A statistical analysis of 'rule-out' diagnoses in outpatient health insurance claims in Japan

Journal of Evaluation in Clinical Practice
Shinichi TaniharaHiroshi Une

Abstract

As each clinical procedure must be justified by a corresponding diagnosis in Japanese health insurance claim (HIC), unconfirmed diagnoses marked as rule-out diagnoses will be written on an HIC. However, little is known about the statistical profiles of such rule-out diagnoses. To illustrate the basic statistical profiles of rule-out diagnoses. We analysed all the diagnoses on 169 622 outpatient HICs in May 2006 from corporate health insurance societies. The proportions of additional diagnoses and rule-out diagnoses in each of the major disease categories defined by the Classification of Diseases for the use of Social Insurance, which is based on the International Statistical Classification of Diseases and Related Health Problems 10th Revision were calculated. There were 442 010 diagnoses on the HICs, of which 96 253 (21.8%) were principal diagnoses and 345 757 (78.2%) were additional diagnoses. Of the principal diagnoses, 1022 (1.1%) were rule-out diagnoses. Of the additional diagnoses, 19 308 (5.6%) were rule-out diagnoses. The percentage of rule-out diagnoses in the additional diagnosis category was significantly higher than that in the principal diagnosis category. Among the major disease categories, neoplasms showed the hig...Continue Reading

References

Oct 16, 2003·International Journal of Epidemiology·Ichiro TsujiShigeru Hisamichi
Jul 10, 2004·Journal of Epidemiology·Shinichi Tanihara, Yasuki Kobayashi
Mar 1, 2008·Nihon eiseigaku zasshi. Japanese journal of hygiene·Shinichi TaniharaHiroshi Une
Aug 12, 2010·Journal of Evaluation in Clinical Practice·Jun TomioYasuki Kobayashi

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Citations

Jan 30, 2015·Hepatology Research : the Official Journal of the Japan Society of Hepatology·Masayuki OhisaJunko Tanaka
Sep 21, 2016·Developmental Medicine and Child Neurology·Satoshi ToyokawaYasuki Kobayashi
Jan 2, 2018·Journal of Managed Care & Specialty Pharmacy·Jason ShafrinKaleb Michaud
Dec 4, 2019·Journal of Bone and Mineral Metabolism·Natsumi SakaShinichi Tanihara
Jul 24, 2020·Computer Methods and Programs in Biomedicine·Hiroaki FukunishiYasuki Kobayashi

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