Pathway for Meaningful Use of Claim Big Data in China: An Exploratory Study of Supporting Commercial Insurance Service with Claim Big Data (Preprint)

Abstract

BACKGROUND With the development of medical information technology, China has built a national unified health insurance data information platform and formed large-scale health insurance big data. The informatization level of China's healthcare industry and the value of healthcare big data are increasing. However, the development and utilization of these data are constrained by conditions such as security compliance, business models, and mission boundaries, resulting in under-exploitation and utilization of data resources. OBJECTIVE Considering that there is a research lacuna in this area, we take the lead in exploring the path of health insurance data sharing. METHODS We clarified the objects involved and their rights and responsibilities in each link of the health insurance data service based on the basis of sorting out the existing laws and regulations, organizing the relevant participants to formulate the specification of the process of health insurance big data sharing based on the Delphi method, and formulating the pricing and revenue distribution method of health insurance data service through the cost analysis method, and taking the data service of underwriting and claim settlement for the commercial insurance company as a case study to validate this study. RESULTS A case study is conducted to verify the feasibility of the proposed method in this study and to provide a reference for future health insurance data sharing and utilization applications. CONCLUSIONS By applying the proposed approach, it is both feasible and convenient to use claim big data to support commercial insurance service.