average annual claims (P < 0.01) and $1459 higher annual charges (P = 0.001) than their male counterparts. The charges per claim were similar between the sexes. The 5 teams with the highest average annual charges were football, wrestling, softball, women's crew, and men's lacrosse. When normalized for roster size, the 5 sports with the highest average annual charges per athlete were softball, women's diving, men's basketball, wrestling, and men's gymnastics. Conclusion: Charges per claim were similar between the sex-matched sports, but the female sports had a higher number of annual claims per athlete and thus higher total charges per athlete/year. Football had the highest average annual total charges as a team, but when normalized for roster size football charges per athlete/year were similar to those of other sports.

Direct medical charges of pediatric traumatic brain injury in multiple clinical settings.

BackgroundData limited to emergency department and inpatient visits undoubtedly underestimate the medical charges associated with traumatic brain injury. The objective of this study was to estimate the direct medical charges of pediatric traumatic brain injuries across all clinical settings in one large, pediatric hospital in the United States.MethodsTraumatic brain injuries sustained by children ≤20 years of age treated across all clinical settings at one large pediatric hospital from August 1, 2010-July 31, 2011 were identified using ICD-9-CM codes 310.2, 800–801.9, 803–804.9, 850–854.16, and 959.01.Results3,971 individuals ≤20 years of age were seen during 5,429 traumatic brain injury-related visits. Total medical charges for pediatric traumatic brain injury-related visits were $13,131,547. Inpatient (68.7%) and emergency department (16.1%) visits accounted for the highest proportion of TBI-related charges; however, >15% of all charges were associated with visits to clinic outpatient, urgent care, and diagnostic/therapy outpatient settings. Fracture of the vault or base of the skull (37.1%) and brain injury with contusion, laceration, or hemorrhage (27.1%) accounted for the largest proportion of total charges. Although unspecified head injuries made up almost half of all TBI-related visits (47.4%), they accounted for only 12.6% of total charges. Mild traumatic brain injuries accounted for 92.0% of all traumatic brain injury-related visits but only 44.7% of all traumatic brain injury-related charges. Mild traumatic brain injuries treated in the emergency department had a higher median total charge than those treated in urgent care (p < 0.0001) or clinic outpatient setting (p < 0.001).ConclusionsThis study, the first to evaluate the direct medical charges of pediatric traumatic brain injury across all clinical settings at one large pediatric hospital, found that pediatric traumatic brain injuries present to a wide variety of clinical settings, and differences exist in total charges by diagnosis, severity of the injury, and clinical site/setting. Investigating traumatic brain injuries across the full spectrum of clinical care is needed for a better understanding of the true medical cost and public health burden of pediatric traumatic brain injury.Electronic supplementary materialThe online version of this article (doi:10.1186/2197-1714-1-13) contains supplementary material, which is available to authorized users.

Analysis of clinicians' attitude towards the “Drug and Medical Service Separation” reform in Beijing

Objective To learn the clinicians'attitude towards the “Drug and Medical Service Separation” reform in Beijing.Methods A number of pilot hospitals of “Drug and Medical Service Separation” reform in Beijing were pinpointed,for a random questionnaires survey among 800 clinicians,to learn their awareness,evaluation and attitudes to the reform.Results The clinicians were found with good awareness and understanding of the reform,with an awareness rate of 99.5％ ; 72.0％ of them hold that the pricing of “medical service charge” of the reform as reasonable; most of them believe that the reform plays a positive role in relieving the difficulties of seeing doctors and affordability of medical treatment; their approval rate for the reform pilot project is 97.3％; their satisfaction for the reform implementation is 90.8％,and their support for full implementation of the reform is 94.0％.Conclusion The clinicians from those pilot hospitals are sufficiently aware of and understand this policy,and are supportive of the pilot with useful suggestions.The recommended strengthened publicity and training,higher medical service charges,better pay for medical workers,improved incentive mechanism and evaluation mechanism,and better clinicians' satisfaction. Key words: Beijing; Drug and Medical Service Separation; Clinician; Attitude

Economic Impact of Human Milk on Medical Charges of Extremely Low Birth Weight Infants

Economic Impact of Human Milk on Medical Charges of Extremely Low Birth Weight Infants

Prevalence of Sexual Violence among Individuals of Different Socio-Economic Status in Eldoret Municipality, Kenya

Incidences of sexual violence in Kenya, especially in urban areas, have been shrouded in mute and silence. This is partly because of the social stigma attached to this problem among several socio-cultural and socio-economic groups in the country. This examines the prevalence of sexual violence among individuals of different socio-economic status. The paper is based on a study conducted in Eldoret Municipality in Kenya. The study focused on of the socio-economic characteristics of victims, gender differences derived from sexual violence, age of victims, marital status and sexual violence and income levels of victims. This study adopted descriptive survey design. The target population comprised victims of sexual violence drawn from FC and households. Key informants were selected staff members of FC, police department and the Centre for Human Rights as well as chiefs, assistant chiefs and village elders. The study employed multi-stage, snowball, simple random and purposive sampling techniques in the selection of the study sample. Since the study was majorly descriptive, it mainly collected qualitative data although a small percentage of quantitative data was also collected. Questionnaire, structured and unstructured interview schedule, participant observation, CVA and content analysis were the main instruments of data collection for this study. Descriptive data was analyzed descriptively by computing measures of central tendency, frequency counts and percentages. Chi-square Correlation Coefficient was computed to establish the level of significance of correlation between study variables. The study established that sexual violence was more prevalent in individuals who were either illiterate or had attained primary level of education. Sexual violence was also prevalent among women than men. The study recommends that a comprehensive public awareness campaign on sexual violence be developed, delivered and evaluated by the Ministry of Health. The study also recommends that medical and legal charges for sexual violence victims be waived by the government.

Linkage Rate Between Data From Health Checks and Health Insurance Claims in the Japan National Database

BackgroundJapan’s National Database (NDB) includes data on health checks and health insurance claims, is linkable using hash functions, and is available for research use. However, the linkage rate between health check and health insurance claims data has not been investigated.MethodsLinkage rate was evaluated by comparing observed medical and pharmaceutical charges among health check recipients in fiscal year (FY) 2009 (N = 21 588 883) with expected charges from the same population when record linkage was complete. Using the NDB, observed charges were estimated from the first published result of linking health check recipients in FY2009 and their health insurance claims in FY2010. Expected charges were estimated by combining 3 publicly available datasets, including data from the Medical Care Benefit Survey and an ad-hoc report by the Japan Health Insurance Association.ResultsOnly 14.9% of expected charges were linked by the NDB. The linkage rate was higher for women than for men (18.2% vs 12.4%) and for elderly adults as compared with younger adults (>25% vs <10%).ConclusionsThe linkage rate in the NDB was so low that any research linking health check and health insurance claims will not be reliable. Causes for the low linkage rate include differences between health check and health insurance claims data in name format (eg, insertion of a space between family and given names) and date of birth (Japanese vs Gregorian calendar). Investigation of the causes for the low linkage rate and measures for improvement are urgently needed.