Pure and simple “truths” from administrative data

May 8th, 2012

Recent editorial in JAMA discusses an original research using administrative data[1] which appears in the same edition. The authors underscore the difficulty to find “pure and simple” truths due to inherent limitations from such source. They explain four factors: new guideline, new diagnosis code, new diagnostic test and lack of prognostic indicators which should be cautiously taken into consideration by researchers, before deriving conclusion.

While those factors are technically correct, however the authors forget to mention the long-standing issue related to the quality of claim data: fraud, waste and abuse. Indeed, it is part of systemic problem in US health care, causing careless spending between $82 billion and $272 billion in 2011[2]. Cases of health care fraud and abuse turn into more complexes, involving different types of health care professionals, sophisticated modus operandi and even crime organized. US government has launched Health Care Fraud Prevention and Enforcement Action Team (HEAT) to encounter. Beside via routine mechanism, fraud investigations are usually started following any anomalies detected by data analysis and algorithm[3]. From this point of view, performing low cost research (using administrative data) could serve to give feedback and provide early sign to save billion dollar healthcare spending. Continue reading »

SIK untuk Jaminan Kesehatan Nasional

March 31st, 2010

Penundaan kunjungan Presiden AS Barack Obama ke Indonesia akhir Maret ini tidak sia-sia dengan dimenangkannya voting UU Reformasi Kesehatan di Kongres. Meskipun tidak berimbas secara langsung, peristiwa tersebut telah menginspirasi kebijakan kesehatan di negeri yang pernah ditinggali oleh Obama selama 4 tahun ini. Hal ini terbukti dari penegasan Menteri Kesehatan tentang keseriusan pemerintah Indonesia untuk memenuhi hak setiap warga negara dalam memperoleh jaminan sosial yang meliputi jaminan kesehatan, jaminan kecelakaan kerja, jaminan hari tua, jaminan pensiun, dan jaminan kematian. Depkes saat ini sedang mempersiapkan berbagai infrastruktur untuk Jaminan Kesehatan Sosial Nasional. (Kompas, 25 Maret 2010). Continue reading »

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