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Korean civil registration and vital statistics: use of unique identification number for universal health coverage

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Presentation by Minah Kang (Ewha Womans University) at the international conference on innovations in Civil Registration and Vital Statistics (CRVS) systems - Ottawa on 27-28 February 2018. See more at http://crvsinnovations.net

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Korean civil registration and vital statistics: use of unique identification number for universal health coverage

  1. 1. Korean Civil Registration and Vital Statistics: Use of Unique Identification Number for Universal Health Coverage Minah Kang, Ph.D. Green Bae, Ph.D. Heeun Kim, MA Seung Yeun Hong, MPH Ewha Womans University Seoul, Korea
  2. 2. CRVS as a UHC Tool • Detector: “Instruments government uses for taking in information” • Effector: “Tools government can use to try to make an impact on the world outside” Source: Hood, Christopher C., and Helen Z. Margetts. The tools of government in the digital age. Palgrave Macmillan, 2007; Y. Kim and M. Kang (2016). Policy tool choice and mix based on policy objectives and government resources: Case study of civil registration system in Korea UHC Cubic Model Roberts MJ, Hsiao WC, Reich MR. Disaggregating the universal coverage cube: putting equity in the picture. Health Systems & Reform 2015; 1(1): 22- 27.
  3. 3. Paradigm Shifts of the Korean CRVS System ~1980s Administrative management instrument • Nonexistent of communication with citizens • Managing and controlling population mobilization • Simple Instrument for administrative management • Insufficient attention to civil services 1990s Secure efficiency in Administration • Incomplete two way communication • Established fast and efficient administrative process • Provided fragmentary administrative information • Lack of awareness of privacy protection 2000s Provide integrated administrative service • Completion of two-way communication channel • Established administrative information sharing system • Integrated administrative service provision • Attention to protection of personal information Established Resident Registration system Established Electronic Resident Registration System (RR DB) Integrated Electronic Resident Registration System (Minwon 24, Administrative Information Sharing System
  4. 4. Source: Ji-Wong YOUN (2016), updated with information from PISC (2016). http://www.pisc.go.kr/fa/fa010/introduction/history.jsp Local Government (Resident registers, Car registers, Cadavers, etc) User Organization Administrative Information Sharing System (Ministry of the Interior) Source Organization 50 Agencies Of Central Government 262 Local Government 124 Public Agencies and 20 Banks, 188 education institutions Supreme Court (Family Relations Register) Central Government (Passports, Tax Revenue, Immigration Control, Military Affairs, etc) Administrative Information [Government Document Forms] [148 Categories] UID for Administrative Information Sharing System
  5. 5. Korea National Health Insurance System and UID • Access • Affordability • Contribution Patient • Reimbursement • Performance valuation • Expenditure control Provider • NHI coverage enhancement policy • Evidence-based decision • Promotion of sustainability and innovation Government
  6. 6. Case study: Prevention Vaccination Health promotion and MCH project Under- nourished Children’s Meal Aid Project Nutri Plus Program Enroll- ment Register vaccination history in the National Immunization Registry Identify individuals by UID at each local public health center investigate the personal information and home environment of the recipient child Pregnant mothers to receive nutritional supplement support Mgmt Medical institution confirmation; inoculated person manage their own history long-term epidemiologi- cal study on chronic disease & promotion Issue electronic meal card to the family Registering history and the result of nutritional assessment Review & Feedback Report the adverse reaction, Continuous review and feedback Medical expense support and reimburse- ment Reevaluate the child's eligibility. feedback and evaluation of the program Eligibility reevaluation process UID for Disease Prevention and Health Promotion MOI Resident Registration Information System MOHW Social Welfare Integrated Information System MOE National Education Information System KCDC Vaccina- tion System Managed by the RR number NHIS Medical Institu- tions Local public health centers Citizens (Children and Guardians) Birth and Death Information Welfare History Student Information Provide Vaccina- tion History Provide Vaccination History Provide Vaccination History Register Vaccination History Register Vaccination History Infant Health Examination Vaccination Subject Management Vaccination Confirm vaccination Alert and encourage issuance of immunization certificate The Vaccination Information System Source: Korea Centers for Disease Control and Prevention (2015). 2015 Guidelines for the Administration of Children’s National Immunization Program
  7. 7. Case study: Treatment and management Infectious disease patients TB/HIV/AIDS Management system Chronic disease management pilot project Enrollment UID is reported through the integrated management system TB patient registered; HIV / AIDS anonymously tested at a local public health center Registration of hypertension and diabetes patients Mgmt Uses patient ID throughout all infectious disease management Identify TB patients throughout the treatment and management; HIV / AIDS patient management by a control number Overall management; patients to report blood pressure and blood glucose levels Review & Feedback Patient's treatment and protection costs support Report the completion of management Clinics confirm data; send in for billing UID for Infectious and Chronic Disease Management Service Model for Chronic Disease Management Pilot Project Source: National Health Insurance Service (NHIS) (2016), Introduction of chronic disease management pilot project • Blood pressure and blood glucose measurement • Report health data • Check doctor opinion and follow up Patients Automatic or manual transfer of data PUSH/ counseling opinion -Institutional data mgmt -Beneficiary data mgmt -Missing data management -Institution/ beneficiary data mgmt Server Analytic results Evaluation / counseling opinion • Monitoring • Checking abnormal results • Suggest counseling opinion Medical Providers Medical institution solution • Monitoring • Management of Claims Service Management Platform
  8. 8. Case study: Health Insurance National Health Insurance Medical Care Insurance Enrollment Health insurance subscription Registration of eligible beneficiaries; Special computer administration number is given to those without UID Mgmt Health insurance card is issued; The card includes birth date and control number Medical institution confirms eligibility of the patients and manage the service plans Review & Feedback Healthcare providers send patient's personal information for billing Systematic evaluation of beneficiary and feedback process Using UID for National Health Insurance System Diagram on the National Health Insurance Data System (Source: Park Jong Heon (2015). National Health Insurance Data System and Resident Registration Number in Korea, CRVS Forum in Seoul, December 7, 2015)
  9. 9. Case study: Healthcare Data Utilization Provision of customized health information Medical record transfer Health Insurance Big Data Registra tion UID to login to personal health management system of the NHIS Sign to transfer personal & clinical information UIDs are removed Storage Format and Security Various measures to ensure data security Medical record stored in distributed system The use and provision of data strictly restricted Big Data Analysis Health iN service links NHIS's national health information database with agencies; integrates social media information to read risk trends of major disease and provide warning Not used for big data analysis purposes Use for academic and policy research <Health iN> Service provided - Diagnose life style and prescriptive information (based on health survey results) * Smoking / Drinking / Exercise - Provide information to prevent specific diseases (based on the medical checkup results) * Metabolic syndrome / Blood pressure /Diabetes / Obesity - Disease prediction * Predict risk of stroke/heart diseases/osteoporosis, and provide prescriptive information <National Health Alarm Service> UID for Personal and Big Data Analysis
  10. 10. Medical Record Transfer Utilization of Patient’s ID in Medical Record Transfer System Source: Ministry of Health and Welfare (2017). 2017 Operational Guideline of Medical Record Sharing Support System Health Insurance Big Data National health insurance big data provision procedure Source: National Health Insurance Service NHISS website.
  11. 11. Implications • Importance of preventing leakage and protection of personal information • Personal Information Protection Act (PIPA) • Act on the Protection of Personal Information Maintained by Public Institutions • Medical Information Protection Act • De-identification of personal information
  12. 12. Thank you

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