The study on integrated community based program of health promotion

为了在社区层面实施综合健康促进计划，有必要构建目标人群的筛查体系。在这一分析中，我们在九州地区的一个地方政府的帮助下构建了这样一个系统。该系统由医疗保险理赔和长期护理保险(LTCI)理赔(含家庭医生评估表)两部分组成。在此基础上，构建了基于OLAP的分析系统。以下是主要发现；1)骨肌疾病(OMD)、脑血管疾病(CVD)和心脏病是导致老年人依赖的三大主要原因。2)虽然老年OMD患者的人均医疗和LTCI费用是相当规律的，但由于OMD的高患病率，OMD导致的总费用是最重要的。3)OMB是女性最重要的医疗和LTCI费用原因，男性是最重要的原因。4)人均医疗费用和LTCI费用之间存在非常微弱的负相关。5)与医疗费用和LTCI费用增加显著相关的因素是高龄家庭和更高的年龄。我们的研究表明，综合卫生信息系统是决策综合分析的有力工具。这一系统使筛查高危人群成为可能，同时也可以评估卫生规划的有效性。为了方便这种健康信息系统的建设，电子索赔的全面实施是不可或缺的。

In order to implement an integrated health promotion program at community level, it is necessary to construct the screening system of the target population. In this analysis we have constructed such a system with the assistance of a local government in Kyushu area. The system composes of medical insurance claim and long term care insurance (LTCI) claim (including the evaluation sheet of home doctor) for the 6582 assistant required level elderly persons in 2002 and 2003.Based on this data base, we have constructed the OLAP based analysis system. The followings are major findings ;1)Osteo-muscular diseases (OMD), Cerebro-vascular diseases (CVD) and cardiac diseases are three major causes for dependency.2)Although the per-capita medical and LTCI expenditures of aged with OMD are rather law, the total expenditure due to OMD was the most important because of its high prevalence rate.3)OMB is the most important cause of medical and LTCI expenditures for female, and CVD for male.4)There is very week negative correlation between per capita medical and LTCI expenditures.5)The factors significantly associated with the increase in medical and LTCI expenditures are aged household and higher age.As shown in our study, the integrated health information system is very useful tool for the comprehensive analyses for policy making. This system make it possible to screen the high risk population and at the same time to evaluate the effectiveness of health programs. In order to facilitate the construction of this kind of health information system, the complete implementation of e-claim is indispensable.